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Purpose@#We aimed to evaluate the usefulness and safety of high-flow nasal cannula (HFNC) oxygen therapy in children with complex chronic diseases (CCD) with impending respiratory failure in the general ward. @*Methods@#Medical records of subjects with HFNC oxygen use in the general ward at a Korean tertiary children’s hospital were reviewed. Children with CCD and impending respiratory failure were included. treatment success was defined as successful weaning from HFNC oxygen support and treatment failure as weaning failure that led to higher level of respiratory support such as invasive ventilation or noninvasive positive pressure ventilation. @*Results@#Fifty cases were included. Thirty-five cases (70%) were weaned off HFNC oxygen successfully, 15 cases (30%) failed. At the time of HFNC oxygen administration, the treatment failure group showed higher heart rate (P = 0.043), carbon dioxide partial pressure (P = 0.002), and initial inspired oxygen fraction (P = 0.007). Within 72 hours of initial treatment, 20% of patients in the treatmentsuccess group were weaned off the HFNC oxygen and half in the treatment-failure group required invasive ventilation. One case experienced complication. @*Conclusion@#HFNC oxygen is safe and effective for respiratory support in the general ward to avoid invasive mechanical ventilation in children with CCD and impending respiratory failure.
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Purpose@#To report our experience of fertility preservation (FP) in female cancer patients. @*Materials and Methods@#We retrospectively analyzed the medical records of female who underwent elective oocyte or embryo cryopreservation before cancer treatment between January 2015 and December 2020 at Asan Medical Center. We analyzed the type of cancer, the rate of reuse of cryopreserved oocytes or embryos, and fertility outcomes such as the resumption of menstruation or pregnancy. @*Results@#A total of 174 patients underwent 182 oocyte retrieval cycles after controlled ovarian stimulation for oocyte or embryo cryopreservation. The median age of patients was 33.0 (range 19–46) years, and the patients were most unmarried female (65.52%). The majority of patients were diagnosed with breast cancer (78.16%), and the remaining were diagnosed with gastrointestinal (6.33%) and hematologic malignancies (5.75%). The maturation rate of oocyte cryopreservation was 83.33%, and the fertilization rate of embryo cryopreservation was 72.07%. Of the 57 patients currently not undergoing cancer treatment, 34 resumed menstruating and 19 (33.33%, 19/57) returned to attempt a pregnancy. Among them, five patients succeeded in natural pregnancy.Eleven patients received frozen-thawed embryo transfer, and four patients succeeded in becoming pregnant (36.36%, 4/11). Only 6.3% of patients returned to use their gametes, and 93.7% of gametes are still in storage. @*Conclusion@#FP in cancer patients should be considered before cancer treatment. Through continuous research on oncofertility, it is necessary to consider how to increase the return rate and provide appropriate information to cancer patients of reproductive age.
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The coronavirus disease 2019 (COVID-19) pandemic has impacted the medical, social, and reproductive health of millions of people since its outbreak. The causative virus transmits, reproduces, and manifests through the respiratory tract. COVID-19 can invade any system of the body, including the cardiovascular and endocrine systems, through a secondary immune response. In particular, because the fatality rate is high in those over the age of 50 years, special attention is required during the medical care of this population. However, considering the benefit of therapy and the risk of COVID-19, high-quality evidence regarding individualized management in relation to hormone therapy is still insufficient in the field of gynecology. Furthermore, this review aims to serve as a reference for clinical application by analyzing and summarizing the results of studies reported to date regarding female hormone therapy in the context of the COVID-19 pandemic.
