A spontaneous pregnancy and Cesarean delivery in a Turner mosaic with previous recurrent miscarriages / 대한산부인과학회지

Ovarian failure and infertility are typical features in Turner syndrome. Conception without ovum donation is very rare. We experienced one case of pregnancy and Cesarean delivery in a Turner mosaic with previous recurrent miscarriages.

Two cases of cesarean section after laparoscopic radiofrequency myolysis / 대한산부인과학회지

Radiofrequency myolysis is a method for preserving uterus and fecundity, and due to its more non-invasive and simpler operation, it is now carried out to cure the uterine myomas. However, not long time has passed since this operation started, and little studies were conducted on this complications and side effects. Therefore, since the authors experienced the pregnancy after radiofrequency myolysis of uterine myoma, we hereby report the cases.

Acute Sheehan's syndrome with hyponatremia and hypoglycemia / 대한산부인과학회지

We report two cases of acute Sheehan's syndrome with a brief review of literature: A 28-year-old woman who had been performed cesarean section delivery complicated by hemorrhage due to uterine atony. And a 29-year-old woman who had vaginal birth after cesarean section (VBAC) complicated by hemorrhage due to birth canal laceration. On 8th day after delivery, both patient visited emergency room in critical condition with nausea, vomiting and general weakness. Although clinically significant Sheehan's syndrome is an uncommon consequence of obstetric hemorrhage, Sheehan's syndrome should be considered in the differential diagnosis of hyponatremia and suggestive hypoglycemia in early postpartum period women with history of massive obstetric hemorrhage.

Clinical analysis of non-blood transfusion treatment in patients who refused a blood transfusion for obstetrical part / 대한산부인과학회지

OBJECTIVE: The goal of this study is to analyze the clinical manifestation of obstetrical patients who refused transfusion of any blood component. Through this analysis, we could define the guideline of non-blood transfusion treatment during the obstetrical procedure. METHODS: 127 patients who visited our non-blood transfusion treatment center and had obstetrical procedures from 1 Jan. 2000 to 31 March 2006 participated in this study. They were retrospectively analyzed according to the following indexes; the reason of refusing blood transfusion, age, ratio of vaginal delivery to Cesarean section, comparison of hemoglobin level, volume of blood loss, presence of bloodless treatment, days of hospitalization, presence of blood transfusion, consequence of patient (including complications and deaths). Bloodless treatment at the hospital are medical method (recombinant human erythropoietin, Aprotinin, Hemocoagulase, Tranexamine acid, Venoferrum), Autotransfusion and Electrocauterization. RESULTS: Among 126 patients (except for 1 patient who was delivered at the other hospital), the vaginal delivery group consisted of 57, and the Cesarean operation group was 69. The most common cause of primary caesarean section was arrest disorder of cephalo-pelvic disproportion. Among 26 patients qualified for indication of transfusion, uterine atony had the highest number of patients at 16. Among the indication of transfusion, low hemoglobin level (< or =8.0 g/dL) after operation had the highest number of patients at 20. Patients qualified indication of transfusion had twice more blood loss (464.6+/-34.2 ml vs 920.5+/-214.2 ml) and two more days of hospitalization (7.6+/-0.5 day vs 9.7+/-0.6 day) compared with those of non-qualified for indication of transfusion. Nobody received direct transfusion of blood component. There were no death but acute renal failure in one patient, and DIC (disseminated intravascular coagulation) in another patient as complications. CONCLUSIONS: This study analyzed the clinical manifestations of patients who refused a blood transfusion in obstetrics. Especially, when the non-blood transfusion treatment was performed, which had been an issue in recent times, more active treatment showed less reduction of hemoglobin level than no treatment. This study also confirmed that bleeding patients can be treated by selective non-blood transfusion treatment.

