Pregnancy outcome after cervical conization: risk factors for preterm delivery and the efficacy of prophylactic cerclage / 부인종양

OBJECTIVE: This study examined the risk factors for preterm birth and the efficacy of prophylactic cerclage in patients who had undergone cervical conization due to cervical intraepithelial neoplasia before pregnancy. METHODS: We reviewed the medical records of all patients who gave live singleton births between May 1996 and April 2009, after having cervical conization. Delivery before 37 gestational weeks was considered as preterm birth. The pregnancy outcomes were analyzed with independent sample t-test, chi-square test, and multiple logistic regression using the SPSS ver. 12.0. RESULTS: Sixty five cases were found. The mean gestational age at delivery was 37 weeks (SD, 3.5). Eighteen patients (27.7%) had preterm delivery. The type of conization, the volume of the specimen, and second trimester cervical length were related to preterm birth (p< or =0.001, p=0.019, p< or =0.001, respectively). In multivariate analysis, only mid-trimester cervical length was statistically significant for preterm birth (p=0.012; odds ratio, 0.194; confidence interval, 0.055 to 0.693). Six out of 65 patients had undergone prophylactic cerclage, and three (50%) of them had preterm births, while 15 (25%) patients without cerclage had preterm births. CONCLUSION: The type of conization, the volume of specimen, and second trimester cervical length may be the risk factors for preterm birth in patients who have a prior history of cervical conization. Prophylactic cerclage may not be helpful in preventing preterm birth, therefore more careful consideration should be paid in deciding cerclage after conization during prenatal counseling.

A case of fetal congenital epulis mimicking oral tumor detected by prenatal ultrasonography / 대한산부인과학회지

Congenital epulis, a kind of hamartoma, is a very rare tumor, which appears in front of maxillary alveolar ridge in most cases, and accompanies no malformations. As the tumor protrudes from the oral cavity, it may lead to respiratory difficulties and feeding problems. Therefore it is important for pregnant women to receive comprehensive prenatal counseling with accurate diagnosis of the fetal oral tumor. We report a rare case of prenatal detection of oral tumor with a brief review of literatures, which was confirmed to be a congenital epulis or granular cell tumor after birth.

Comparison between tension-free vaginal tape (TVT) and transobturator tape (TOT) with concomitant surgery for pelvic organ prolapse / 대한산부인과학회지

OBJECTIVE: To compare tension-free vaginal tape (TVT) and transobturator tape (TOT) for surgical treatment of stress urinary incontinence (SUI) associated with pelvic organ prolapse (POP). METHODS: Two hundred seventy eight consecutive patients affected by SUI associated with POP more than stage II were included in this retrospective study. Cure rate and postoperative complications such as hemoglobin difference between preoperative and postoperative period, vaginal hematoma, bladder and bowel injury, vaginal mesh erosion, urinary retention, de novo urgency, urinary tract infection were compared. Student's t-test and chi square test were used for statistical analysis. A P-value below 0.05 was considered statistically significant. RESULTS: The number of patients underwent TVT was 145 and TOT was 133. All patients were followed up for more than 12 months. The general characteristics of patients showed no significant difference between the two groups. There was no difference between two groups in cure rate. However, hemoglobin difference (TVT, 2.91+/-0.93 g/dL; TOT, 1.53+/-0.77 g/dL; P=0.04) was higher in TVT group than TOT group and urinary retention within 1 month (TVT, 35.17%; TOT, 21.05; P=0.02), and urinary tract infection (TVT, 11.72%; TOT, 3.75%; P=0.02) more frequently appeared in TVT group than TOT group. Other postoperative complications such as vaginal hematoma (TVT, 6.89%; TOT, 6.76%; P=0.86), bowel injury (TVT, 0%; TOT, 1.5%; P=0.64), vaginal mesh erosion (TVT, 7.58%; TOT, 4.51%; P=0.47), urinary retention after 1 month (TVT, 2.76%; TOT, 3.00%; P=0.35), de novo urgency (TVT 7.58%, TOT: 6.01%, P=0.48) were not different between two groups. CONCLUSION: Both procedures appear to be equally effective in the surgical treatment of SUI associated with POP. However, TOT seems to be a more safe procedure in postoperative complications.

