A meningomyelocele with normal intracranial signs on ultrasound and false-negative amniotic fluid alpha-fetoprotein and acetylcholinesterase

Neural tube defects are the major targets of prenatal diagnoses, along with Down syndrome. Prenatal diagnosis of spina bifida is possible at second trimester of gestation through alpha-fetoprotein and acetylcholinesterase biochemistry assays and ultrasound. In particular, the discovery of characteristic intracranial signs on ultrasound leads to a very high diagnosis rate. However, it is rare for spina bifida to present without intracranial signs while also showing normal values of maternal serum alpha-fetoprotein, amniotic fluid alpha-fetoprotein, and acetylcholinesterase. In our hospital, a fetus with spina bifida was delivered at 37+5 weeks' gestation by cesarean section, and was continually followed up over 2 years to date.

A case of postpartum spontaneous ovarian artery rupture in patient with preeclampsia / 대한산부인과학회지

Spontaneous ovarian artery rupture is exceedingly rare case that occur in the postpartum period. There were the cases that occurred aneurysmal rupture of ovarian artery and the coronary artery rupture in the women postpartum period without preeclampsia. There were the cases that occurred the cerebral artery rupture or retinal artery rupture in preeclampsia, but ovarian artery rupture is unreported. The cause of ovarian artery rupture in the postpartum period is unknown, but we thought that thinned arterial wall may be the cause during this period. The women in preeclampsia have high risk factors such as hypertension and pathologic disorder of the vessel. The retroperitoneal hemorrhage due to ovarian artery rupture cause hypovolemic shock, eventually death, therefore, it is necessary to immediate diagnosis and treatment. We described a case of spontaneous right ovarian artery rupture that occurred 2 days after vaginal delivery in preeclampsia including a review of the literature.

A case of normal spontaneous vaginal delivery after transvaginal radiofrequency myolysis / 대한주산의학회잡지

Radiofrequency myolysis does not require general anesthesia and is safe and effective treatment for uterine myomas tried to women in women who wish to conserve the uterus. However, a controversial issue is whether radiofrequency myolysis is safe to women who desire future pregnancies. We report a case who experienced full term spontaneous vaginal delivery without uterine rupture after radiofrequency myolysis.

Comparative analysis on the effectiveness of transvaginal radiofrequency myolysis for conservative management of leiomyoma and adenomyosis / 대한산부인과학회지

OBJECTIVE: To compare the clinical effectiveness of transvaginal radiofrequency myolysis of the patients with leiomyomas and the patients with adenomyosis which have similar clinical symptoms. METHODS: From May 2005 to May 2006 at Eulji university hospital, 108 women who were diagnosed of leiomyoma and adenomyosis had undergone transvaginal radiofrequency myolysis. Before and after the procedure size, number of uterine myomas, location and the volume of the leiomyomas and adenomyosis were measured by ultrasound. And on every visit after the procedure improvement of the symptom was checked by questionnaire of the symptom and life quality. Using Wilcoxon signed ranked test, the statistical significance was proved and the P value lower than 0.05 was judged to be significant. RESULTS: 76 women with leiomyoma who had undergone transvaginal radiofrequency myolysis, were followed up 1 month, 3 months, 6 months and 9 months after the procedure. The average maximal diameter of the myoma was decreased by 14.6%, 23.3%, 30.6%, 33.6% respectively, and the average volume was decreased by 35.7%, 53.3%, 67.3%, 72.2% respectively. 32 women with adenomyosis who had undergone transvaginal radiofrequency myolysis were followed up, at the same period after the procedure. The average maximal diameter of the adenomyosis was decreased by 8.9%, 13.6%, 14.6%, 11.9% respectively, and the average volume was decreased by 22.6%, 30.0%, 32.3%, 28.4% respectively. Before and after the procedure the symptom score was 62.3, 52.2, 40.6, 32.6, 28.6 respectively, and the quality of life score was 68.9, 78.1, 82.9, 85.7, 87.3 respectively in the leiomyoma group. In the adenomyosis group, before and after the procedure the symptom score was 77.7, 37.6, 30.6, 54.4, 67.5 respectively, and the quality of life score was 48.1, 76.5, 85.5, 66.5, 55.1 respectively. CONCLUSION: Transvaginal radiofrequent myolysis had benefits in conserving the uterus, and was less invasive, and had great effect on the reducing the size of the leiomyoma and improving the symptoms, and also returning to normal life pattern was earlier. But in women with adenomyosis the symptoms were worsened after approximately 6 to 9 months after the procedure. Therefore additional research and follow-up is required and a strict criterion is needed.