Bilateral Uterine Arterial Embolization for Treatment for Uterine Myoma / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to evaluate the effectiveness and safety of uterine artery embolization for the treatment of symptomatic leiomyomas in the patients who want to preserve uterus, want fertility or feel fear for operation. METHODS: From January 2003 to June 2005, among the patients with symptomatic uterine leiomyoma, fifteen women who wanted to preserve uterus or wanted fertility or had fear for operation were included in this retrospective study. Bilateral Uterine artery embolization (UAE) was performed. At the preprocedure and at 2, 6, and 12 weeks of postprocedure, transvaginal ultrasonography was performed for all patients. Clinical symptoms and follow-up information for each patient were evaluated. RESULTS: 15 leimyomas were treated with UAE. The initial mean volume of leiomyomas was 55.4 (46.3-67.4) cm3. The mean volume decrease was 58.6+/-9.7%, 77.5+/-12.3%, 86.8+/-23.5% at 2, 6, 12 weeks. The outcome of clinical symptoms were as followed; 'much improved' 20% (3/15), 'somewhat improved' 60% (6/15), 'no improvement' 20% (3/15), 'somewhat worsen's 0% (0/15), and 'much worsen' was 0% (0/15). There was no case of hysterectomy or myomectomy after UAE. And also no case of increasement of volume nor worsening of clinical symptoms were found. Lower abdominal pain was the most common symptoms after UAE, but complications were not detected. CONCLUSION: In this study, UAE to treat patients with uterine leiomyoma is proved to be effective not only in volume reduction, but also in symptom improvement. And it is a relatively less-invasive procedure which decreases the risk of side effects of operation. Above all things, it preserves fecundity in young women. Therefore, UAE is very effective and safe procedure in the treatment of symptomatic uterine leiomyoma.

Seroprevalence of parvovirus B19 in pregnant women in Korea: A study of sociodemographic and medical risk factors / 대한산부인과학회지

OBJECTIVE: The prevalence of Parvovirus B19 antibody in Korea has not been known. The aim of this study is to analyze variation of prevalence according to area, job and maternal age. METHODS: A prospective study of the pregnant women was performed at first & second trimester. This study was an analysis of 221 pregnant women who lived in Seoul, Bucheon, Cheonan, and Gumi in South Korea. All serum samples were drawn during first and second trimester. Presence of parvovirus B19 IgG antibodies and IgM antibodies was determined by ELISA using Parvovirus B19 IgM-3rd Generation EIA, Parvovirus B19 IgG-3rd Generation EIA, Parvovirus B19 Quantitative IgG Calibrators Kit (Biotrin International, Ireland). Data and level of significance were analysed by chi-square test using the SPSS program. RESULTS: In total, 118 (53.3%) of the 221 pregnant women were IgG antibody positive for parvovirus B19 during first and second trimester. Only 1 (0.5%) of 221 pregnant women was IgM antibody positive. There were no nonimmune fetal hydrops, spontaneous abortion and stillbirth in acutely infected woman. There were no statistically significant differences in Parvovirus IgG positive rate according to maternal age, area, parity and gestational age. CONCLUSION: This study has confirmed seroprevalence rate of human parvovirus B19 in South Korea comparable to the rate found in Asian countries. But positive rate of Parvovirus IgG was higher than other Asian countries. This study also showed that a proportion of adults of childbearing age was still susceptible to the virus and serological data also showed evidence of infection occurring in this age group. It will be of interest for the obstetricians in this country to note the role of Parvovirus B19 in relation to the extent of stillbirths and hydrops fetalis and to if there is any need for a vaccine to reduce fetal wastage.

A Case of Advanced Gastric Cancer in Third trimester / 대한산부인과학회지

Gastric cancer associated with pregnancy is extremely rare and the information on this particular subject is limited. Gastrointestinal symptoms such as abdominal pain, nausea, vomiting and loss of appetite are common during pregnancy but also can be the only symptoms in stomach cancer until the late stage. Clinicians' reluctance to pursue diagnostic studies appears to be a major contributing factor of delayed diagnosis and poor outcome. A 33-year-old-women at 30 weeks gestation with advanced gastric cancer died sixteen days after emergency cesarean delivery. We report this case to alert clinicians to this rare possibility.