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Objective@#To evaluate the efficacy of vaginal hysterectomy combined with anterior and posterior colporrhaphy (VH APR) for the management of pelvic organ prolapse (POP). @*Methods@#A total of 610 patients with POP who underwent VH APR from January 2010 to June 2019 at Asan Medical Center were included in this study. We analyzed the patient characteristics and surgical outcomes. In addition, we compared the POP quantification system (POP-Q) pre- and postoperatively at 2 weeks, 3 months, and 1 year, and analyzed the risk factors for recurrence. @*Results@#The mean age of the patients was 65.5±7.6 years. The most common preoperative POP-Q stage was stage 2 (60.8%), followed by stage 3 (35.9%). Complications were identified during surgery in 1.6% of the patients. The most common postoperative complication (6.4%) was voiding difficulty. All POP-Q scores significantly decreased at 1 year after surgery (P<0.0001). The recurrence rate was 9.6%, and most recurrences (77.5%) occurred in the anterior compartment. An advanced stage of preoperative POP was a risk factor for recurrence (stage 3 or 4 vs. stage 1 or 2; odds ratio [OR], 5.337, 95% confidence interval [CI], 2.58-11.036, P<0.0001). Only two patients underwent surgical correction for POP recurrence, and most of the remaining patients did not undergo further treatment for prolapse. @*Conclusion@#VH APR is a safe and effective surgical procedure for POP, with a low recurrence rate. In addition, advanced preoperative stage was the only risk factor for recurrent POP.
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In this study, surface characteristics of plasma electrolytic oxidized Ti-mesh for dental use were studied using various experimental instruments. The titanium mesh was used as a substrate for PEO. Using a pulsed DC power supply, PEO treatment was carried out at 280 V for 3 min in the electrolytic solution containing Ca, Mg, and P ions. And the electrolyte used for PEO was prepared by mixing with Ca(CH 3COO)2·H 2O, C 3H 7CaO 6P, and (CH 3COO) 2Mg·4H 2O. The PEO-treated surface was observed by using X-ray diffraction, field-emission scanning electron microscope, energy dispersive X-ray spectroscopy, atomic force microscopy (AFM), and nanoindentation tester.PEO-treated Ti-mesh in solution containing Ca, Mg, and P ions (CaMgP) sample showed the active spark discharge reaction compared to in solution containing Ca and P ions (CaP) sample. In CaP and CaMgP samples, the PEO surface of Ti-mesh showed mainly circular, irregular, and oval shapes of pores. In the case of CaMgP, the defects and precipitates such as MgO were formed on the surface. On the sample surface, the distribution of the desired element was detected homogeneously.The PEO-treated CaP and CaMgP specimens were mainly composed of anatase, Mg, and hydroxyapatite. From the AFM result, the average roughness was 0.247 µm for CaP and 0.226 µm for CaMgP, respectively. The hardness of CaMgP containing Mg ions was increased compared to CaP containing without Mg ions, also, the elastic modulus of CaMgP sample was higher than that of CaP sample.
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Background@#To assess the clinical efficacy of intravenous immunoglobulin G (IVIG) administration combined with low-dose aspirin in women with unexplained recurrent pregnancy loss (RPL). @*Methods@#We retrospectively analyzed the medical records of patients who had been diagnosed with unexplained RPL and treated with IVIG and low-dose aspirin between January 2000 and March 2020 at Asan Medical Center. We analyzed pregnancy outcomes and their association with the percentage of natural killer (NK) cells. @*Results@#The study analyzed a total of 93 patients and 113 natural and assisted reproductive technology pregnancy cycles. The live birth rate per cycle was 73.5% (83/113), and the term delivery rate was 86.7% (72/83). The live birth rate was high regardless of the type of RPL, method of pregnancy, timing of IVIG treatment, and presence or absence of autoantibodies.In addition, the live birth rate was significantly higher in patients who received IVIG more than once, compared with patients who received IVIG only once (77.8% vs. 42.9%, P = 0.006). There was no significant association between the NK cell counts and live birth rate (65.5% in the group with NK cell < 12%, and 69.7% in that with NK cell ≥ 12%, P = 0.725). Among all patients, 87.6% had no complications, and there were no congenital malformation among newborn babies. @*Conclusion@#IVIG combined with low-dose aspirin treatment showed favorable pregnancy outcomes regardless of the patient’s NK cell counts (%).
