Comparison of Two Dose Regimens of Misoprostol for Cervical Ripening and Labor Induction / 대한산부인과학회잡지

OBJECTIVE: To compare the safety and efficacy of two dose regimens of intravaginally administered misoprostol (PGE1) for cervical ripening and labor induction. METHODS: One hundred patients with unfavorable cervix (including PROM) for labor induction were randomly assigned to group A and group B. Group A patients received 25 g of vaginal misoprostol every 4 hours with maximum of 6 doses and group B patients received 25 g, 50 g, 100 g, 100 g of misoprostol every 4 hours with maximum of 4 doses. Misoprostol was inserted to the posterior vaginal fornix. Successful induction was defined when Bishop score was increased to greater than 9 or regular uterine contractions were developed. The rates of successful induction, vaginal delivery, mean time from induction to delivery, drug side effects, and neonatal outcomes were compared. RESULTS: The average interval from start of induction to vaginal delivery was shorter in group B (780.1+/-313.0 minutes) than group A (1108.9+/-485.9 minutes) (p<0.01). The rate of vaginal delivery was higher in group B (42/50, 84.0%) than group A (35/50, 70.0%) although statistically not significant. The incidences of tachysystole, abnormal fetal heart rate tracing, meconium passage, low 1-min and 5-min Apgar scores, and admission to the neonatal intensive care unit were not different between two groups. CONCLUSIONS: Induction with misoprostol using dose-increasing schedule showed shorter time from induction to delivery and higher rate of successful induction than using same dose schedule without increase of side effects and adverse neonatal outcomes.

Fetal Axillary Cystic Hygroma Detected by Prenatal Ultrasonography: A Case Report

Fetal cystic hygroma is a rare developmental congenital anomaly of the lymphatic system, characterized by the formation of a multilocular, variable sized cystic mass. Most of cystic hygromas are found in the neck and other rare locations include axilla, mediastinum, and limbs. There are many papers about cystic hygroma colli, but there are only a few papers about fetal axillary cystic hygroma and no domestic papers. We present a case of fetal axillary cystic hygroma diagnosed antenatally followed by full-term delivery in a 30-yr-old woman. Operation was performed on the 8th day after birth and the mass was excised and confirmed as cystic hygroma.

Nitric Oxide Concentrations in the Uterine, Umbilical, and Peripheral Venous Plasma of Women with Preeclampsia / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to measure circulating levels of nitric oxide metabolites (nitrites) in the uteroplacental, fetoplacental, and peripheral circulation in women with normal pregnancy and preeclampsia. METHODS: Two groups of pregnant women were included : 20 patients with preeclampsia and 18 normotensive women. At cesarean, blood samples were taken from the antecubital vein and uterine vein draining the placental site before delivery of the baby, and the umbilical vein after delivery of the baby. Plasma nitric oxide concentrations were determined with the Griess reaction by measuring combined oxidation products of nitric oxide, plasma nitrite and nitrate after reduction with nitrate reductase. RESULTS: Significantly higher serum nitrite concentrations were found in umbilical (46.53+/-22.01 vs. 17.51+/-7.43 M/L, p<0.05), uterine (51.78+/-14.19 vs. 21.23+/-11.6 M/L, p<0.05) and antecubital (66.41+/-20.87 vs. 21.26+/-9.54 M/L, p<0.05) venous plasma in the preeclamptic group compared with the control group. CONCLUSION: We observe higher levels of nitirc oxide metabolites in the uteroplacental, fetoplacental, and peripheral circulation in women with preeclampsia than in normal pregnancy. These results support the hypothesis that increased nitric oxide production may be a compensatory response to improve blood flow and offset the pathologic effects of preeclampsia.

