A Case of Asymmetric Crying Face After Cesarean Delivery in Mother with Hyperthyroidism / 대한산부인과학회잡지

Asymmetric crying face is caused by unilateral weakness of the depressor muscles of lower lip, which is most obvious during crying and is associated with other congenital anomalies, especially congenital heart disease. We experienced a case of asymmetric crying face after cesarean delivery in mother with hyperthyroidism and present it with a brief review of literature.

A Clinical Study of Placental Adhesions: Placenta Accreta, Placenta Increta, and Placenta Percreta / 대한산부인과학회잡지

OBJECTIVE: The objective of this study is to investigate the clinical characteristics of placental adhesions in order to improve maternal and fetal well-beings. METHODS: We reviewed the medical records of twenty cases of placental adhesions from January 1, 1995 to December 31, 1999 in Dankook University Medical Center. RESULTS: The incidence of placental adhesions is 0.267%. Of them, the percentage of placenta accreta was 35%, placenta increta, 60% and placenta percreta, 5%. Placental adhesions were observed more often in multipara (80%) than nullipara (20%). Co-existing placenta previa (50%), previous cesarean delivery (40%), multigravidity (5 or more; 40%) and previous artificial abortion (70%) were associated with placental adhesions. 85% of placental adhesions were treated by hysterectomy in order to manage postpartal uterine bleeding. Packed red cell transfusions were necessary in 18 cases of placental adhesions (90%). Maternal complications were wound infection (10%), disseminated intravascular coagulation, throm- boembolism, stress ulcer, postoperative fever, bladder perforation, pulmonary edema, and pleural effusion etc. Fetal complications were preterm birth (30%), neonatal death (5%), and fetal death in utero (10%). CONCLUSION: This study revealed that placental adhesions show grave maternal and fetal complications. Obstetricians should examine carefully to confirm placental adhesions and prepare thoroughly the postpartal emergency-care, especially in the high-risk gravida.

Three Cases of Endodermal Sinus Tumor of the Ovary / 대한산부인과학회잡지

The endodermal sinus tumor (EST) is the second most common form of malignant germ cell tumor of the ovary. It accounts for 22% of germ cell lesions and the median age of the patients is 19 years. Three fourths of the patients are initially seen with a combination of abdominal pain and abdominal or pelvic mass. Acute pain is caused by torsion of the tumor and the symptoms are acute and may lead to the diagnosis of acute appendicitis or a ruptured ectopic pregnancy. The tumor is usually large with most tumors measuring between 10 and 30 cm diameter. These neoplasms are highly malignant. In the past, these tumors were once almost uniformly fatal within 2 years of diagnosis, but recent advances in treating the EST of the ovary with the combination chemotherapy result in improvement of the prognosis. Management of younger patients with early stage ovarian EST who desire to preserve fertility can be a challenging problem, and treatment strategies which can save ovarian function must be considered. We have experienced three cases of endodermal sinus tumor in three women (Ic, 18 years; IIc, 20 years; Ic and right proximal femur metastasis, 21 years) and report them with eager review of literatures.

A Comparative Study of Continuous Combined Hormone Replacement Therapy and Tibolone on Lipid Metabolism in Postmenopausal Women / 대한산부인과학회잡지

OBJECTIVE: To evaluate the effects of tibolone on lipid metabolism in comparison to continuous conjugated equine estrogen and medroxyprogesterone acetate in postmenopausal women METHODS: In a randomized, group-comparative study, the effects on lipid profiles (total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol) were studied between tibolone 2.5 mg/day (N=48) and continuous combined regimen (conjugated equine estrogen 0.625 mg/day combined with medroxyprogesterone acetate 2.5 mg/day, CEE/MPA) (N=46) (CEE/MPA) for 12 month period.Satistical analysis were performed using Student's t-test for paired samples and independent groups. RESULTS: There were no statistical differences in age, age of menopause and body mass index (BMI) of both group before treatment. While treatment with tibolone significantly lowered plasma concentration of triglycerides, there were no significant changes in serum total cholesterol, HDL-cholesterol and LDL-cholesterol levels. In the CEE/MPA group, there were no significant changes of all variables. CONCLUSION: While there a statistically significant decrease in triglyceride concentration in tibolone group. there were no statistically significant differences in total cholesterol, HDL-cholesterol and LDL-cholesterol levels in both tibolone and CEE/MPA group, during 12 months of treatment period.

Clinical Analysis of Fetuses with Single Umbilical Artery / 대한주산의학회잡지

OBJECTIVE: Our purpose was to evaluate the clinical outcomes of fetuses with a single umbilical artery(SUA). METHODS: We studied 17 fetuses with a single umbilical artery retrospectively. The maternal age, maternal disease, gestational age, fetal sex, Apgar score, fetal weight, perinatal outcome, and fetal blood karyotype were reviewed. RESULTS: 1) Maternal age ranged 24-39 years old, mean age was 29.5 +/- 4.1 years. 2) Mean gestational age at birth was 38.3+/- 2.2 weeks, except one case of preterm labor due to cervical incompetence. 3) In three cases, low Apgar score, under seven, was recorded at one minute, and there was no case where Apgar score was low at five minute, except one case of preterm labor due to cervical incompetence. 4) Intrauterine growth retardation was found in two cases, and associated fetal malformations were noted in seven cases. 5) Among two cases of fetal blood karyotype, one case revealed normal and the other Patau syndrome. CONCLUSION: Our data suggest that fetuses with single umbilical artery may be risky because of its association with growth retardation and malformation including chromosomal anomaly. It is imperative to diagnose the congenital disease as early as possible and conduct appropriate treatment, with an aid of noninvasive diagnostic modality such as ultrasonogram, and through a delicate prenatal care, one should promote good perinatal outcome.