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Background@#This study was performed to evaluate etiologies and secular trends in primary amenorrhea in South Korea. @*Methods@#This retrospective multi-center study analyzed 856 women who were diagnosed with primary amenorrhea between 2000 and 2016. Clinical characteristics were compared according to categories of amenorrhea (hypergonadotropic/hypogonadotropic hypogonadism, eugonadism, disorders of sex development) or specific causes of primary amenorrhea. In addition, we assessed secular trends of etiology and developmental status based on the year of diagnosis. @*Results@#The most frequent etiology was eugonadism (39.8%). Among specific causes, Müllerian agenesis was most common (26.2%), followed by gonadal dysgenesis (22.4%). Women with hypergonadotropic hypogonadism were more likely to have lower height and weight, compared to other categories. In addition, the proportion of cases with iatrogenic or unknown causes increased significantly in hypergonadotropic hypogonadism category, but overall, no significant secular trends were detected according to etiology. The proportion of anovulation including polycystic ovarian syndrome increased with time, but the change did not reach statistical significance. @*Conclusion@#The results of this study provide useful clinical insight on the etiology and secular trends of primary amenorrhea. Further large-scale, prospective studies are necessary.
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Objectives@#This paper aimed to use machine learning to identify a new group of factors predicting frailty in the elderly population by utilizing the existing frailty criteria as a basis, as well as to validate the obtained results. @*Methods@#This study was conducted using data from the Korean Frailty and Aging Cohort Study (KFACS). The KFACS participants were classified as robust or frail based on Fried’s frailty phenotype and excluded if they did not properly answer the questions, resulting in 1,066 robust and 165 frail participants. We then selected influential features through feature selection and trained the model using support vector machine, random forest, and gradient boosting algorithms with the prepared dataset. Due to the imbalanced distribution in the dataset with a low sample size, holdout was applied with stratified 10-fold and cross-validation for estimating the model performance. The reliability of the constructed model was validated using an unseen test set. The model was then trained with hyperparameter optimization. @*Results@#During the feature selection process, 27 features were identified as meaningful factors for frailty. The model was trained based on the selected features, and the weighted average F1-score reached 95.30% with the random forest algorithm. @*Conclusions@#The results of the study demonstrated the possibility of adopting machine learning to strengthen existing frailty criteria. As the method analyzes questionnaire responses in a short time, it can support higher volumes of data on participants’ health conditions and alert them regarding potential risks in advance.
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Objective@#Ultrasonographic differential diagnosis of ovarian tumors is important for appropriate management. We conducted study to compare the performance of the Assessment of Different NEoplasias in the adneXa (ADNEX) model with a subjective assessment (SA) in differentiating between benign and malignant adnexal masses in Korean women. @*Methods@#A total of 353 patients who underwent adnexal surgery with abnormal pelvic ultrasonographic findings from August 2016 to August 2017 were included in study. The presumptive diagnosis of adnexal malignancy was determined by both SA and the ADNEX model to be >10% calculated risk of malignancy. The area under the curve (AUC) comparison between the SA and ADNEX models was performed using DeLong’s method. @*Results@#340 patients with benign tumors and 13 with malignant adnexal tumors among 292 (82.72%) premenopausal and 61 (17.28%) postmenopausal women were included. The AUCs of SA and the ADNEX model for discrimination between benign and malignant tumors were 0.79 and 0.92, respectively (P=0.10). The sensitivity and specificity of SA and the ADNEX model were 83.5% and 97.0%, and 90.0% and 82.0%, respectively. Comparison of the ADNEX model regarding menopausal status revealed that the predictability was not different. The AUCs of SA and the ADNEX model in premenopausal women were 0.74 and 0.89, respectively (P=0.12). The AUCs of SA and the ADNEX model in postmenopausal women were 0.86 and 0.94, respectively (P=0.60). @*Conclusion@#The ADNEX model offers excellent discrimination between benign and malignant ovarian tumors with similar sensitivity and specificity to SA in both premenopausal and postmenopausal Korean women.
