ABSTRACT
OBJECTIVE: To investigate what factors are associated with a failed arterial embolization for postpartum hemorrhage (PPH) and to attempt to estimate efficacy of arterial embolization. METHODS: Between 2004 and 2008, 60 patients at Korea University Medical Cencter underwent arterial embolization to control obstetrical hemorrhage. In all cases, arterial embolization was performed because of intractable hemorrhage unresponsive to conservative management. Medical records and angiographic results were reviewed. Arterial embolization failure was defined as the requirement for subsequent surgical procedure to control PPH with the procedure, and its results. RESULTS: Arterial embolization was attempted in 60 of deliveries. Failures occurred in 7 of 60 cases (11.7%) and in 4 of 7 cases (57.1%) of abnormal placentation (placenta previa totalis with or without placenta accrete or increta). Comparison of the failed and successful arterial embolization groups showed no differences in maternal characteristics, clinical status, and angiographic finding. Amount of total transfusion in failed arterial embolization group were larger than successful group although hemoglobin before embolization was not different. CONCLUSION: The only factor significantly associated with failed arterial embolization was an abnormal placentation. Arterial embolization is a safe and highly effective method to control PPH.
Subject(s)
Humans , Hemoglobins , Hemorrhage , Korea , Medical Records , Placenta , Placentation , Postpartum Hemorrhage , Postpartum PeriodABSTRACT
Agenesis of corpus callosum is the cerebral malformations whose prognosis is uncertain. But the complete agenesis shows more poor prognosis than partial agenesis. So, the type of agenesis can affect significantly the antepartum management. Recently, there has been a development in diagnostic tools like MRI to overcome these limitations of antenatal ultrasonography. We report a case of agenesis of corpus callosum which was diagnosed by prenatal MRI. This case was confused with Dandy-Walker complex in prenatal ultrasonography and supported in diagnosis by prental MRI.
Subject(s)
Agenesis of Corpus Callosum , Dandy-Walker Syndrome , Diagnosis , Magnetic Resonance Imaging , Prognosis , Ultrasonography , Ultrasonography, PrenatalABSTRACT
OBJECTIVE: The aim of the present study was to investigate the clinical usefulness of serum CA 125 and CA 19-9 levels for diagnosing and determining the severity of endometriosis. METHODS: A total of 112 women who underwent gynecologic surgery between January 1998 and August 2004 were selected in this study. 81 patients had histologically confirmed endometriosis and the remaining 31 had benign ovarian tumor but no obvious evidence of endometriosis. Blood samples were collected in all patients before the operation and the mean values and standard deviations of both serum CA 125 and CA 19-9 levels were measured in various stages of disease. Both tumor markers were also measured in the control group. The results were compared to determine the usefulness of CA 125 and CA 19-9 in diagnosing and predicting the severity of endometriosis. As a results, new cutoff values of serum CA 125 and CA 19-9 in endometriosis were obtained. RESULTS: The mean levels of serum CA 125 and CA 19-9 in patients at stage III and IV of endometriosis were significantly higher than in patients without endometriosis, and increased in accordance with the advancement of the clinical stage. Statistically appropriate cutoff values of CA 125 and CA 19-9 were calculated to be 20 IU/mL and 10 IU/mL, respectively. The sensitivity and specificity of CA 125 at this cutoff value for endometriosis were 72% and 71%, respectively. The sensitivity and specificity were 59% and 55% respectively in the case of CA 19-9. CONCLUSION: CA 125 is a useful marker for diagnosing and determining the severity of endometriosis. CA 19-9 shows limitation in diagnosing endometriosis, but is indeed a potential marker in predicting the severity of disease.
Subject(s)
Female , Humans , Endometriosis , Gynecologic Surgical Procedures , Sensitivity and Specificity , Biomarkers, TumorABSTRACT
OBJECTIVE: The aim of the present study was to evaluate changes of vascular endothelial growth factor levels in maternal circulating blood during normal pregnancies and examine their relationship with maternal platelet counts. METHODS: The 33 subjects were selected from healthy normotensive women from the antenatal clinic at Korea University Medical Center, Guro Hospital. Blood samples for VEGF were taken at 7 to 8 weeks' gestation, 16 to 18 weeks' gestation, 24 to 26 weeks' gestation, 30 to 32 weeks' gestation, 37 to 41 weeks' gestation. Serum and plasma were extracted from all samples, and VEGF concentrations were measured in duplicates by competitive enzyme immunoassay. The 23 of them, the platelet counts were performed with an automated blood Coulter counter. RESULTS: Serum VEGF levels during normal pregnancies were mean 6.73 ng/mL at 7-8 weeks' gestation, 7.88 ng/mL at 16-18 weeks' gestation, 7.18 ng/mL at 24-26 weeks' gestation, 8.42 ng/mL at 30-32 weeks' gestation, 14.03 ng/mL at 37-41 weeks' gestation. Plasma VEGF levels were mean 5.50 ng/ mL at 7-8 weeks' gestation, 7.23 ng/mL at 16-18 weeks' gestation, 7.98 ng/mL at 24-26 weeks' gestation, 7.35 ng/mL at 30-32 weeks' gestation, 14.05 ng/mL at 37-41 weeks' gestation. The trends in the mean VEGF levels were similar between serum and plasma, with stable levels until 30 to 32 weeks' gestation, and then the levels were increased. There was no significant difference between serum VEGF levels and plasma VEGF levels (p=0.236) and no correlation between circulating VEGF levels and platelet counts. CONCLUSION: Our data suggests that platelets may not be the origin of elevated VEGF levels in normal pregnancies because there was no correlation between VEGF levels and platelet counts.
