To evaluate the influence of myoma characteristics on cesarean myomectomy and to demonstrate its additional advantages. Retrospective data were collected from 292 women with myomas who had undergone cesarean section at Kangnam Sacred Heart Hospital between 2007 and 2019. We performed subgroup analysis according to the type, weight, number, and size of myomas. Preoperative and postoperative hemoglobin levels, operative time, estimated blood loss, length of hospital stay, incidence of transfusion, uterine artery embolization, ligation, hysterectomy, and postoperative complications were compared among subgroups. There were 119 patients who had cesarean myomectomy and 173 who had cesarean section only. An increase in postoperative hospitalization and operation time was observed in the cesarean myomectomy group compared to that in the caesarean section only group (mean difference, 0.7 days, p = 0.01, 13.5 minutes, p <0.001). Estimated blood loss, hemoglobin differences, and transfusion rates were higher in the cesarean myomectomy than in the cesarean section only group. There were no differences in postoperative complications (fever, bladder injury, and ileus) between the two groups. No hysterectomy cases were reported in the cesarean myomectomy group. In subgroup analysis, the larger and heavier the myoma, the higher the risk of bleeding that led to transfusion. Estimated blood loss, differences in hemoglobin, and transfusion rate increased depending on myoma size and weight. A significant increase in postoperative hospitalization was observed in women with larger and heavier myomas. However, there was no statistical difference among the three types of myomas. In cesarean myomectomy, larger (≥ 10 cm), and heavier myomas (≥ 500 g), were associated with postoperative outcomes, but not the number or type of myoma. The safety of cesarean myomectomy is not inferior to that of caesarean section only, considering its positive effects such as gynecological symptom relief and avoidance of the next surgery.

Background. To report the pregnancy and neonatal outcomes in patients with twin pregnancies who underwent ultrasound‐indicated cerclage (UIC) and to compare them to patients with singleton pregnancies undergoing the same procedures. Methods. Patients who underwent UIC between January 2010 and December 2020 at Kangnam Sacred Heart Hospital were reviewed. We compared characteristics, pregnancy, and neonatal outcomes between patients with singleton and twin pregnancies. Results. A total of 94 women (56 singleton and 38 twin pregnancies) underwent UIC were included. The mean gestational age (GA) at cerclage and preoperative cervical length (CL) were not significantly different. Twin pregnancies were more likely to deliver at earlier median gestations than singletons (singleton, 36 + 1 weeks vs twin, 32 + 6 weeks, and p = 0.004). The frequency of preterm delivery <34 weeks in twin group was higher than in singleton group (15 (26.8%) vs 20 (52.6%) and p =0.016). However, the frequency of preterm delivery <32, <28, and <24 weeks was not significantly different between two groups. Although neonatal weights in singleton pregnancies were heavier than twin pregnancies, neonatal mortality and morbidities were not significantly different between two groups. Among various factors contributing to preterm birth, preoperative CL ≤ 15 mm was independently associated with a higher risk of preterm delivery before 34 weeks. Furthermore, pregnancy and neonatal outcomes of twin pregnancies with cervical length ≤ 15 mm are comparable with those of singleton pregnancies (GA at delivery, singleton, 35 + 1 weeks vs twin, 32 + 5 weeks, and p = 0.24; neonatal mortality, singleton, 3.4% vs twin, 4.8%, and p = 0.64). Conclusion. The pregnancy and neonatal outcomes of UIC in twin pregnancies were comparable to those in singleton pregnancies, especially when CL is ≤15 mm. UIC might be considered a safe procedure for twin pregnancies.

This study compared glycosylated hemoglobin (HbA1c) levels in the first and second trimesters of pregnancy and assessed maternal and neonatal outcomes according to HbA1c variations among women with pregestational diabetes. This retrospective, multicenter Korean study involved mothers with diabetes who had given birth in 17 hospitals. A total of 292 women were divided into three groups based on HbA1c levels during the first and second trimesters: women with HbA1c levels maintained at <6.5% (well-controlled [WC] group); women with HbA1c ≥ 6.5% (poorly-controlled [PC] group); and women with HbA1c ≥ 6.5% in the first trimester but <6.5% in the second trimester (improved-control [IC] group). The PC group had the highest pregnancy-associated hypertension (PAH) incidence, while the incidence did not significantly differ between the WC and IC groups. The receiver operating characteristic (ROC) curve indicated that HbA1c in the second trimester could predict PAH with a cut-off value of 5.7%. The PC versus WC versus IC group showed statistically significantly higher neonatal birthweight and significantly higher rates of large for gestational age (LGA); however, those were not significantly different between the WC and IC groups. HbA1c levels in the second trimester could predict LGA, with a cut-off value of 5.4%. Therefore, the second trimester HbA1c levels were significantly associated with both maternal and neonatal outcomes.