The Clinical Significance of Uterine Artery Doppler Flow Velocity Waveforms as a Screening Test in the Second Trimester Pregnancies / 대한주산의학회잡지

OBJECTIVE: We performed uterine artery doppler flow velocity waveforms between 20~24 weeks of gestation to access the screening properties for predicting pregnancy-induced hypertension or intrauterine growth retardation in general population. METHODS: Total 458 normal pregnant women were enrolled in this study. The abnormal uterine artery doppler flow velocity waveforms was defined that systolic/diastolic ratio is greater than 2.6 or diastolic notch waveforms are seen. RESULTS: The incidence of PIH and IUGR among study population was 3.5% and 3.5%, respectively. The incidence of PIH in normal and abnormal uterine artery Doppler flow velocity waveforms group were 2.0% and 11.4%, and those of IUGR were 3.4% and 4.2%, respectively. The incidence PIH or IUGR among abnormal doppler group was 14.2%, which was higher than in normal group of 5.4%. This method had a sensitivity of 34.3%, a specificity of 86.1% and positive predictive value of 15.7% for the prediction of PIH and IUGR. CONCLUSION: Although abnormal uterine artery doppler flow velocity waveforms is associated with an increased risk of PIH or IUGR, the lowered positive predictability lead to apply the follow-up examination or standardization of doppler ultrasonography.

Analysis of the Evaluation for Clinical Performance Examination using Standardized Patients in one Medical School / 한국의학교육

PURPOSE: Analysis of the evaluation for clinical performance examination (CPX) using standardized patient (SP) in one medical school was done to compare the evaluations between the staffs and SPs, among the staffs, and among the SPs, and to investigate the correlation between the evaluation scores and the school record. METHODS: Clinical performance examination was done to seventy-nine 4th grade medical students. Checklist was modified from the existing reference and added more items. Three SPs who were non-physician volunteers were trained by authors about what is the disease and how to act the patient and how to evaluate the students. Three staffs and three SPs both filled up the checklist at the same time right after each student's performance. RESULTS: Agreements between the staffs and the SPs were relatively high enough in the items of physical examination and management but low in the history taking related items although they were statistically significant. In the evaluation between the staffs and the SPs, the mean scores in the management and overall attitude were not significantly different, but, mean scores in the history taking, physical examination and overall skill were significantly different. Among the staffs there were no significant differences in history taking, physical examination, overall attitude, and there were significant differences in patient management and overall skill. Among the SPs there were no significant differences in physical exam, patient management and overall skill, and there were significant differences in history taking and overall attitude. The correlation coefficients between the evaluation scores and school records, between the evaluation scores and written report were relatively low respectively. CONCLUSION: To increase the agreement rates between the staffs and SPs, more training for the staffs and SPs are necessary

A Clinical study of Intrauterine Fetal Death / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate intrauterine fetal death and elucidate the etiology of intrauterine fetal death. METHODS: This is a clinical study of 74 cases of intrauterine fetal death (IUFD) among 5,523 deliveries at Soonchunhyang University Hospital during Jan. 1998 to Apr. 2003. RESULTS: The overall incidence of IUFD was 1.34%. And the age distribution of mother with IUFD was between 19 to 44 year old and was highest in the 25 to 29 year old age group (39.1%). The parity of mothers with IUFD was the highest in nulliparous group (78.3%) and there was a decreased tendency with high parity. There were 47 cases (63.5%) with previous history of abortion and 2 cases (2.7%) with previous history of IUFD. The highest incidence rate of IUFD was shown at 20-24 weeks of gestation (48.6%) and in the fetus weighted less than 1,000 gm (59.5%), and the sex ratio of male versus female fetus was 1:1.07. The modes of delivery were labor induction (54.1%), laparotomy (18.9%), spontaneous labor (27.0%). The indication for laparotomy was placental abruption, placenta previa, previous cesarean section state. The etiology factors of IUFD were unexplained causes (55.4%), cord complication (12.2%), placental abruption (9.4%), placenta previa (9.4%) in order. CONCLUSION: The causes of IUFD were unexplained, cord complication, placental abruption in order. So, the proper antenatal care should be taken of fetuses on the basis of risk factors of antepartum and intrapartum.