A Case of Placenta Increta in the Uterine Sacculation which was Treated with Conservative Methods / 대한주산의학회잡지

Uterine sacculation is a very rare complication associated with pregnancy in which a part of the uterine wall balloons, and it is difficult to diagnose because it is usually asymptomatic. It frequently contains the placenta and sometimes may be involved with the trapped placenta after delivery due to its structural characteristic. It is impossible to remove the retained placenta in the sac by using usual methods such as manual delivery or curettage so most of patients with it end up with having a laparotomy. Especially, if the placenta in it is accompanied by abnormal adherence of the placenta or serious hemorrhage, hysterectomy should be considered. Currently several conservative methods for the retained placenta including selective uterine artery embolization and administration of methotrexate have been introduced and these may be tried to treat the retained placenta in the uterine sacculation for avoiding operation and preserving future reproductive potential in selective cases. We experienced a case of placenta increta in the uterine sacculation that was diagnosed first during cesarian section and was treated with selective uterine artery embolization followed by methotrexate administration. This case is reported with a brief review of the literatures.

A Case of Placenta Increta in the Uterine Sacculation which was Treated with Conservative Methods / 대한주산의학회잡지

Uterine sacculation is a very rare complication associated with pregnancy in which a part of the uterine wall balloons, and it is difficult to diagnose because it is usually asymptomatic. It frequently contains the placenta and sometimes may be involved with the trapped placenta after delivery due to its structural characteristic. It is impossible to remove the retained placenta in the sac by using usual methods such as manual delivery or curettage so most of patients with it end up with having a laparotomy. Especially, if the placenta in it is accompanied by abnormal adherence of the placenta or serious hemorrhage, hysterectomy should be considered. Currently several conservative methods for the retained placenta including selective uterine artery embolization and administration of methotrexate have been introduced and these may be tried to treat the retained placenta in the uterine sacculation for avoiding operation and preserving future reproductive potential in selective cases. We experienced a case of placenta increta in the uterine sacculation that was diagnosed first during cesarian section and was treated with selective uterine artery embolization followed by methotrexate administration. This case is reported with a brief review of the literatures.

Laparoscopic assisted vaginal hysterectomy for large uterus; the comparison of conventional LAVH with LH / 부인종양

OBJECTIVE: To compare clinical results of laparoscopic assisted vaginal hysterectomy for uteri weighing 500 g or more with less than 500 g. And we compared clinical results between laparoscopic coagulation of uterine vessel (LH) and conventional LAVH. METHODS: We reviewed medical records of 296 patient who underwent LAVH from February 2004 to May 2006. They were divided into two groups, uteri weighing greater than 500 g and less than 500 g. And each group was divided into two groups, LH and conventional LAVH. Each groups were compared by operative time, hemoglobin change, complication, transfusion and hospital days. RESULTS: Operation time ,hemoglobin change on the 1st postoperative day and transfusion were significant greater in the uteri > or =500 g group than in the or =500 g group, there was no signicant difference in hospital days, operative time, hemoglobin change on the 1st postoperative day. However, hemoglobin change was smaller in the LH group than conventional LAVH group on the 4th postoperative day. CONCLUSION: This study demonstrates that despite the increased operating time and blood loss, LAVH can be safely performed for large uterus. However, surgeons need to be aware of high risk of blood transfusion. Modification of surgical method can decrease operating time and blood loss in LAVH.