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Purpose@#Although there are many articles about single incision laparoscopic (SIL) hernioplasty, a large-scale study or article about its long-term outcome has not been reported yet. The aim of this study is to assess short- and long-term outcomes of SIL totally extraperitoneal (TEP) hernia repair with large number of cases. @*Methods@#A prospectively collected database containing details of 1,231 procedures in 1,129 consecutive patients who underwent SIL-TEP hernia repair between June 2010 and December 2017 at a single institution was retrospectively analyzed. SIL-TEP hernia repair was performed using a glove single port device and standard laparoscopic instruments.Recurrence rate of SIL-TEP hernia repair was analyzed by a telephone questionnaire. @*Results@#Among 1,129 patients, 1,027 (91.0%) had unilateral hernia and 102 (9.0%) had bilateral hernia. There were 12 (1.1%) conversions to single or 3 ports laparoscopic transabdominal preperitoneal hernioplasty or Lichtenstein repair. Mean operative time was 40.3 minutes for unilateral hernia and 61.6 minutes for bilateral hernia. Intraoperative complication rate was 21.8%. Most intraoperative complications were peritoneum or sac tearing (20.1%). Postoperative complications occurred in 97 (8.6%) cases, most of which were minor morbidity except for 1 mesh infection. Five-year recurrence rate was 4%. @*Conclusion@#SIL-TEP hernia repair is safe and technically feasible with acceptable short- and long-term outcomes. Largescale randomized controlled trials comparing SIL-TEP hernia repair with conventional laparoscopic TEP are needed to confirm these results.
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Objectives@#Ovarian suppression using Gonadotropin releasing hormone (GnRH)-agonist in premenopausal women with breast cancer has been known to improve disease-free survival and overall survival. However, long-term effect of ovarian suppression on lipid metabolism has not been studied yet. In this retrospective cohort study, we aimed to investigate cholesterol changes during medical ovarian suppression. @*Methods@#and Materials: We reviewed medical records and blood test results of 152 women who have been diagnosed as breast cancer and started GnRH-agonist every 12 weeks therapy for more than 24 weeks in Asan Medical Center between 2018.1.1 and 2020.12.31. Patients who had previously diagnosed dyslipidemia or diabetes, or newly received lipid-lowering agents during study period were excluded from the cohort. Age at diagnosis and preoperative Body Mass Index (BMI) were investigated as baseline demographics. Generalized additive mixed model was applied to analyze the relationship between duration of GnRH-agonist and cholesterol changes. @*Results@#The age was distributed as 42.5±5.2 years old (mean±SD), and preoperative BMI was 23.0±3.6 kg/m2 (mean±SD). Duration of GnRH agonist therapy ranged from 5.6 to 37.7 months, with mean of 19.3. Total cholesterol was 171 mg/dL before starting GnRH-agonist, whereas 181 mg/dL on last check, which was significantly higher than initial value (p=0.03). Duration of GnRH-agonist did not affect total cholesterol level until 19.3 months, while significantly increased by 1.8 mg/dL for each month thereafter (p=0.011). There was no significant effect of age, preoperative BMI and GFR on total cholesterol. @*Conclusion@#While long-term use of GnRH-agonist is applied, patients should be monitored for dyslipidemia after 19 months of treatment and lipid-lowering agents may be considered especially when indicated.
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Rapid-onset obesity with hypoventilation, hypothalamic, and autonomic dysregulation (ROHHAD) syndrome is a rare disease characterized by rapid progression of obesity and central hypoventilation with autonomic and endocrine dysregulation. There is no gold-standard diagnostic method for ROHHAD syndrome; it is diagnosed based on a years-long clinical course. For this reason, diagnosis of ROHHAD syndrome is often delayed. In particular, ROHHAD has a high mortality rate due to cardiopulmonary arrest when quick diagnosis and appropriate intervention of central sleep apnea are not timely. We report a case in which an 11-year-old girl with central sleep apnea was diagnosed with ROHHAD syndrome: the clinical course with early breathing intervention using noninvasive positive pressure ventilation. We emphasize the importance of respiratory interventions in the clinical course of ROHHAD syndrome.
