Labor Induction at Term with Different Regimens of Misoprostol / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the efficacy and the safety of two different dose regimens of intravaginal misoprostol for labor induction. METHODS: Sixty-seven consenting women with maternal or fetal indication for labor and no prior cesarean delivery were randomly assigned to receive either vaginal misoprostol 100 microgram or 50 microgram every 4 hours with maximum 6 doses. Uterine contraction, abnormal fetal heart rate pattern, mean time from induction to vaginal delivery, apgar score, and meconium staining were compaired. RESULTS: In two groups, dermographic characteristics and the average number of doses of misoprostol used were simliar. The group who were administered 100 ug misprostol showed shorter average time interval from induction to delivery. Both groups showed similiar result in terms of tachysystole, abnormal fetal heart rate tracing, meconium passage, fetal weight, low 1-min and 5-min Apgar scores, and admission to the neonatal intensive care unit. CONCLUSION: The optimal misoprostol dose to induce labor in term pregnant women has not been established. We also could not find any difference between two groups (100 microgram or 50 microgram every 4 hours) in time interval from induction to delivery and neonatal outcomes.

A Case of Ruptured Cornual Pregnancy in Adenomyosis Uterus at 29 Weeks' Gestation / 대한산부인과학회잡지

A case of ruptured cornual pregnancy in adenomyosis uterus at 29 weeks' gestation is presented here. A cornual pregnancy occurs when the conceptus implants at the junction between the tube and the uterus rather than in main part of uterine cavity. It is relatively rare entity, but the rich vascularity of the uterus in this location makes rupture particularly dangerous. resulting in higher maternal mortality. The presented case was unique in continuing till the third trimester of pregnancy. We present a case of a ruptured cornual pregnancy in adenomyosis uterus at the third trimester of pregnancy with a brief review of literatures.

Prevalence of Chlamydia Trachomatis and Relation with Human Papilloma Virus / 대한산부인과학회잡지

OBJECTIVE: One of the most common causative microorganisms in pelvic inflammatory disease (PID) is the chlamydia trachomatis. In many cases chlamydia trachomatis infection has weak and nearly absent symptom, but it's endocervical infection usually disseminates into upper genital tract. In this infection tubal obstruction, infertility, tubal pregnancy, and recurrent pelvic infection has involved. In this study, we investigated the prevalance of chlamydia trochoma infections in symptomatic and asymptomatic women and its relation with Human Papilloma infection. METHODS: From Jan, 1999 to July, 2003, in St. Vincet's Hospital, The Catholic University of Korea, endocervial swabs were obtained in 3416 patients (1137 in Heath Promotion Center, 2226 in OPD) by Amplicor Chlamydia Trahomatis Kits (STD swab specimen collection transprt kits). Chlamydia trachomatis DNA was extracted and amplified by PCR assays to investigate the prevalence. Also in this study we investigated the prevalence of human papilloma virus by hybrid capture method. Women who visted Hospital were received routine gynecologic examination, history taking, and physical examination and information on potential risk factors was obtained by questionnaire. RESULTS: The prevalence rate of Chlamydia trachomatis in symptomatic women was 12.6% and there was a high peak prevalence among the early twenties (66%). The prevalence rate of Chlamydia in asymtomatic women was 8.2% but there was no peak in early twenties. In asymptomatic woman, asymptomatic chlamydia infection can be statistically anticipated by 1) Economic status, 2) Occupation status, 3) Alcohol intake, 4) History of Gynecologic disease, 5) History of STD. Women with chlamydia infection was 1.5 times greater risk of coincidal HPV infection and was statistically significant. CONCLUSION: The prevalence rate of chlamydia infection is higher than any other developed country, especially in asymptomatic women. Although symptoms are weak, the rate of prevalence and complications can be reduced by the screening of chlamydial infection.

A Case of Ovarian Hyperstimulation Syndrome Associated Spontaneous Pregnancy without Ovulation Induction / 대한산부인과학회잡지

The ovarian hyperstimulation syndrome (OHSS) is a rare but serious complication of ovulation induction therapy with gonadotropin. The pathogenesis of OHSS is unclear, but the proposed mechanisms are the production of vasoactive substances that increase local capillary permeability resulting in shifting of fluid from the intravascular space to the third space. The clinical manifestations varies from ascites, hypovolemia, oliguria, hemoconcentration, thromboembolism, and even death. We have experienced a case of severe OHSS with severe ascites, pleural effusion and bilateral enlarged ovaries associated with spontaneous pregnancy without any ovarian stimulation for ovulation induction.

Induction of Anti-tumor Immunity by Vaccination with E7 of HPV16 and IL-12 / 대한산부인과학회잡지

OBJECTIVE: Interleukin-12 is well known to induce cellular immune response materials and suppress the tumor growth. HPV infection has significant roles in cervical carcinogenesis, and HPV oncoprotein E6 and E7 are important roles in formation and maintenance of cervical cancer. E7 specific immune response was detected in cervical cancer patients, and this shows that E7 protein would be important in potential immunetherapy in cervical cancer. This study is aimed to investigate antitumor effect and E7 immune response by injection of adenovirus IL-12 and E7 in cervical cancer animal model. METHODS: In the cervical cancer animal model using C57BL/6 mice and HPV16 E7 immortalized hosts, 5 X 10(8) pfu/100 ul of PBS, AdLacZ, AdE7 and AdIL-12 were injected into the tumor mass when the tumor sized is increased to 7-8 mm. After the injection, the tumor size was caliperated every 2-3 days, and pathologic and blood studies were done on day 1, 3, 5, 7, 11, 12, and 21 days. The expression level of IL-12 and INF- and E7 specific immune response were measured by ELISA. RESULTS: After the injection of AdIL-12 into the tumor mass, 45% of tumor growth suppression was noted in comparison with control group. In the cases of combination injections of AdIL-12 and AdE7, 80% growth suppression was observed, and complete regression was shown in 40% of the study group. After injection of AdIL-12, the expression of IL-12 in the tumor mass was 9 time higher than that of control group, and 6 times higher in blood sample in comparison with control group. In the group with combined AdIL-12 and AdE7, the highest expression of INF- was noted in comparison with single injection of AdIL-12 or control group. IgGI and IgG2b isotype expression level increased 2.5 times and 2.2 times respectively 3 weeks after adenovirus injection. CONCLUSION: In cervical cancer animal model, IL-12 and E7 application using Adenovirus vector is significant antitumor effect and this demonstrates the potential immunotherapy in near future.