OBJECTIVE:To evaluate the feasibility of five-dimensional Long Bone (5D LB), a new technique that automatically archives, reconstructs images, and measures lengths of fetal long bones, to assess whether the direction of volume sweep influences fetal long bone measurements in three-dimensional (3D) ultrasound and 5D LB, and to compare measurements of fetal long bone lengths obtained with 5D LB and those obtained with conventional two-dimensional (2D) and manual 3D techniques.METHODS:This prospective study included 39 singleton pregnancies at 26+0 to 32+0 weeks of gestation. Multiple pregnancies, fetuses with multiple congenital anomalies, and mothers with underlying medical diseases were excluded. Fetal long bones of the lower extremities-the femur, tibia, and fibula were measured by 2D and 3D ultrasound, and 5D LB, by an expert and non-expert examiner. First, we analyzed the 3D ultrasound and 5D LB data according to 2 different sweeping angles. We analyzed intra- and inter-observer variability and agreement between ultrasound techniques. Paired t-test, interclass correlation coefficient, and Bland-Altman plot and Passing-Bablok regression were used for statistical analysis.RESULTS:There was no statistical difference between long bone measurements analyzed according to 2 different volume-sweeping angles by 3D ultrasound and 5D LB. Intra- and inter-observer variability were not significantly different among all 3 ultrasound techniques. Comparing 2D ultrasound and 5D LB, the interclass correlation coefficient for femur, tibia, and fibula was 0.91, 0.92, and 0.89, respectively.CONCLUSION:5D LB is reproducible and comparable with conventional 2D and 3D ultrasound techniques for fetal long bone measurement.

The objective of this study was to evaluate if low pre-pregnancy body mass index (BMI) and mid-trimester weight gain increase preterm birth risk. we retrospectively reviewed the medical records of 1452 patients who delivered singleton live births between 25 and 42 gestational weeks at Severance Hospital from October 2005 to March 2009. Pre-pregnancy BMI (kg/m2) was categorized as underweight (under 18.5), normal (18.5-24.9), overweight (25-29.9), and obese (above 30). Gestational weight gains (kg/week) were measured between 14 and 28 weeks of gestation, and categorized as <0.15, 0.16-0.25, 0.26-0.35, 0.36-0.45, 0.46-0.55, and >0.55kg/week. Delivery before 37 weeks of gestation was considered preterm birth and delivery before 33 weeks of gestation was considered as early preterm birth. Women with low pre-pregnancy BMI were at increased risk of preterm delivery. Odds ratio of underweight mothers for preterm birth was 1.91 (1.52-1.98), and for early preterm birth was 2.3 (1.6-3.5). The risks for spontaneous preterm birth increased in women with very low weight gain (<0.15kg/week) during pregnancy with odds ratios of 3.4 (1.8-3.8) for underweight women, 2.0 (1.1-3.0) for normal weight women, and 1.4 (0.7-2.8) for overweight women compared to normal weight women with normal weight gain during pregnancy. In contrast, odds ratios of underweight women with normal weight gain was 1.3 (0.8-1.8) for preterm birth and 1.1 (0.6-1.5) for early preterm birth. Low pre-pregnancy maternal BMI and failure to gain adequate weight during mid-trimester are risk factors for preterm delivery. These suggest normal pre-pregnancy BMI and adequate level of gestational weight gain are important in order to reduce the risk of preterm birth, especially in pre-conceptional counseling with underweight women.

We report on a newborn girl presenting with a 2.01.5 cm sized pinkish, doughy lump arising between right labia majora and anus. We performed antenatal sonogram at 33 and 36th weeks gestation. A polypoid mass of 0.81.0 cm sized in size was noted on ultrasonography. After birth, we observed a skin-covered protruding mass not to detect other anatomic anomalies–spinal anomalies, anorectal malformations, etc. After 3 months, excision of the perineal mass was done at the Department of Pediatric Surgery of our hospital. Mature fat cells were noted on histopathological exam. To our knowledge, there are few studies in the English literatures about congenital perineal lipoma without combined structural anomalies.

To determine the performance of screening for preeclampsia by combining second trimester maternal serum screening and uterine artery Doppler ultrasound. A total of 876 women underwent both maternal serum screening (using α-fetoprotein (AFP), uE3, and human chorionic gonadotropin (hCG)), measurement of uric acid, and second trimester uterine artery Doppler ultrasound. The sensitivity, specificity and predictive value of different combinations of tests were compared. Of 876 pregnancies originally participating, 38 (4.3%) women developed preeclampsia. The mean values for hCG and AFP were significantly higher in women with subsequent preeclampsia (P = 0.001 and P < 0.0001, respectively). Taking into account obstetrical history, hCG, AFP, and uric acid levels, abnormal uterine artery Doppler and parity, a high level of AFP (> 1.5 MoM (multiples of the median)) and the presence of abnormal uterine artery Doppler were significantly and independently associated with a preeclampsia. (adjusted odds ratios: 2.60 95% CI:0.78–8.66, adjusted odds ratios: 5.00 95% CI:2.03–12.32, respectively). The positive predictive value (PPV) for preeclampsia of the uterine artery Doppler ultrasound is 14%, and the combination of an elevated serum AFP level and the presence of abnormal uterine artery Doppler velocimetry had a PPV for preeclampsia of 21%. The sensitivity of the different tests ranged from 2–40%. The combination of serum markers and abnormal uterine artery Doppler ultrasound may help identify women at risk for subsequent preeclampsia. However, the sensitivity of tests is too low to provide an efficient screening.

Hysterectomy is one of the most common non-pregnancy-associated surgical techniques in the field of gynecology. Over the years, this laparoscopic approach has evolved to include both subtotal and total laparoscopic hysterectomy. Robot-assisted technology may attenuate the learning curve for complex laparoscopic procedures, leveling the playing field between conventional laparotomy practitioners and laparoscopists. The advantages of robotics, such as motion scaling, three-dimensional visualization, and articulated instrumentation, enables complex surgical procedures to be performed with greater dexterity, more quickly, and more easily by many surgeons. We have experienced a case of patient with carcinoma in situ of the uterine cervix treated by robotic surgery. We report the first case treated by robotic total laparoscopic hysterectomy with a brief review of literature.