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Purpose@#To compare the recurrence pattern, disease-free survival (DFS), and overall survival (OS) after curative surgery for pancreatic ductal adenocarcinoma (PDAC) in patients who underwent preoperative evaluation with CT alone or in combination with MRI, and to compare the prognosis according to the first recurrence site. @*Materials and Methods@#We retrospectively evaluated 152 patients who underwent R0 resection of PDAC. Preoperative CT or combined CT and MRI were performed for 103 and 49 patients, respectively. Two radiologists recorded the location and date of the first recurrence in consensus. The recurrence pattern, DFS, and OS were compared between the two groups. OS was analyzed according to the first recurrence site. @*Results@#In both groups, liver metastasis was the most common recurrence pattern. DFS (p = 0.247) or OS (p = 0.067) showed no significant difference between the two groups. OS according to the first recurrence site was the lowest for liver metastasis, followed by locoregional recurrence (p < 0.001). @*Conclusion@#There were no significant differences in the recurrence pattern, DFS, or OS between patients evaluated with preoperative CT alone or with CT and MRI after curative resection of PDAC. Liver metastasis was the most common tumor recurrence pattern with the lowest OS.
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Purpose@#The purpose of this study was to investigate the clinical practice patterns of Korean obstetricians and gynecologists the diagnosis and management of hypertensive disease in pregnant women. @*Methods@#From April 2015 to October 2015, questionnaire was distributed via email to obstetricians who were members of the Society for Maternal and Fetal Medicine. The survey consisted of 37 questions in 6 categories. Responses to the questions on the management of hypertensive disorders of pregnancy, from diagnosis to treatment, were evaluated. @*Results@#A total of 93 obstetricians and gynecologists responded to the survey. High blood pressure was allocated the highest priority as an index mainly used when deciding to hospitalize patients with hypertensive disease during pregnancy, followed by pregnancy symptoms, proteinuria, and blood test results. Calcium channel blocker (CCB) for oral administration and hydralazine for injection were preferred as antihypertensive drugs mainly used to control severe hypertension. Regarding the delivery method for hypertensive disease during pregnancy, in cases of preeclampsia, 63% of the respondents chose the delivery method according to the cervical status, and in cases of hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and eclampsia, which increased in severity, 52% and 31% responded that the delivery method was determined according to the cervical status, respectively. In cases of mild preeclampsia, the 70% of respondents preferred 37–38 weeks of gestation for the delivery time. Regarding the use of aspirin in patient with hypertension during pregnancy, 52% of the respondents occasionally administered aspirin, and in patients with a history of hypertensive disease during pregnancy, only 43% were administered prophylactic aspirin. @*Conclusion@#Domestic obstetricians regarded blood pressure as the most meaningful factor when treating women with hypertension during pregnancy and considered blood pressure control as important. The preferred antihypertensive agents were oral CCB and hydralazine injections, and the choice of delivery method was determined according to the condition of the cervix and severity of the disease. Even in women with high risk factors for preeclampsia, prophylactic aspirin was administered in as low as 50%, of patients, possibly may due to the absence of domestic guidelines for aspirin use during pregnancy. Korean guidelines for prophylactic aspirin administration during pregnancy is needed based on additional research on the efficacy of aspirin for domestic women in the future.