The Influence on Birth Canal Laceration of New Head Delivery Method by Rapid Breathing / 대한산부인과학회잡지

OBJECTIVE: This study was conducted to evaluate the effect of new delivery method of fetal head on the vaginal and perineal laceration at vaginal delivery. METHODS: In this prospective clinical trial of 291 parturients with singleton pregnancy at or more than 37 weeks' gestation, pregnant women were radomely assigned to classical delivery method (control group) or new delivery method (study group) of the fetal head from September 1999 to August 2000 at Chonnam National University Hospital. The frequency and degree of vaginal and perineal lacerations at vaginal delivery were compared between two groups. RESULTS: Perineal lacerations of the 3rd or 4th degree was developed in 20 women (13.8%) among 145 cases of control group and 6 women (4.1%) among 146 cases of study group (P<0.01). Vaginal wall laceration was developed in 55 women (37.9%) of the control group and 37 women (25.3%) of the study group (P<0.01). The incidence of the laceration of perineum and vaginal wall was significantly lower in the study group than that of control group. CONCLUSION: The new delivery method of fetal head was effective for reducing the laceration of perineum and vaginal wall at full-term vaginal delivery.

Lipid Peroxide Levels and Total Peroxyl Radical-Trapping Ability in the Placenta of Women with Normal Pregnancy and Preeclampsia / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to investigate lipid peroxide levels, total peroxyl radical-trapping antioxidative parameter (TRAP) values, and antioxidant vitamin levels in placental tissues of women with preeclampsia and to evaluate their roles in the pathophysiology of preeclampsia. STUDY DESIGN: Samples of placental tissue homogenates were obtained from 23 normal and 18 preeclamptic women between 33 and 40 weeks gestation. TNF-alpha was assayed by an enzyme-linked immunoassay. Lipid peroxide levels measured by thiobarbituric acid reaction. The TRAP values were measured by modified Wayners method. Ascorbic acid, uric acid, retinol, alpha-tocopherol, and gamma-tocopherol were measured by high performance liquid chromatography (HPLC) CoulArray detector. RESULTS: TNF-alpha levels in placental tissue homogenates of women with preeclampsia were significantly higher than that of women with preeclampsia (21.4+/-3.39 vs. 10.3+/-1.06 pg/ml, p<0.05). Lipid peroxide levels in placental tissue homogenates of women with preeclampsia were significantly higher than that of women with preeclampsia (6.65+/-0.57 vs. 4.98+/-0.37 nmol/mg protein, p<0.05). TRAP values in placental tissue homogenates of women with preeclampsia were significantly lower than that of women with normal pregnancy (0.24+/-0.02 vs. 0.31+/-0.03 mM, p<0.05). Ascorbic acid levels in placental tissue homogenates of women with preeclampsia were significantly lower than that of women with normal pregnancy (217.0+/-21.0 vs. 333.3+/-32.8 nmol/ml, p<0.05). CONCLUSION: The above results suggest that increased oxidative stress in placenta is involved in the pathophysiology of preeclampsia and ascorbic acid may act as an important preventive factor in the development of preeclampsia.

The Comparison of Conventional Pap Smear with ThinPrep Pap Smear in detecting HSIL and Cervix cancer / 대한산부인과학회잡지

OBJECTIVE: To compare the conventional Pap smear with the ThinPrep Pap smear in detecting HSIL and invasive cervical cancer and to determine the clinical value of ThinPrep Pap smear. METHODS : We evaluated the Pap smear results of 2933 patients. These subjects were selected from women having visited the early cancer clinic of the department of Obstetrics and Gynecology, Chonnam University Hospital, from Jan. 1998 to Dec. 2000. Of 2933 patients, conventional Pap smear and ThinPrep Pap smear were performed in 1594 and 1339 cases respectively. According to the results, sensitivity, specificity, positive predictability and negative predictability of both tests were compared and analyzed. RESULTS: In detecting HSIL and invasive cervical cancer, the conventional Pap smear examinations showed sensitivity 62.0%, specificity 96.5%, positive predictability 87.7%, and negative predictability 86.3%, while ThinPrep Pap smear did sensitivity 85.1%, specificity 98.3%, positive predictability 97.4% and negative predictability 89.7%. CONCLUSION: ThinPrep Pap smear makes it possible to obtain better specimen by reducing probable mistakes in sampling, and which can result in decreasing the rate of false negativity of Pap smear and increasing the accuracy of the Pap smear examination. Therefore, ThinPrep pap smear is a useful method in raising detection rate of HSIL and invasive cervical cancer.