Subject(s)
Female , Humans , Pregnancy , Academic Medical Centers , Blood Platelets , Immunoenzyme Techniques , Korea , Plasma , Platelet Count , Vascular Endothelial Growth Factor AABSTRACT
Intramural pregnancy is a rare variant of ectopic pregnancy, which was first reported in 1924 by Perli, and only 21 cases have been reported in the literature. The pathologic diagnosis of an intramural pregnancy can be made by the myometrium surrounding the products of conception that separate it from the endometrial cavity or fallopian tubes. Recent development of radiologic ultrasonography and radioimmunoassay of the beta-subunit of human chorionic gonadotropin has markedly enhanced the ability to diagnose intramural pregnancy during very early gestation. Many reports have noted that there would be possible relationships between the intramural pregnancy and prior uterine traumatic factor-curettage, cesarean section, myomectomy, salpingectomy, and manual removal of the placenta. We experienced a 28-year-old female patient with amenorrhea for 7 weeks and sudden vaginal spotting. She underwent dilatation and curettage at 4 weeks of gestation. We report this case with a brief review of the literature.
Subject(s)
Adult , Animals , Female , Humans , Mice , Pregnancy , Amenorrhea , Cesarean Section , Chorionic Gonadotropin , Curettage , Diagnosis , Dilatation and Curettage , Fallopian Tubes , Fertilization , Metrorrhagia , Myometrium , Placenta , Pregnancy, Ectopic , Radioimmunoassay , Salpingectomy , UltrasonographyABSTRACT
The cesarean section has been considered as one of the most prime and most commonly performed operations in the obstetrics and gynecology field. In fact, all cesarean sections have depended upon the operator`s experience. However, there have been several cases reported on new technique of cesarean section in many developed countries, but not in Korea until we started the recent research. We have developed a new type of cesarean section named FAST(Finger Assisted Stretching Technique) through study on strength/weakness of other operation techniques as well as many other researches we conducted in the past plus our own experiences. To find the differences on the following subjects; operating time, postoperative complication, and recovery period. We compared and analyzed data from using new and traditional techniques. We selected 120 patients(group A using FAST: 45 patients, group B using traditional technique: 75 patients) as samples for this study. Together, they were all conducted cesarean section at Korea University, Guro Hospital between May 1993 and December 1995. Student-t-test and chi-square test were used for statistical analysis. We consider that below 0.05 for P value is statistically significant. The results of comparative study between two groups are; 1. There was no comparative difference on average age: group A: 29.6(range 23~39, S/D 7.1) group B: 31.1(range 24~38, S/D 5.4) 2. There was a significant difference on average operation times: group A: 15.4 min.(range 11~19, S/D 3.6) group B: 41.3 min.(range 23~50, S/D 19) 3. There was a significant difference on average amount of bleeding: group A: 580 ml(range 450~750, S/D 101) group B: 916 ml(range 800~1000, S/D 99) 4. There was a significant difference on the value of hemoglobin before and after operation group A: 0.8 g/dl(range 0.4~1.6, S/D 0.25) group B: 1.9 g/dl(range 0.9~2.6, S/D 0.21) 5. There was a significant difference on average period of hospitalization: group A: 3.7 days(range 3~4, S/D 0.7) group B: 6.4 days(range 5~8, S/D 0.6) 6. No one from group A experienced any infection, but 3 cases of wound infection and 2 cases of voiding difficulty were reported from group B. 7. 11 cases from group A and 16 cases from group B had laparotomy for some other reasons, later. There was no adhesion found in group A, but adhesions found in 2 cases from group B.
Subject(s)
Female , Humans , Pregnancy , Cesarean Section , Developed Countries , Fingers , Gynecology , Hemorrhage , Hospitalization , Korea , Laparotomy , Obstetrics , Postoperative Complications , Wound InfectionABSTRACT
Fourty three patients known to hnve cervical intraepithelial neoplasia were assigned to Papanicolaou smear in five different ways, i, e, A) cotion tipped wood applieator at the pasterior vaginal fronix and the ectocervix, B) cotton tipped wood applicator at the ectocervix and the endocervical canal, C) Cytohrush at the endocervical canal, D) Cervexbrusk and E) Cyto-spatula. At the completion of cytologic study, all the subjects were done colposcopically directed biopsy and/or ECC. To evaluate the false negative rates of the cytologic test, cervical cone biopsy or hysteectorny was performed on all the patient. The false negat,ive rates were 53.5% in A) 39.5% in B), 14,0% in C), l8.6% in D), 25.6% in E) and statistical differences occurect between each group, It was also found that bleedings were most frequently endountered in E) and the encocervical cells were most frequently appeared in C). With these results, it can he stated that the rate of negative encocervical cells in the srnear were correlated with the false negative rates of cervical cytology.
Subject(s)
Female , Humans , Biopsy , Uterine Cervical Dysplasia , Cervix Uteri , Papanicolaou Test , WoodABSTRACT
No abstract available.