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Müllerian development anomalies (MDAs) are most commonly diagnosed in the reproductive period. A bicornuate uterus is the result of a fusion defect of the Müllerian ducts, causing an abnormal fundal outline. Most of the cases are diagnosed early in life and present with obstetrical complications, such as recurrent pregnancy loss, preterm birth, intrauterine growth restriction, placental abruption, and cervical incompetence. Pelvic organ prolapse (POP) in women with MDAs has been reported; however, all reported cases were when MDAs are diagnosed before or simultaneously with the development of POP in premenopausal young women aged < 35. A 52-yearold menopausal woman, who successfully delivered vaginally at term, was presented with protruding mass through vaginal introitus. On POP-Q examination, the cervix was elongated and descended to 1 cm out of the hymen during bearing down; however, the uterine bodies were confined in the pelvic cavity, which is commonly encountered among POP patients with large uterus due to uterine fibroids or adenomyosis. She also diagnosed for complete bicornuate uterus and underwent robotic sacrocolpopexy for advanced stage POP. It is presumed to have been caused by the bicornuate uterus that prevented the total uterine prolapse with the effect of extending both uterine horns bilaterally inside the pelvic cavity and trapping the uterus within the pelvis. Herein, we report a rare case of complete bicornuate uterus with multiple successful vaginal deliveries at term without obstetric complications, which remained undiagnosed until she was managed for the POP in her postmenopausal period.
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Uterine perforation related with dilatation and curettage (D&C) is an uncommon event. Combined complications such as hemorrhage, adjacent organ injury, and omental incarceration may require an emergent surgical treatment. These are usually evident immediately or several days after the D&C, and a delayed presentation of uterine perforation are extremely rare. Herein, we report a rare case of omental incarceration presenting as a hyperechoic endometrial mass in a postmenopausal woman, diagnosed twenty-three years after the D&C. According to this case, when we encounter a hyperechoic endometrial lesion penetrating the uterine wall in women with a history of an intrauterine procedure such as D&C, we need to consider the possibility of an incarcerated omentum.
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Objective@#Ultrasonographic differential diagnosis of ovarian tumors is important for appropriate management. We conducted study to compare the performance of the Assessment of Different NEoplasias in the adneXa (ADNEX) model with a subjective assessment (SA) in differentiating between benign and malignant adnexal masses in Korean women. @*Methods@#A total of 353 patients who underwent adnexal surgery with abnormal pelvic ultrasonographic findings from August 2016 to August 2017 were included in study. The presumptive diagnosis of adnexal malignancy was determined by both SA and the ADNEX model to be >10% calculated risk of malignancy. The area under the curve (AUC) comparison between the SA and ADNEX models was performed using DeLong’s method. @*Results@#340 patients with benign tumors and 13 with malignant adnexal tumors among 292 (82.72%) premenopausal and 61 (17.28%) postmenopausal women were included. The AUCs of SA and the ADNEX model for discrimination between benign and malignant tumors were 0.79 and 0.92, respectively (P=0.10). The sensitivity and specificity of SA and the ADNEX model were 83.5% and 97.0%, and 90.0% and 82.0%, respectively. Comparison of the ADNEX model regarding menopausal status revealed that the predictability was not different. The AUCs of SA and the ADNEX model in premenopausal women were 0.74 and 0.89, respectively (P=0.12). The AUCs of SA and the ADNEX model in postmenopausal women were 0.86 and 0.94, respectively (P=0.60). @*Conclusion@#The ADNEX model offers excellent discrimination between benign and malignant ovarian tumors with similar sensitivity and specificity to SA in both premenopausal and postmenopausal Korean women.
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Purpose@#To compare the recurrence pattern, disease-free survival (DFS), and overall survival (OS) after curative surgery for pancreatic ductal adenocarcinoma (PDAC) in patients who underwent preoperative evaluation with CT alone or in combination with MRI, and to compare the prognosis according to the first recurrence site. @*Materials and Methods@#We retrospectively evaluated 152 patients who underwent R0 resection of PDAC. Preoperative CT or combined CT and MRI were performed for 103 and 49 patients, respectively. Two radiologists recorded the location and date of the first recurrence in consensus. The recurrence pattern, DFS, and OS were compared between the two groups. OS was analyzed according to the first recurrence site. @*Results@#In both groups, liver metastasis was the most common recurrence pattern. DFS (p = 0.247) or OS (p = 0.067) showed no significant difference between the two groups. OS according to the first recurrence site was the lowest for liver metastasis, followed by locoregional recurrence (p < 0.001). @*Conclusion@#There were no significant differences in the recurrence pattern, DFS, or OS between patients evaluated with preoperative CT alone or with CT and MRI after curative resection of PDAC. Liver metastasis was the most common tumor recurrence pattern with the lowest OS.