Three cases of cervical pregnancy treated by intra-amniotic methotrexate injection after systemic methotrexate treatment / 대한산부인과학회잡지

Cervical pregnancy is a rare condition representing less than 1% of ectopic gestations in which the blastocyst implant within the cervical canal below the internal os of uterine cervix. Most cervical pregnancy result in early spontaneous abortion, complicated by severe hemorrhage from the eroded blood vessels within the cervix. Because of the fear of profuse hemorrhage, hysterectomy has been historically considered the standard therapy. However, a number of new therapies have been aimed at uterine preservation, conservative treatment is highly desirable for young women who want to preserve her fertility. Methotrexate has been utilized recently in the management of tubal, interstitial, and cervical pregnancies. We experienced three cases of successful treatment of cervical pregnancy by local injection of methotrexate into gestational sac under the guidance of vaginal sonogram after systemic methotrexate treatment, so we report the cases with a brief review of the literatures.

The Total Peroxyl Radical-Trapping Ability of Amniotic Fluid in Pregnant Women with Preterm Premature Rupture of Membranes / 대한산부인과학회잡지

OBJECTIVE: This study was to determine the levels of cytokines, lipid peroxides, and total peroxyl radical-trapping antioxidative prameter (TRAP) values of amniotic fluid in pregnant women with preterm premature rupture of membranes (PPROM). METHOD: Amniotic fluid samples were obtained by amniocenteses for chromosomal analyses and other indications(control, n=26). Amniotic fluid samples were also obtained by amnioceteses from pregnant women with preterm premature rupture of membranes (n=22). Amniotic fluid cytokines(IL-6, IL-8) were determined by enzyme-linked immunosorbent assay (ELISA). Lipid peroxide levels of amniotic fluid were measured by thiobarbituric acid (TBA) reaction. The TRAP value of amniotic fluid was assessed by measuring the rate of oxygen consuming during controlled lipid peroxidation by 2,2'-azobis-2-amidinopropane hydrochloride, a water soluble peroxyl radical generator. Ascorbic acid and uric acid were measured by high performance liquid chromatography (HPLC) CoulArray detector of water-soluble antioxidants. Retinol, alpha-tocopherol, and gamma- tocopherol were measured by HPLC-CoulArray detector of fat-soluble vitamins. RESULTS: Cytokine levels of amniotic fluid in pregnant women with PPROM(IL-6: 23.37+/-10.61 ng/ml, IL-8: 10.23+/-3.04 ng/ml) were significantly higher than those in normal pregnant women(IL-6: 0.62+/-0.32 ng/ml, IL-8: 0.55 +/- 0.15 ng/ml), (p<0.05). Lipid peroxide levels of the amniotic fluid in pregnant women with PPROM(10.42+/-1.11 nmol/mg protein) were significantly higher than those in normal pregnant women (7.32+/-0.65 nmol/mg protein), (p<0.05). The amniotic fluid obtained from pregnant women with PPROM showed significantly lower TRAP values (0.46+/-0.04 mM) than those from normal pregnant women(0.62+/- 0.03 mM), (p<0.01). Amniotic fluid ascorbic acid levels in pregnant women with PPROM (52.1+/-15.1 nmol/ml) were significantly lower than in normal pregnant women(231.9+/-33.9 nmol/ml), (p<0.01). There were no significant differences of amniotic fluid uric acid, retinol, alpha-tocopherol, and gamma-tocopherol levels between these groups. CONCLUSIONS: This findings suggest that a low antioxidant activity in amniotic fluid may cause PPROM and demonstrate that antioxidant vitamin, ascorbic acid, may act an important factor in the prevention of PPROM.

Placental apoptosis in preeclampsia / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to investigate the incidence of placental apoptosis in pregnancies complicated by preeclampsia. METHODS: Placental samples were obtained from 15 uncomplicated third-trimester pregnancies and from 17 pregnancies complicated by preeclampsia. TUNEL (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling) staining and electron microscopy were performed on all placental samples and identified apoptosis within the cells of the placenta. TUNEL positive stained cells were counted at each photograph(five sections were photoragphed at 1,500 magnifications for each sample). We focused on only the syncytiotrophoblast nuclei of the placenta. The number of apoptotic syncytiotrophoblast nuclei identified was expressed as a percentage of total number of syncytiotrophoblast nuclei counted. RESULTS: Quantification of apoptosis (mean+/-SD) was as follows: normal third trimester (n=15) 0.57+/- 0.47% of cells and preeclampsia third trimester (n=17) 1.41+/-0.67% of cells. The incidence of apoptosis was significantly increased in placentas from pregnancies with preeclampsia compared with normal placentas (p< 0.01). CONCLUSION: These results suggest that placental apoptosis may play a role in the pathophysiologic mechanisms of preeclampsia.