A Study of Predicting Postpartum Depression and the Recovery Factor from Prepartum Depression / 대한주산의학회잡지

OBJECTIVE: To discover the risk factor of postpartum depression and whether this is different from the induced factor of prepartum depression and to clarify what is the recovery factor from prepartum depression. METHODS: In the first test stage, 310 pregnant women were examined and with their postpartum follow-up survey, materials from 85 people in total were retrieved. In order to predict the postpartum depression and find out the recovery factor from prepartum depression, longitudinal study was carried out. For the statistical analysis hierarchical regression analysis and MANOVA were used. RESULTS: Postpartum depression (Beck Depression Inventory; BDI score of 16 or greater) was prevalent amongst 22.4% of pregnant women and prepartum depression was experienced by 10.5% in pregnant women. There were no significant on psychological variable factor of prepartum and postpartum depression. Only preatum depression redicted 33% for postaprtum depression. In the case of depressed during pregnancy but not depressed after pregnancy, recovery factor is related to increase in self-esteem, husband support and improvement in marital satisfaction. Postpartum depression showed twice higher depression ration than prepartum depression and it was serious in terms of degree of depression. CONCLUSION: Postpartum depression is related with lack of husband support that is recovery factor from prepartum depression. Also, unstable attachment is vulnerable to depression but even people with unstable attachment can be recovered from depression with better marriage relationship. Even people without unstable attachment if husband support is reduced then it is suggested that can be subject to vulnerability in depression.

Study on the Factor V Leiden Mutation in Pregnant Women and Relationship with Preeclampsia Severe Form / 대한주산의학회잡지

OBJECTIVE: A study showed that resistance to activated protein C may develope some cases of severe preeclampsia. A common missense mutation in the factor V gene, the Leiden mutation, is the most frequent genetic cause of resistance to activated protein C. Our objective was to determine whether this mutation is more prevalent in patients with severe preeclampsia than in normotensive controls. METHOD: Deoxyribonucleic acid was extracted from whole blood of 158 gravid women of severe preeclampsia and 403 normotensive gravid women. The polymerase chain reaction was used to amplify exon 10 of the factor V gene, followed by allele-specific restriction with Mnl 1 for mutation detection. RESULTS: No patients were homozygous for the Leiden mutation. We could not find any positive case with FV:Q506 in the normal or patient group. CONCLUSION: We could not find that carriers of the factor V Leiden mutation are increased risk for severe preeclampsia. In contrast to the reports in Caucasian, the prevalence of APC resistance and FV:Q506 might be very low or absent in the Korean population. But, carriers of this common thrombophilic mutation may be identified so that other causes and risk factors for inherited thrombophilia should be investigated in the Korean population.

The Relationship of HPV Infection with Ki-ras and p53 Mutation in Uterine Cervical Carcinomas / 대한산부인과학회잡지

OBJECTIVE: Human papillomavirus(HPV) is an important pathogenetic agent in the uterine cervical carcinoma. It has been known that E6 and E7 proteins of high risk HPV viruses abolish the action of tumor suppressor genes, Rb and p53, resulting in cellular proliferation. This study was designed to determine the incidence of Ki-ras and p53 mutations in uterine cervical carcinomas and evaluate the results of mutations according to the status of HPV infection. METHODS: Paraffin-embedded tissue samples obtained from 42 CIN III and 70 invasive carcinomas of the uterine cervix(56 squamous, 7 adenosquamous and 7 adenocarcinomas). Ki-ras codon 12 mutation was analysed by PCR-RFLP method and p53 exons 5, 6, 7 and 8 mutations by PCR-SSCP. The presence of HPV was detected by PCR using consensus primers for high risk viruses(HPV 16, 18, 31, 33, 35, 52b, and 58) and low risk viruses(HPV 6 and 11). RESULTS: HPV viruses were detected in 83.3% of CIN III and 90% of invasive carcinomas; 71.4% of adenocarcinomas, 91.7% of squamous cell carcinomas and 100% of adenosquamous carcinomas. Ki-ras codon 12 mutation was detected in 4.7% of CIN III and 11.4% of invasive carcinomas, and p53 mutations in 4.8% of CIN III and 7.1% of invasive carcinomas. There was no significant difference of Ki-ras mutation between HPV-positive group(9.2%) and HPV-negative group(7.1%). However, p53 mutation was more frequent in HPV-negative group(28.6%) than HPV-positive group(3.1%). (p=0.0002) CONCLUSIONS: HPV is an agent which is detected in high frequency of uterine cervical carcinomas and p53 mutation may have a role in the HPV-negative uterine cervical carcinomas. However, the relationship between Ki-ras gene and HPV in uterine cervical carcinogenesis remains to be defined.