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Purpose@#The purpose of this study was to investigate the clinical practice patterns of Korean obstetricians and gynecologists the diagnosis and management of hypertensive disease in pregnant women. @*Methods@#From April 2015 to October 2015, questionnaire was distributed via email to obstetricians who were members of the Society for Maternal and Fetal Medicine. The survey consisted of 37 questions in 6 categories. Responses to the questions on the management of hypertensive disorders of pregnancy, from diagnosis to treatment, were evaluated. @*Results@#A total of 93 obstetricians and gynecologists responded to the survey. High blood pressure was allocated the highest priority as an index mainly used when deciding to hospitalize patients with hypertensive disease during pregnancy, followed by pregnancy symptoms, proteinuria, and blood test results. Calcium channel blocker (CCB) for oral administration and hydralazine for injection were preferred as antihypertensive drugs mainly used to control severe hypertension. Regarding the delivery method for hypertensive disease during pregnancy, in cases of preeclampsia, 63% of the respondents chose the delivery method according to the cervical status, and in cases of hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and eclampsia, which increased in severity, 52% and 31% responded that the delivery method was determined according to the cervical status, respectively. In cases of mild preeclampsia, the 70% of respondents preferred 37–38 weeks of gestation for the delivery time. Regarding the use of aspirin in patient with hypertension during pregnancy, 52% of the respondents occasionally administered aspirin, and in patients with a history of hypertensive disease during pregnancy, only 43% were administered prophylactic aspirin. @*Conclusion@#Domestic obstetricians regarded blood pressure as the most meaningful factor when treating women with hypertension during pregnancy and considered blood pressure control as important. The preferred antihypertensive agents were oral CCB and hydralazine injections, and the choice of delivery method was determined according to the condition of the cervix and severity of the disease. Even in women with high risk factors for preeclampsia, prophylactic aspirin was administered in as low as 50%, of patients, possibly may due to the absence of domestic guidelines for aspirin use during pregnancy. Korean guidelines for prophylactic aspirin administration during pregnancy is needed based on additional research on the efficacy of aspirin for domestic women in the future.
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Müllerian development anomalies (MDAs) are most commonly diagnosed in the reproductive period. A bicornuate uterus is the result of a fusion defect of the Müllerian ducts, causing an abnormal fundal outline. Most of the cases are diagnosed early in life and present with obstetrical complications, such as recurrent pregnancy loss, preterm birth, intrauterine growth restriction, placental abruption, and cervical incompetence. Pelvic organ prolapse (POP) in women with MDAs has been reported; however, all reported cases were when MDAs are diagnosed before or simultaneously with the development of POP in premenopausal young women aged < 35. A 52-yearold menopausal woman, who successfully delivered vaginally at term, was presented with protruding mass through vaginal introitus. On POP-Q examination, the cervix was elongated and descended to 1 cm out of the hymen during bearing down; however, the uterine bodies were confined in the pelvic cavity, which is commonly encountered among POP patients with large uterus due to uterine fibroids or adenomyosis. She also diagnosed for complete bicornuate uterus and underwent robotic sacrocolpopexy for advanced stage POP. It is presumed to have been caused by the bicornuate uterus that prevented the total uterine prolapse with the effect of extending both uterine horns bilaterally inside the pelvic cavity and trapping the uterus within the pelvis. Herein, we report a rare case of complete bicornuate uterus with multiple successful vaginal deliveries at term without obstetric complications, which remained undiagnosed until she was managed for the POP in her postmenopausal period.