The perinatal outcome of vaginal delivery in twin pregnancy / 대한산부인과학회지

OBJECTIVE: To evaluate the perinatal outcome of vaginal delivery in twin pregnancy according to the presentation of the fetus. METHODS: A total of 274 cases suitable to this objective were selected from the 301 cases of twin pregnancy delivered between March 2000 and February 2005. They were categorized into 3 groups according to the presentation of the fetus; vertex/vertex as the group A (133 cases), vertex/nonvertex as the group B (80 cases), nonvertex in the first twin as the group C (61 cases). And then each group also was divided into 2 subgroups according to the mode of delivery; vaginal delivery and cesarean delivery. The difference between the subgroups in each group as to perinatal outcome was retrospectively compared and analyzed for statistical significance. RESULTS: The incidence of vaginal delivery in group A (46/133, 34.6%) was significantly higher than in group B (5/80, 6.3%) and C (5/61, 8.2%). A total of 218 (79.6%) cases were underwent the cesarean delivery and the most common indication of cesarean delivery was elective twin cesarean delivery in all 3 groups (65.4%, 93.8%, 91.8% respectively). The incidence of neonatal admission to the neonatal intensive care unit was, however, higher in vaginal delivery (40.2%) than in cesarean delivery (32.8%) in group A. The most common cause for neonatal intensive care unit admission was low birth weight for simple observation, and average admission dates of vaginal delivery was 17.0 days and cesarean delivery was 16.8 days. CONCLUSION: Vaginal delivery of twins depends on the presentation of the fetus, but no significant difference in perinatal outcome of group A were observed between the mode of delivery. Therefore attempt to decrease the incidence of elective twin cesarean delivery in group A is demanded.

Prognostic factors of stage IB1 cervical cancer treated surgically / 부인종양

OBJECTIVE: To determine pathologic variables associated with disease free interval and overall survival of patients with stage IB1 cervical cancer who underwent radical hysterectomy and pelvic lymph node dissection. METHODS: The records of 91 patients with stage IB1 cervical carcinoma who underwent radical hysterectomy and pelvic lymphadenectomy from 1997 to 2003 at Gil Medical Center were reviewed retrospectively. Clinical and pathologic variables including tumor size, histologic type, involvement of resection margin, parametrium invasion, lymph node metastasis, lymph-vascular space invasion (LVSI), depth of invasion and age were analyzed by the Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by Cox's proportional hazards model. RESULTS: Univariate analysis revealed no significant differences in subgroups according to age, tumor size, histologic type and lymph-vascular space invasion (LVSI). However, significant differences in disease free interval were found in subgroups according to lymph node metastasis and depth of invasion. There were significant differences in overall survival in only subgroups according to lymph node metastasis. Multivariate analysis revealed that lymph node metastasis was the only independent significant prognostic factor. CONCLUSION: These results show that lymph node metastasis was the only independent prognostic factor in stage IB1 cervical cancer managed surgically.