Ovarian Tumors Associated with Pregnancy / 대한주산의학회잡지

No abstract available.

Umbilical Venous Blood Gases, Middle Cerebral, and Renal Arterial Blood Flow Velocity Waveforms in Intrauterine Growth Restriction Fetuses / 대한주산의학회잡지

No abstract available.

Induction of labor in patients with a previous cesarean birth / 대한산부인과학회잡지

OBJECTIVE: To determine the efficacy and safety of labor induction in patients previously delivered by a low transverse cesarean section. METHOD: A retrospective review was done at Chonnam National University Hospital, Kwangju, Korea. All patients with a previous cesarean section who required labor induction from April, 1986 to June, 1999 were identified. Outcome of labor induction, including mode of delivery, maternal and perinatal morbidity, and birth trauma were evaluated. RESULTS: Trial of labor was undertaken by 1256 women(55.8%) who had previously been delivered by a low transverse cesarean section. 973 patients(77.5%) with a previous cesarean birth had a spontaneous onset of labor. Labor was induced in 283 patients(22.5%) with a previous cesarean birth. Successful vaginal delivery rate were 82.9%(807/973) in spontaneous labor and 79.2%(224/283) in induced labor group (p= NS). There were no differences in uterine dehiscence and rupture rate, perinatal and maternal mortality rate, and the rate of infants with low 1 or 5-minute Apgar scores between patients attempting a trial of labor after cesarean, spontaneous and induced. CONCLUSION: we conclude that labor induction in patients with a previous low transverse cesarean section is a safe procedure requiring close peripartum maternal and fetal surveillance.

Role of Doppler flow imaging in the diagnosis of ovarian cancer / 대한산부인과학회잡지

OBJECTIVE: The aim was to assess the value of resistance index(RI) and pulsatility index(PI) to differentiate between benign and malignant ovarian tumors by color and pulsed Doppler ultrasound. METHODS: 129 ovarian tumors identified with ultrasound were referred for color and pulsed Doppler ultrasound evaluation to calculate the lowest RI and PI, and the corresponding histopathologic diagnosis was recorded. RESULTS: The intratumor artery waveforms were obtained in 37.1%(36 of 97) of benign tumors and in 91.0%(29 of 32) of the malignant group. RI and PI were lower in malignant tumors than in benign tumors(p<0.01). Also, there was a significant incremental decrease in both indices value from the benign tumor toward borderline malignancy(p<0.05) and to invasive ovarian cancer(p<0.01). But, there was no significant difference in both indices value according to the FIGO stage of ovarian malignancy. For RI cut-off value of 0.6, sensitivity and specificity were 89.7% and 91.7%; for PI cut-off value of 1.1, 86.2% and 91.7%. Therefore, the most accurate cut-off values of RI and PI were 0.6 and 1.1, respectively. CONCLUSION: RI and PI calculated by color and pulsed Doppler ultrasound can help in the diagnosis and selection of treatment plan of ovarian tumors, especially when the morphological finding of ovarian tumor is equivocal. And during the follow up of benign tumors, both indicies can give us the clue of malignant potential of benign tumors.

Radical abdominal trachelectomy with pelvic lymphadenectomy: Report of 2 cases / 대한산부인과학회잡지

Traditionally, radical hysterectomy is the main surgical method for the treatment of early cervical carcinoma and always results in the loss of fertility. But, large numbers of young women are recently being diagnosed with cervical carcinoma and fertility preservation has become a concern. So, there has been a move towards more conservative approaches for the treatment of cervical carcinoma in recent years. Radical trachelectomy, which allows preservation of uterus but removes the cervix, parametrium and upper one third of the vagina, is a conservative but locally radical procedure. We performed radical abdominal trachelectomy with pelvic lymphadenectomy for two cases of invasive cervical carcinomas, which may be the first report in korea. One patient was 37 years old single women who had stage Ib cervical cancer and was disease free for 17 months after treatment. The other patient was 19 years old student who was also single and had stage IIa cervical cancer and was disease free for 14 months after treatment. We report the first two cases and review the literature on radical trachelectomy.