A Case of Diagnosis and Management of Noncommunicating Rudimentary Horn Pregnancy with the Use of Laparoscopy / 대한주산의학회잡지

A non-communicating rudimentary uterine horn is a rare Mllerian duct anomaly. We experienced a case of unruptured rudimentary uterine horn pregnancy. The patient was diagnosed by laparoscopy and removed by laparoscopic resection of the pregnant rudimentary uterine horn was performed. We report our case with brief review of literatures.

Transvaginal radiofrequency myolysis for conservative management of uterine myomas / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of transvaginal radiofrequency myolysis of uterine myomas. METHODS: 67 women who had undergone transvaginal radiofrequency myolysis of uterine myomas at Eulji university hospital between May 2005 and March 2006 were participated in this study. Pre-procedural transabdominal and transvaginal ultrasonographic evaluation was done for measurement of the size, numbers, location, and volume of the myomas. 1 month, 3 months, and 6 months after the procedure the numbers and size of the myomas were measured by the same examiner. And also improvement of menorrhagia, dysmenorrhea, abnormal vaginal bleeding, and any symptoms like urinary frequency and pelvic pain that were caused by compression of the myomas were observed on every visit. RESULTS: The average age of the patients were 42.2 years. The average number of myomas were 1.18, the average of the maximal diameter was 5.52 cm, and the average volume was 89.9 cm3. The average procedure time was 15.1 minutes, and the average procedure frequency was 1.4 times. 1 month, 3 moths, and 6 months after the procedure the average maximal diameter of the myomas were decreased by 14.2%, 22.8%, and 29.8% respectively and the average volume decreased by 34.9%, 52.5%, and 63.6% respectively. 8 women who had no early symptoms and who were postmenopaused were excluded and from the other 59 women, 45 women and 37 women had been confirmed of their symptoms after 3 months and 6 months of the procedure respectively. 86.7%, 82.8% of the group had improvement of dysmenorrhea, and 65.2%, 60% had improvement of menorrhagia after 3 months and 6 months of procedure respectively. The group which had both symptoms, 85% and 81.2% had improvement. There were post-procedural complications of lower abdominal pain in 7 women, vaginal bleeding in 1 woman and in 1 case the patient was transferred to the department of internal medicine due to post-procedural fever and abdominal discomfort. No other major complications were found. CONCLUSION: Transvaginal radiofrequency myolysis had benefits in conserving the uterus, and was less invasive and had great effect on the reduction of size of the myomas and improving the symptoms. So this method could be a effective alternative treatment for uterine myomas.

The comparison of laparoscopic assisted vaginal hysterectomy, total vaginal hysterectomy and total abdominal hysterectomy / 대한산부인과학회지

OBJECTIVE: To compare the clinical results for women undergoing total abdominal hysterectomy (TAH), laparoscopic assisted vaginal hysterectomy (LAVH) and total vaginal hysterectomy (TVH). METHODS: We reviewed the medical records of patients who underwent TAH (n=97), LAVH (n=112) and TVH (n=95) from June 2002 to June 2005. We compared and evaluated patient's characteristics, previous abdominal operation histories, indication of hysterectomy, uterine weight, operative time, perioperative hemoglobin and hematocrit change, the degree of postoperative pain, hospital stay and complications. RESULTS: The patient's characteristic (age, weight, height, parity, perioperative hemoglobin and hematocrit change, complication rate) had no statistical difference in all three groups. In the TVH group, the rate of previous abdominal operations (25%) was significantly lower than TAH (56%), and LAVH (40%) (p=0.023). The mean uterine weight was the heaviest in TAH group (443.6+/-407.3 g), compared to LAVH group (301.9+/-133.9 g) and TVH group (225.3+/-91.8 g) (p<0.001). Operative time was the longest for LAVH group (p=0.001), and there was no significant difference between TAH group and TVH group (p=0.087). The TAH group had the highest postoperative pain scale and the length of hospital stay. The LAVH group and TVH group had almost the same postoperative pain scale and the length of hospital stay. CONCLUSION: Both LAVH and TVH had the following advantages compared with total abdominal hysterectomy: less pain, shorter hospital stay, cosmetic advantages. But limited operation field in TVH and expensive operative cost in LAVH were disadvantages. Specific guidelines for determining the route of hysterectomy result in decreased morbidity and lower costs, and thus the gynecologist can ensure that the patient receives the best possible surgical care.