We compared the obstetric and neonatal outcomes of women with and without gestational diabetes recurrence during subsequent pregnancy and identified the risk factors for gestational diabetes recurrence. In this nationwide population-based study, we analyzed pregnant women and their neonates delivered in Korea between January 2015 and December 2021 using the Korea National Health Insurance claims and National Health-Screening Program for Infants and Children databases. In total, 1985,678 pregnant women were analyzed, of whom 15,086 were diagnosed with gestational diabetes in their first pregnancy. By categorizing pregnant women into the gestational diabetes recurrence and nonrecurrence groups, we attempted to confirm the risk factors for gestational diabetes recurrence. Herein, 5672 and 9414 cases of gestational diabetes recurrence and nonrecurrence were analyzed. In the first and second pregnancy, maternal age and gestational age at delivery, and neonatal birthweight, were significantly different between 2 groups (P < .001). Preterm birth under 37 weeks of gestation, gestational hypertension, and neonates of large for gestational age, were also significantly more occurred in the recurrence group, compared to the nonrecurrence group (P < .001). The interval between the first and second deliveries was significantly longer in the recurrence group (P = .0016). In the multivariate analysis, recurrence of gestational diabetes was significantly associated with interpregnancy interval (adjusted odds ratios [OR], 1.008; 95% confidence interval [CI], 1.001–1.016, P = .031), presence of gestational hypertension (adjusted OR, 1.206; 95% CI, 1.015–1.432, P = .0331), earlier gestational ages at delivery (adjusted OR, 0.913; 95% CI, 0.885–0.942, P < .001) and heavier neonates (adjusted OR, 1.134; 95% CI, 1.014–1.268, P = .0272), at the first pregnancy. The factors predicting the recurrence of gestational diabetes are interpregnancy interval, gestational hypertension, earlier delivery, and neonates with higher birth weight in the first pregnancy.

Background/Objectives: The objective of this study is to investigate pregnancy and neonatal outcomes in women with pre-gestational diabetes (PGDM) in the Korean population and compare outcomes according to glycosylated hemoglobin (HbA1c) levels in the third trimester. Methods: Singleton pregnant women with PGDM, with follow-up data, and who delivered at 16 Korean tertiary institutions between 2010 and 2023 were included for analysis. Eligible patients were divided into two groups according to HbA1c levels (47.5 mmol/mol, 6.5%) in the third trimester (well-controlled and poorly controlled group). Adverse pregnancy and neonatal outcomes between the two groups were compared. The primary outcome was the composite neonatal adverse outcome and the secondary outcome was pregnancy-related hypertension. Results: In 416 pregnancies, the mean HbA1c in the third trimester was 45 mmol/mol (6.26%). Of these, 296 (71.2%) women were included in the well-controlled group and 120 (28.8%) in the poorly controlled group. Between these, the poorly controlled group showed a significantly higher risk of composite neonatal adverse outcome (57.8% vs. 79.2%, p < 0.001) and pregnancy-related hypertension (14.5% vs. 24.2%, p = 0.022). In multivariate analysis, HbA1c > 6.5% in the third trimester was associated with higher risk of composite neonatal adverse outcome and pregnancy-related hypertension. HbA1c ROC curves for the third trimester that predicted composite neonatal adverse outcomes had an AUC of 0.66; HbA1c of 43.7 mmol/mol (6.15%) had a sensitivity of 52.3% and specificity of 73.5% (p < 0.001). Conclusions: In PGDM, HbA1c > 47.5 mmol/mol (6.5%) in the third trimester was significantly associated with a higher risk of adverse neonatal and pregnancy outcomes and could be a predictive factor for composite neonatal adverse outcomes and pregnancy-related hypertension. Maintenance of HbA1c levels below 43.7 mmol/mol (6.15%) in the third trimester might decrease the risk of adverse neonatal outcomes.

Background: Chronic spontaneous urticaria (CSU) is an immune-mediated disorder driven by mast cell activation, whereas abnormal uterine bleeding (AUB) is a heterogeneous condition with diverse etiologies. Although immune and inflammatory dysregulation has been independently implicated in CSU and certain forms of AUB, the association between CSU and AUB remains unclear. We therefore examined whether CSU was associated with AUB. Methods: We performed a retrospective population-based cohort analysis using data from the Korean National Health Insurance Service. Women newly diagnosed with CSU between 2009 and 2021 were individually matched 1:1 with controls according to age, income, and region of residence. Cox proportional hazards regression and Kaplan–Meier analysis were used to evaluate the risk of AUB. Results: The final cohort comprised 890,010 women with CSU and an equal number of matched controls. The incidence rates of AUB were 12.50 and 10.90 cases per 1000 person–years, respectively, yielding an absolute incidence rate difference of 1.60 cases per 1000 person–years (95% CI, 1.54–1.81). CSU was associated with an increased risk of AUB (aHR, 1.155; 95% CI, 1.142–1.168), and this association persisted among women aged <50 years. Conclusions: CSU was associated with a modestly increased risk of AUB, and this association persisted among women aged <50 years. These findings provide an initial epidemiological signal supporting further investigation, although the underlying mechanisms and associations with specific etiological subtypes of AUB remain unclear.