Diagnostic Significance of Serum Tumor Markers in Paitents with Ovarian Tumors / 대한산부인과학회잡지

OBJECTIVE: This study was designed to evaluate the efficiency of tumor markers level for early diagnosis of ovarian malignancy and for differentiation between benign and malignant ovarian tumors. MATERIALS AND METHODS: We determined preoperative serum tumor markers level in patients who were going to have an operation due to ovarian tumor in OB & GY Dept. of Chonnam University Hospital from April 1993 to September 1999. RESULTS: 1) The average values of serum tumor markers in patients with malingnant ovarian tumors were statistically higher than those of benign ovarian tumors. among malignant ovarian tumors, positive rate of all serum tumor markers was highest in epithelial ovarian carcinoma group. and among ovarian tumor markers, and positive rate of CA 125 was highest in epithelial ovarian carcinoma. 2) Dermoid cyst and endometioma were correlated to CA 19-9, CA 125 levels respectively. for malignant tumors, mucinous ovarian adenocarcinoma and non-mucinous ovarian adenocarcinoma were CA 19-9, CA 125 levels respectively. 3) Among ovarian tumor markers, CA 125 was the most in sensitivity and CA 72-4 was the most in specificity and diagnostic efficiency. 4) For postmenopausal women with ovarian tumors, elevated levels of at least one of the 4 tumor markers were present in the serum in 85.7% of the women who developed cancer, 62.5% of women with borderline, 27.8% of women with benign ovarian tumors. Conclusion; It is suggested that determination of serum tumor markers in patient suspected of ovarian tumor may be helpful to clinician for early diagnosis, differentiation between malignant and benign ovarian tumors.

Preoperative Diagnosis of Ovarian Cancer by Serum CA-125 and Sonographic Morphologic Scoring System / 대한부인종양콜포스코피학회잡지

OBJECTIVE: The object of this study was to compare the diagnostic accuracy of a sonographic morphologic scoting system, the serum CA-125 assay, and a combination of both in patients undergoing laparotomy for a clinically diagnosed adnexal mass. METHODS: In 129 consecutive patients, the morphology of the mass was evaluated and scored by the morphologic scoring system of Sassones using transabdominal or transvaginal sonography and blood samples were obtained for CA-125 assay before planning surgery, RESULTS: The sensitivity of the sonographic morphologic scoring system was 90.6%, the specificity 84.5%, the positive predictive value 65.9%, and the negative predictive value 96.5%, compared with 68.8, 77.3, 50.0, and 88.2% for CA-125 and 96.9, 66.0, 48.4, and 98.5% for the two tests combined, respectively. Only one case of serous borderline ovarian tumor was missed when the two tests were combined. The sensitivity and mean value of the serum CA-125 increased with the stage of ovarian cancer. CONCLUSION: The combination of sonographic findings with a serum CA-125 assay was more sensitive, but less specific, than sonography or the serum CA-125 assay alone in predicting the malignancy of an adnexal mass. The serum CA-125 level generally reflected the stage of the disease. We think that it is reasonable to check the serum CA-125 only in cases of ovarian malignancy diagnosed by sonography.

Treatment of endometrial hyperplasia with Medroxyprogesterone acetate(MPA) / 대한산부인과학회잡지