A Case of Peripartum Cardiomyopathy associated with Preeclampsia superimposed on Idiopathic Thrombocytopenic Purpura / 대한산부인과학회지

Peripartum cardiomyopathy is a dilated cardiomyopathy of unexplained cause that occurs during the last trimester of pregnancy or within 5 months after delivery. And, It is a rare disease that has a frequency of 1 in 1,300-15,000 deliveries. It has not yet been reported that peripartum cardiomyopathy has occurred in an preeclampsia woman superimposed on idiopathic thrombocytopenic purpura. Moreover, the association between idiopathic thrombocytopenic purpura and peripartum cardiomyopathy has not been studied. Recently, we experienced a case of a woman who has undergone emergency Cesarean section due to complicated severe preeclampsia superimposed on idiopathic thrombocytopenic purpura. On the postoperative day, this patient developed respiratory distress and pumonary edema. Peripartum cardiomyopathy was diagnosed by echocardiography and we present with a brief review of literatures.

Clinical comparisons of laparoscopically assisted vaginal hysterectomy and total vaginal hysterectomy / 대한산부인과학회지

OBJECTIVE: To compare the clinical results between laparoscopically assisted vaginal hysterectomy (LAVH) and total vaginal hysterectomy (TVH). METHODS: We reviewed the medical records of patients who underwent LAVH and TVH from January 2002 to December 2004 in 00 university hospital without the history of uterine prolapse or pelvic relaxation. We evaluated age, parity, previous abdominal operations, indication of hysterectomy, size of the uterus, operation time, hemoglobin change, hospital day, the degree of postoperative pain and initiation of diet and postoperative complications. RESULTS: The age and parity of the patients in both groups were not different statistically. There were history of previous abdominal operations in 20.8% of LAVH group and 25.3% of TVH group which didn't have statistic significance. Major indications of the operation were uterine myomas in both groups. The average weight of the extracted uterus were 272.9+/-114.5 gm and 225.6+/-87.0 gm in the LAVH group and the TVH group respectively which had significance, and the operation time were 81.1+/-23.4 minutes and 71.1+/-37.8 minutes respectively which had significance. There were no difference in the hemoglobin drop of the postoperative day 1, but the hemoglobin drop of the postoperative day 4 was larger in the LAVH group. Postoperative complications occurred more often in the TVH group (15.2%) than LAVH group (11.9%) but didn't have significance, and the complications were treated by conservative managements and observation of the progress. And also the hospital day, the degree of postoperative pain and initiation of diet had no significance. CONCLUSION: Both LAVH and TVH had no statistic difference in the postoperative morbidity and recuperation. Moreover the indications of operation for both surgeries had no statistic difference, but LAVH had a preference for the larger size of uterus. Furthermore in order to increase the satisfactions of patients and remedy the weak points of procedures, research on the indications and contra-indications between the operative approaches and training on the operative procedures are required.

Clinical significance of Doppler velocimetry and oligohydramnios in intrauterine growth restriction / 대한산부인과학회지

OBJECTIVE: The aim of this study is to prove the clinical significance by evaluating pregnancy outcomes from intrauterine growth restriction using waves of the Doppler velocimetry of uterine and umbilical artery and amniotic fluid index. METHODS: Throughout the period of January 2000 to May 2005 at our hospital, we reviewed 127 cases diagnosed with intrauterine growth restriction after 24 weeks of pregnancy and the existences of diastolic notch of uterine artery (DNUT), absent or reversed end-diastolic velocity of umbilical artery (AEDV) and oligohydramnios were considered abnormal. We set the group that had no abnormal signs as the control group (62 cases), and respectively compared the groups that had oligohydramnios (24 cases), unilateral DNUT (27 cases), bilateral DNUT (10 cases) and AEDV (13 cases) with the control group. And we compared the groups that had only one abnormal sign, that is oligohydramnios (20 cases), bilateral DNUT (7 cases), AEDV (7 cases) and the group showing 2 or more complicated abnormal signs those above (9 cases) with the control group. RESULTS: Perinatal outcomes such as preterm birth, low birth weight, lower 5-min Apgar score (A/S), neonatal acidosis, admission rate of neonatal intensive care unit (NICU) and perinatal mortality were poor statistically in groups with DNUT, AEDV and oligohydramnios compared to those which have none of these abnormal signs. And those with DNUT had worse results when affected on both sides. And those with AEDV showed worse perinatal outcomes compared to those with bilateral DNUT or oligohydramnios; any overlapping of these abnormal signs indicated worse perinatal outcomes, which had statistic significance. CONCLUSION: Close observation of the fetal well-being by analysis on the wave velocimetry of the blood flow such as the uterine arteries and umbilical arteries and the measurement of the amniotic fluid volume enables predicting the perinatal prognosis of the intrauterine-growth restricted fetuses which may contribute in reducing the perinatal morbidity and mortality.