A Case of Acardiac Fetus in a Triplet Pregnancy / 대한산부인과학회잡지

Acardiac fetus in triplet pregnancy is a very rare, fatal congenital anomaly that had not been reported in Korea. It only occurs in multiple gestations associated with placental vascular anastomoses between the affected fetus and its co-twin. The major complications associated with acardiac fetus in triplet pregnancy are congestive heart failure in normal pumping fetus, maternal polyhydramnios, preterm labor, intrauterine fetal death, etc, and perinatal diagnosis can be made with the perinatal ultrasonographic examination. We report a case of acardiac fetus in a spontaneous triplet pregnancy at 23 weeks of gestational age with a brief review of the literature.

The Clinical Effectiveness of Cervicography in Cervical Cancer Screening / 대한부인종양콜포스코피학회잡지

In an effort to reduce the false-negative rate of PAP smear, several new technologic screening methods have recently evolved. Cervicography is one of these methods. The purpose of this study was to evaluate the screening use of cervicography as an adjunctive method and the clinical effectiveness of cervicography in korean reports, compared with other countries. And we estimated the specificity and sensitivity of cervicography in cervical cancer screening in several korean reports. The results were : 1. The sensitivity of cervicography and pap smear was 89.2% and 85.7%. 2. The false negative rate of cervicography and pap smear was 3.8% and 22.4%. 3. When cervicography and Pap smear were used conjointly, the sensitivity was higher than for cervicography or pap smear used alone(95.7% vs 89.2%, 95.7% vs 85.7%) Cervicography is one of the useful screening method for detect cervical cancer, However when cervicography are used in conjunction with Pap smear, the detection rate of cervical cancer will be increased.

Correlation of Leptin Level between Maternal and Umbilical Cord Plasma in Normal Pregnancy and Preeclanpsia / 대한주산의학회잡지

OBJECTIVE: We investigated the effect of preeclampsia, birth weight, fetal sex, maternal body mass index(BMI) on cord blood leptin concentrations. This study is to test whether leptin would be increased in preeclampsia and to test cord leptin concentrations for correlation with maternal leptin concentrations. METHOD: Maternal blood samples were obtained from 56 normal pregnancies and 24 preeclampsia women prior to delivery. Umbilical cord blood were obtained from the all cases studied immediately after delivery. The total leptin levels were determined by radioimmunoassay. RESULTS: Mean maternal leptin level was 16.4+/-6.4ng/ml in normal pregnancy and was 19.4+/-7.9 ng/ml in preeclampsia. Mean cord leptin level was 5.4+/- 3.4ng/ml in normal pregnancy and 4.6+/-3.2ng/ml in preecalmpsia. Mean cord blood leptin level in female fetus was 6.6+/-3.7ng/ml and 4.8+/-2.8ng/ml in male fetus. CONCLUSION: This study shows that there are correlation with leptin level and fetal birth weight, body mass index, and fetal gender. Furthermore, physiologic role and mechanism of leptin of maternal serum and umbilical cord would be studied.

A Study of the Effect of Changes in Ano-Rectal Function after Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: It has been suggested that hysterectomy has a disturbing influence on bowel function, mainly constipation. We performed a prospective study to assess the changes of ano-rectal physiology after hysterectomy. METHODS: Fourteen consecutive patients were assessed before and two months after hysterectomy. A detail questionnaire was devised to allow assessment of bowel function and ano-rectal pressure test and balloon expulsion test were performed before and after hysterectomy. The parameters measured in ano-rectal pressure test included the minimal sensible volume, ano-rectal resting pressure, maximal squeezing pressure, recto-anal inhibitory reflex and balloon expulsion test. Data analysis was carried out by paired t-test. Statistical significance was inferred when the p value was0.05). There were no significant changes in ano-rectal pressure test after hysterectomy. The disturbance of balloon expulsion capacity was increased in four patients after hysterectomy(29%). CONCLUSION: Our results demonstrate that hysterectomy does not cause a decrease in ano-rectal pressure and rectal sensitivity, but has an adverse effect on rectal expulsion capacity in a some of patients.