OBJECTIVE: To investigate the response of hyperplastic endometrium to Medroxyprogesterone acetate according to the histologic types such as simple typical, complex typical and atypical hyperplasia. METHODS: A total of 79 patients with histologically proved endometrial hyperplasia were enrolled into this prospective study between March 1996 and May 1998. Patients without atypia were placed on a regimen of cyclic therapy with 10mg MPA orally, each day for 14days per month for 3 months. In the cases in which hyperplasia did not regress , MPA was increased to 20mg. Patients with atypical hyperplasia received continuous MPA therapy, 20mg orally each day for 3 month. All patients were followed up for a minimum of 3 months and a maximum of 1 year(mean 7 months). RESULTS: In patients with simple typical hyperplasia, 45 patients(80.4%) had regression, 11 patients(19.6%) had persistence and none had progression. In patients with complex typical hyperplasia, 10 patients(83.3%) had regression, 2 patients(16.7%) had persistence and none had progression. But, in patients with atypical hyperplasia 5 patients(45.4%) had regression, 4 patients(36.4%) had persistence and 2(18.2%) patients had well differentiated endometrial adenocarcinoma. There was no recurrence during the follow up. CONCLUSION: This data suggest that most women with typical hyperplasia respond to progestin therapy, but there is high failure rate of response to progestin therapy and risk of endometrial cancer in patients with atypical hyperplasia. If the young patient desires to preserve her fertility, then progestin therapy may be considered as primary treatment in patients with atypical hyperplasia. But older patients in whom fertility is not an issue, hysterectomy should be selected as treatment of choice for atypical lesion.

Perinatal Prognosis of Single Umbilical Artery / 대한주산의학회잡지

OBJECTIVE: To evaluate the perinatal prognosis of fetuses with a single umbilical artery. METHODS: From 1992 to 1998, nineteen cases with single umbilical artery(SUA) was observed in 8,704 deliveries at Chonnam University Hospital. RESULTS: Out of nineteen fetuses, thirteen fetuses with single umbilical artery were detected by antenatal ultrasonographic examination and six fetuses were detected after birth. The male to female ratio was 0.9: 1. Congenital malformations were observed in 8 babies(42.1%) and included leg deformity, esophageal atresia, imperforated anus, ventriculomegaly, meningocele, hydronephrosis, ventricular septal defect, joint contracture, cleft lip and palate, toe anomaly, imperforated anus, kyphosis, no urethra and testis, clubfoot, patent ductus arteriosus and rnild mitral regurgitation. Among 10 cases of karyotyping analysis three cases were diagnosed as trisomy 18. Fourteen fetuses(77.8%) showed growth restriction at delivery. Antenatal obstetric complications were hydramnios(n = 3), oligohydramnios(n =2), and severe preeclampsia(n = 3). CONCLUSION: Careful ultrasonographic evaluation for the identification of a SUA is necessary because of its frequent association with congenital anomaly, growth restriction and cytogenetic abnormality.

Irradiation alone in Stage IB , IIA and IIB Cervix Cancer: 2 Correlation between Treatment Factors and Pelvic Tumor Control / 대한암학회지

No abstract available.

A Clinical Study in Nulliparous Women: Age 35 and Older / 대한산부인과학회잡지

OBJECTIVE: To compare pregnancy and delivery complications in first births between women 35 years or older and those who are younger. METHODS: Matemal and newborn records for first births at Chonnam university hospital from January 1, 1988 to December 31, 1996 were studied. The study group included 123 women who were 35 years or older. A control group consisting of 120 younger women was used for comparison. The X2 test was used to identify trends in individual variables and outcomes. RESULTS: Premature rupture of membrane, uterine myoma, and malpresentation were much mare prevalent in the older nullipara. However, there were no significant differences in incidences of preeclampsia, placenta previa, and pyelonephritis between the older nullipara and younger nullipara groups. Older nullipara had a significantly higher incidence of Cesarean delivery than younger women, Elective cesarean section was performed only in the older nullipara and it was the most common indication for Cesarean delivery in older nullipara. Fetal distress and breech presentation as indications for Cesarean delivery were significantly more common in the older study group. There were no noticeable differences in postpartal complication between the groups. Pretam birth and low birth weight were much more common in the older nullipara. but there were no significant differences in small for gestational age, low Apgar score, perinatal morbidity and deaths between the groups. CONCLUSION: From the results, it was difficult to conclude that women 35 or older are pmne to higher risk pregnancies, compared to their younger counterparts. Although more incidences of premature rupture of membrane, preterm delivery, and Cesarean delivery were observed, there were no significant differences in other pregnancy and delivery complications. With appropriate obstetric care, it is most probable that first time pregnancies in older women will result in similar outcome as those in younger women.