A case of placenta accreta successfully treated with methotrexate / 대한산부인과학회지

Placenta accreta is a rare condition and is associated with considerable maternal morbidity and mortality. Though hysterectomy is a definitive therapy, there are some occasions that conservation of the uterus is desired by the patient and bleeding is not excessive. We report a case successfully treated using methotrexate in patient whose placenta was not detached from the uterus with a brief review of literature.

A Case of Persistent Cloaca Diagnosed by Prenatal Sonography / 대한산부인과학회잡지

Persistent cloaca is a very rare congenital anomaly with a single common perineal opening for the genital urinary and gastrointestinal tract, which is caused by abnormal formation of the urorectal septum. It has an incidence of 1 in 50,000 to 1 in 125,000 births and is much more common in females and in twin pregnancies. Pathologic findings of persistent cloaca include dilated bowel, hydrocolpos, urethral obstruction, hydronephrosis and oligohydramnios caused by obstruction of the bladder, vagina and intestine. Failure of the paired m llerian ducts to fuse also usually results in duplication of the uterus and vagina. Currently, the diagnosis depends on the prenatal sonography but the diagnosis may be very difficult due to the complex nature of the anomaly and variable appearances. We present a case of persistent cloaca with one opening confirmed by autopsy after therapeutic termination which was initially diagnosed by prenatal sonography.

A Case of Limb-body Wall Complex / 대한산부인과학회잡지

Limb-body wall complex, also known short umbilical cord syndrome and body stalk anomaly, is a complex set of disruptive abnormalities consisting of failure of ventral body wall to close, short umbilical cord, disruption of lateral body wall, distinctive scoliosis of spine, limb defects, facial defects and cranial defects. This disorder has similar findings to amnioitic band syndrome. but limb-body wall complex appears severe scoliosis of spine, herniation of internal organs, absent or short umbilical cord. Recently, we present a case of limb-body wall complex which found at 32+1 weeks. A case was diagnosed with ultrasonography, so we report a case of limb-body wall complex with brief review of literature.

Fetal vesico-amniotic shunting procedure (VASP) for posterior urethral valve syndrome at 19weeks' gestation / 대한산부인과학회잡지

An ultrasonographic examination revealed increased fetal bladder size and decreased AFI as well as fetal bilateral hydronephrosis at 173weeks' gestation. Diagnosis of the fetal posterior urethral valve syndrome was made. Percutaneous fetal bladder puncture with aspiration and amniocentesis was performed. The fetus was normal male karyotype and with a predicted good renal function(sodium concentration, chloride concentration, and osmolarity at 74 mEq/L, 60 mEq/L, and 148 mOsm, respectively). So, the fetus underwent amnioinfusion and vesico-amniotic shunting procedure (VASP) using a double-basket catheter at 194weeks' gestation in order to prevent development of dysplastic kidneys and hypoplastic lungs. The healthy male baby was delivered at 384weeks' gestation and had normally functioning kidney. Cutaneous vesicostomy was performed for the newborn since the urethral orifice was small. The one year old infant is now well and waiting for urethroscopic valve ablation procedure.

Clinical Evaluation of Ovarian Tumors associated with Pregnancy / 대한산부인과학회잡지

No abstract available.