ABSTRACT
OBJECTIVE: The purpose of this study was to establish the distribution and obstetric outcomes in women with congenital uterine malformations. METHODS: A review of the medical records from the department of obstetrics and gynecology from January 1995 to June 2004 were diagnosed 79 patients with congenital uterine malformations. All of the cases were divided into groups according to classification of ASRM (American Society for Reproductive Medicine), which is based on the degree of failure of normal development of the female genital tact. The obstetric outcomes were compared between the groups. Statistical processing of the material was carried with Pearson chi square test. RESULTS: 79 patientss with congenital uterine malformations were diagnosed by operation or imaging studies. Symmetric congenital uterine malformations, consisting of bicornuate uterus (45.6%), septate uterus (19.0%), and uterus didelphys (31.6%), were the most common, constituting 96.2% of the malformations. Two patients (2.5%) had unicornuate uterus and one patient (1.3%) had arcuate uterus. No cases of the agenesis type and T-shaped uteri were found. 196 pregnancies occurred in the 74 patients. Only 43.4% of the pregnancies reached term, while 8.2% resulted in preterm delivery, and 48.4% terminated as miscarriages. CONCLUSION: Obstetric complications occur more frequently among women with congenital uterine malformations than among women in general. Knowledge concerning of congenital uterine malformations is important in recognizing and managing the obstetric complications that may result.
Subject(s)
Female , Humans , Pregnancy , Abortion, Spontaneous , Classification , Gynecology , Medical Records , Obstetrics , UterusABSTRACT
This is a very important differential diagnosis for postpartum hemorrhage following cesarean delivery because repeated life-threatening bleeding may induce multiple blood transfusion and require emergency surgery including hysterotomy. False or pseudoanuerysm can be acquired in association with trauma, previous surgery, trophoblastic disease, neoplasm, infection or diethylstilbestrol exposure. When a punctured or lacerated artery does not seal completely, blood may escape and dissects the adjacent tissues, and collects in perivascular areas. If this collection maintains in communication with the parent vessel, a pseudoaneurysm could result. Typically the lesion are discovered because the patients have symptoms related to delayed rupture of the pseudoaneurysms, causing hemorrhage. Radiographic techniques (angiography, ultrasound, and magnetic resonance imaging) have provided the opportunity to diagnose pseudoaneurysm, arteriovenous malformation. We report a case of postpartum hemorrhage following cesarean delivery attributed to a pseudoaneurysm of the uterine pedicle and treated with arterial embolization. Angiographic study confirmed the diagnosis and embolization of the false aneurysm was successful in controlling the hemorrhage.
Subject(s)
Female , Humans , Pregnancy , Aneurysm, False , Arteries , Arteriovenous Malformations , Blood Transfusion , Cesarean Section , Diagnosis , Diagnosis, Differential , Diethylstilbestrol , Emergencies , Hemorrhage , Hysterotomy , Parents , Postpartum Hemorrhage , Postpartum Period , Rupture , Trophoblasts , Ultrasonography , United NationsABSTRACT
During the past 50 years, the maternal mortality ratio has decreased dramatically. The leading causes of maternal deaths were pulmonary embolism, the complications of the pregnancy-induced hypertension, hemorrhage, the complications of the ectopic pregnancy and infection. Pulmonary embolism is one of the most fatal maternal complications that abruptly happen and rapidly progress, and has been a major cause of maternal death recently. Early detection of pulmonary embolism is difficult, because there is not any specific clinical symptoms and signs. We have experienced a case of a fatal pulmonary embolism which was diagnosed by lung perfusion scan on postoperative 1 day after cesarean delivery and managed with heparin therapy. We report this case with a brief review of literatures.
Subject(s)
Female , Pregnancy , Hemorrhage , Heparin , Hypertension, Pregnancy-Induced , Lung , Maternal Death , Maternal Mortality , Perfusion , Phlebography , Pregnancy, Ectopic , Pulmonary EmbolismABSTRACT
OBJECTIVE: To compare the outcomes of a method of assigning patients to a vaginal or laparoscopically assisted vaginal approach to hysterectomy. METHOD: Hysterectomy is the most common gynecologic operation. A clinical evaluation was attempted to analyze 100 cases of LAVH which was performed at St. Paul hospital from May 1997 to March 2000, and to compare them with 100 cases of vaginal hysterectomy at the same hospital. we used simple electrosurgical technique without using the disposable staples and other instruments. RESULTS: The mean age of the patients for LAVH was 46.18 years and that of VTH was 50.23 years. The most common indication for LAVH and VTH was Myoma uteri. The mean Hb change in LAVH was 2.15 and the Hb change of VTH was 2.17. The mean operative time of LAVH was 142.96 minutes and that of VTH was 77.06 minutes. The mean weight of uterus for LAVH was 221g and the mean weight of VTH was 182 g. The total percentage of urinary tract injury for LAVH was 3 % and that for VTH was 2 %. CONCLUSION: VTH, if possible, must be considered as a primary choice since it is were efficient than LAVH in cost, cosmetic aspects and complications. Further LAVH may be replaced with a laparotomy for hysterectomy in case of an insufficient operational experience, a previous abdominal operation hystory and the incapability of being indicated for VTH.
Subject(s)
Female , Humans , Hysterectomy , Hysterectomy, Vaginal , Laparotomy , Myoma , Operative Time , Urinary Tract , UterusABSTRACT
The overt effects of the anticancer drugs such as cisplatin and taxol appear to be DNA modification and microtubule stabilization respectively. But the mechanism by which these drugs affect tumor cell cycle perturbation and their correlation to apoptosis and cytotoxicity are not well understood, especially in combined sequential treatment of cisplatin and paclitaxel (taxol). In this study, to elucidate the action mechanisms as a function of cell cycle changes and cytotoxicities and to determine the adequate treatment sequence of cisplatin and taxol to acquire more enhanced cytotoxic effects when they are combined, we evaluated the cell cycle perturbations and its correlation to cytotoxic effects, which is measured by the extents of apoptosis and the fractions of cellular debris and live cells after combination treatment of cisplatin and taxol changing their treatment sequences in NIHOVCAR-3 ovarian cancer cell line. Our results were as follows; (1) The accumulation in S phase inhibited the entrance of tumor cells to G2M phase when the cisplatin treatment was preceded to taxol in their combination. (2) The tumor cells were not accumulated in S phase but most of them entered to and accumulated in G2M phase and they were leading to cell death when the taxol treatment was preceded to cisplatin in their combination. (3) Apoptotic peaks in taxol pretreatment group were detected earlier and persisted longer than that of cisplatin pretreatment group. (4) The cytotoxicities represented by the decreased fractions of live cells and the increased fractions of cellular debris were higher in taxol pretreatment group than those of cisplatin pretreatment group. These results suggested that the taxol pretreatment is more effective in combination of cisplatin and taxol and the relative decrease in the cytotoxicity in cisplatin pretreatment group was considered to be derived from the inhibition of entrance of tumor cells to G2M and protected them from the action by taxol. From these results, we concluded that the taxol pretreatment will enhance the cytotoxic effects to tumor cells when cisplatin and taxol will be administered and it indicates that correlations between cell cycle perturbation, apoptosis and cell death have to be considered in the future combination treatment of other drugs and in the development of new treatment regimens.