Association between bacterial vaginosis and cervical intraepithelial neoplasia / 부인종양

OBJECTIVE: The aim of this study was to determine whether the presence of bacterial vaginosis (BV) is associated with cervical intraepithelial neoplasia (CIN) and human papilloma virus (HPV) infection. METHODS: A total of 588 women who had abnormal Pap smears and had finally undergone loop electrosurgical excision procedure (LEEP) in our institute from September 2002 to May 2006 were selected. The screening tests for BV were done in 552 of the 588, and BV was diagnosed if three of the following four findings were satisfied: presence of abnormal discharge, vaginal pH>4.5, presence of clue cells, positive amine or whiff test. Five hundred and five patients had HPV typing tests by the HPV DNA chip. Forty two patients diagnosed with invasive cancer were excluded from this study. CIN was subdivided into low-grade CIN (CIN I) and high-grade CIN (CIN II/III) groups. RESULTS: There was no statistically significant difference in patient characteristics between BV-present and BV-absent group. The incidence of CIN was significantly higher in the BV-present group (p=0.043), however, no statistical significance of BV on CIN was observed on multivariate analysis. HPV infection showed no significant relationship with BV. BV with or without HPV infection did not influence the incidence of CIN, regardless of the severity. CONCLUSION: There was significant correlation between BV and the presence of CIN, regardless of the severity of CIN. In addition, there was no significant association between the presence of BV and HPV infection.

Pregnancy outcomes in women with epilepsy using lamotrigine / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to investigate pregnancy outcomes in women with epilepsy using lamotrigine (LTG). METHODS: We retrospectively reviewed the medical records of all patients who had been diagnosed as epilepsy and gave live singleton births in Yonsei University Health System, Seoul, Korea, between February 1996 and December 2007. Nine patients who were not taking antiepileptic drugs (AEDs) were excluded from this study. We subdivided the enrolled patients into 2 groups; patients exposed to LTG and others exposed to other AEDs. Congenital malformation, spontaneous abortion, small for gestational age, termination of pregnancy, intrauterine fetal death, preterm delivery, and adverse maternal outcomes were documented to evaluate the pregnancy outcomes. The statistical significance was defined as P<0.05. RESULTS: 129 cases were found in all medical records. The overall risk of congenital malformations in the AED group was 6.2% (n=8), which included 4 cases to carbamazepine (CBZ) monotherapy, 1 to valproate (VPA) monotherapy, and 3 to VPA+CBZ polytherapy. Congenital malformations were significantly increased in the non- LTG groups than in the LTG group (8.7% vs. 0%, P=0.047), especially in non-LTG polytherapy group (20.0% vs. 0%, P=0.049). The rates of spontaneous abortion, small for gestational age, termination of pregnancy, intrauterine fetal death, preterm delivery, and adverse maternal outcomes were no significant differences between the two groups. CONCLUSION: This study demonstrates that administration of LTG in pregnant women with epilepsy could be more effective in decreasing teratogenicity than administration of other AEDs in polytherapy.

Fetal cardiac tumor: Prenatal diagnosis and postnatal outcome / 대한산부인과학회지

OBJECTIVE: The objective of this study was to evaluate the ultrasonographic appearance of suspected fetal cardiac tumor and their evolution until delivery and in the postnatal period, and to document the associated problems including tuberous sclerosis. METHODS: We retrospectively reviewed the medical records of all cases born in Yonsei University Health System, Seoul, Korea, between September 1996 and August 2006, and diagnosed as fetal cardiac tumor prenatally. RESULTS: 10 cases were found in all medical records. The mean age of the mothers on delivery was 30.2+/-2.4 and the mean gestational age on diagnosis was 30.6+/-5.4 weeks. The cardiac tumors were single in five cases and multiple in the other five cases. The size ranged from 7 to 34mm. Most of the tumors were located in right ventricle (RV, n=9), left ventricle (LV, n=6), but they also located in interventricular septum (IVS, n=4), right atrium (RA, n=1). In one case, fetal arrhythmia was found, which was normalized in two days after birth, and in another case, mild intracardiac flow obstruction was noted. The duration of postnatal follow-up ranged from 2 months to 36 months (mean, 18.9+/-13.1 months). In most cases the tumor masses decreased after birth (n=6), but had no change in utero (n=5). Three of them were diagnosed as tuberous sclerosis after birth, and none of them needed surgical intervention. CONCLUSION: Fetal cardiac tumors and their effect on the fetal cardiac function could be well evaluated by two-dimensional and Doppler echocardiography. The fetal cardiac tumors may have little effect on the fetal well being both prenatally and postnatally from the cardiovascular standpoint in most affected fetuses, but are important in the early diagnosis of tuberous sclerosis and in suggesting careful follow-up and management.

A case of ultrasound-guided cyst aspiration and sclerotherapy for the management of intractable pelvic pseudocyst / 대한산부인과학회지

Patients who underwent laparotomy often experience recurrent pelvic pseudocysts and they may need to undergo another laparotomy. Nowadays, many less invasive techniques such as the use of ultrasound-guided aspiration of pelvic pseudocysts and sclerotherapy were developed and were replacing laparotomy. We report a case of intractable pelvic pseudocyst treated successfully with ultrasound-guided cyst aspiration and sclerotherapy using acetic acid with a brief review of literature.