Expressions of the cell proliferation Ag Ki-67, p53 and p21wa f1/cip1 in uterine cervical squamous tumor / 대한부인종양콜포스코피학회잡지

OBJECTIVE: To evaluate the expressions of Ki-67, p53 and p21 waf1/cip1 according to the age and the histologic type of preinvasive and invasive cervical lesions. MATERIAL AND METHOD: Microwave-oven-processed formalin-fixed, paraffin-embedded, cervical biopsy specimens and hysterectomy specimens were obtained from 1997 to 1998 at the Soonchunhyang university Chunan hospital. These included 55 cervical intraepithelial neoplasm(CIN I-III), 14 invasive squamous cell carcinoma and 3 adenocarcinoma, and immunohistochemically evaluated by monoclonal MIB-1 antibody, monoclonal p53 antibody, and monoclonal p21 antibody. Positive index was expressed as a percentage of strong staining cells per 300 counted cells in evenly strong staining area. RESULT: Ki-67, p53 and p21 protein were expressed in the nuclei. Ki-67 was specifically expressed in all phases of cell cycles in proliferating cells. p21 expression was not seen in CIN I and CIN II, but was increased with increasing histologic grade. According to the age, Ki-67 expression was significantly higher in 30 > or =aged group than 30 or =aged group. CONCLUSION: Conclusions of this study indicate that cell proliferating rate is higher in young age groups than old age groups. p53 expression was not significantly different according to age and histologic grade. These indicates that mutation of the p53 gene may be associated with the development of cervical cancer, but not associated with the progression of cervical cancer. Besides, p21 expression was increased in increasing histologic grade, but decreased in old aged women. Further study of this paradoxical increase in p21 expression in cervical carcinoma is necessary to clarify the mechanisms of p53 indepent pathway.

A case of Squamous cell carcinoma with transitional cell component of the Bartholin Gland / 대한부인종양콜포스코피학회잡지

A patient with squamous carcinoma of Bartholin gland including transitional component is reported and the literature related to this disease is reviewed. Carcinoma of the Bartholin gland is rare, comprising less than 1% of female genital tract cancer. This report was summurized a clinical experience of a 53 year old women with Bartholin gland carcinoma, FIGO Stage II. Histologically, this tumor is characterized by poorly differentiated squamous cell carcioma, individually cellular keratinizationa and transitional component. This patient was treated by modified radical vulvectomy with ipsilateral lymph node dissection and neoadjuvant chemotherapy(4 courses) and followed by radiation therapy.

A Case of Prenatal Diagnosis of Congenital Fetal Goiter in Hyperthyroidism Mother / 대한주산의학회잡지

We report a case of prenatal diagnosis of fetal congenital goiter at 31weeks of gestation by ultrasonogram and fetal hypothyroidism confirmed at birth as thyroid function test by umbilical cord blood sampling. Maternal Graves' disease and the drugs used to treat hyperthyroidism in pregnant women can affect the fetus, causing hyperthyroidism or hypothyroidism and goiter. Fetal hypothyroidism may be caused by transplacental passage of either maternal thyrotropic-binding inhibitory immunoglobulin(TBII) antibodies or maternal treatment with propylthiouracil(PTU). Untreated fetal hypothyroidism may result in mental retardation, perceptual-motor, visual-spatial, and language developmental problems. In this article fetal thyroid function was not assessed by cordocentesis, but fetal congenital goiter was detected ultrasound. Ultrasound should be used to detect fetal goiter from 20 weeks onward. Fetal goiter should resolve when maternal PTU treatment is decreased. We have diagnosed fetal hypothyroidism in utero by ultrasonography. Significance of in utero management of fetal hypothyroidism is discussed.