A case of abdominal pregnancy implanted on uterosacral ligament / 대한산부인과학회지

Abdominal pregnancy, a rare type of ectopic pregnancy is difficult to be suspected at its first presentation. The diagnosis of this rare disease may often be delayed, since early symptoms are usually non-specific. In some cases, delayed diagnosis of abdominal preganacy can be associated with catastrophic hemorrhage secondary to placental separation. A 24-year old woman visited our emergency unit, presenting with a sudden-onset low abdominal pain. She had undergone uterine curettage 3 weeks before. Transvaginal sonogram of the cul-de-sac revealed complex fluid consistent with blood. On diagnostic laparoscopic operation, we found a ruptured cystic, conception-like structure near the right uterosacral ligament. Histology of the resected structure finally showed chorionic villi consistent with abdominal pregnancy. In this report, we present an unusual case of abdominal pregnancy. This case underscores the careful ultrasonic determination of gestational location at early pregnancy.

Prognosis of Threatened Abortion according to Embryonic Heart Rate / 대한주산의학회잡지

OBJECTIVE: The purpose of our study was to investigate the relationship between prognosis of threatened abortion and embryonic heart rate at diagnosis. METHODS: The study group included 86 patients in which a singleton fetus with cardiac activity was initially documented. The study population was divided into successful pregnancy group (73 cases, pregnancy was maintained above 20 weeks of gestation) and spontaneous abortion group (13 cases). We compared the embryonic heart rate, age of mother, gestational age at diagnosis between two groups. RESULTS: A significant difference of embryonic heart rate was noted between the successful group and the spontaneous abortion group (153.1+/-22.9 vs 134.6+/-18.8 beats/min, p=0.0076). There was no statistical difference in the gestational age at diagnosis (8.0+/-1.9 vs 7.5+/-1.9 weeks), the age of mother, and primi para proportion. CONCLUSION: The prognosis of threatened abortion was related to the embryonic heart rate. Embryos with slow heart rates had a greater risk of spontaneous abortion. All cases with slow embryonic heart rate (<110 beats/min) had occurred spontaneous abortion. Therefore, these case were needed more information and aggressive treatment.

Diagnosis of an Interstitial Pregnancy with 3-dimensional Transvaginal Sonography / 대한주산의학회잡지

Interstitial pregnancy is an ectopic pregnancy which is located in the intramural portion of the tube covered by myometrium. Rupture usually results in catastrophic hemorrhage, since there is an anastomosis of uterine artery and tuboovarian vessels. Therefore, the early diagnosis is important to decrease maternal morbidity. However, the diagnosis using the conventional 2-dimensional transvaginal sonography has some difficulties in differentiation from corneal pregnancy. In this case, we diagnosed an interstitial pregnancy using the 3-dimensional sonography in a woman with amenorrhea for 7 weeks and 1 days, which was resected through laparoscopic operation. The 3-dimensional sonography has a potential role to define the location of pregnancy implanted on the outer site of uterine fundus.

Diagnosis of an Interstitial Pregnancy with 3-dimensional Transvaginal Sonography / 대한주산의학회잡지

Interstitial pregnancy is an ectopic pregnancy which is located in the intramural portion of the tube covered by myometrium. Rupture usually results in catastrophic hemorrhage, since there is an anastomosis of uterine artery and tuboovarian vessels. Therefore, the early diagnosis is important to decrease maternal morbidity. However, the diagnosis using the conventional 2-dimensional transvaginal sonography has some difficulties in differentiation from corneal pregnancy. In this case, we diagnosed an interstitial pregnancy using the 3-dimensional sonography in a woman with amenorrhea for 7 weeks and 1 days, which was resected through laparoscopic operation. The 3-dimensional sonography has a potential role to define the location of pregnancy implanted on the outer site of uterine fundus.

Effectiveness of sacrospinous colpopexy in vault prolapse patients / 대한산부인과학회지

OBJECTIVE: To evaluate the effectiveness of sacrospinous colpopexy in vault prolapse patients. METHODS: It is the retrospective study including 10 vault prolapse patients who received sacrospinous colpopexy at St. Paul Hospital, the Catholic University from July 1999 to April 2004. RESULTS: The 10 patients receiving sacrospinous colpopexy had the average age of 58.9 years, and the parity of 3.4. They were moderately overweighted with average BMI of 24.5. The average period from hysterectomy to diagnosis of vault prolapse was 11.1 years. Hypertension was noted on most of patients (70.0%). The average operation time was 68.5 minutes and postoperative hemoglobin decrement was 2.4 on average. During 2-month period of postoperative follow-up, there were no significant complications noted except one case of wound infection associated with diabetes and one case of transfusion due to anemia. After sacrospinous colpopexy, protruding mass out of vagina was resolved on 100% and urologic and other complications were improved over 50% of cases. CONCLUSION: Considering that several underlying medical conditions such as hypertension, obesity are associated with vault prolapse patients, sacrospinous colpopexy in case of vault prolapse is an excellent operative approach with low complication and recurrence rates.

Laparoscopic finding of Acute Pelvic Inflammatory Disease / 대한산부인과학회지

OBJECTIVE: To analyze physical, laboratory and laparoscopic findings of suspicious cases of pelvic inflammatory disease (PID) and compare the group shown positive findings during laparoscopic surgery with that shown negative findings. METHODS: We selected 42 doubtful cases of PID that were treated by diagnostic laparoscopic surgery in St. Paul hospital of Catholic Medical Center from Jan. 2001 to Jun. 2003 and evaluated symptoms, duration of pain, and physical, laboratory, laparoscopic and histological findings. RESULTS: Of the 42 patients, we classified 22 patients shown pelvic inflammatory findings at laparoscopic surgery into the positive group and 20 patients shown non-specific or free-inflammatory findings into negative group. Between two groups, there were no significant differences in ages, parities and histories of PID. Number of intrauterine device (IUD) users was 5 and all of the five patients were positive group though none was belonged to negative group. Mean duration for developing acute pain was much shorter in positive group (3.1 days) than negative group (22.3 days). There were no meaningful differences in rise of body temperature and CRP level, but the degree of leukocytosis was greater in positive group (10,581/mm3) than negative group (7,720/mm3). Ratio of polymorphonuclear (PMN) leukocytes was higher in positive group (73.3%) than in negative group (59.7%) and number of cases those erythrocyte sedimentation rate (ESR) above 30 mm/Hr was larger in positive group (n=17) than in negative group (n=10). CONCLUSION: Of the suspicious cases of PID based on patient's symptoms and physical findings, the rate of the cases shown positive findings in laparoscopic surgery was 52.3%. Distinctive factors between two groups were usage of IUD, urgency of symptom, degree of leukocytosis, increase in ratio of PMN leukocytes and ESR. We suggest the exploration of more sensitive and specific diagnostic tools.

Comparison of diagnostic methods used for detection of preterm premature rupture of membrane / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to compare the detection rate among diagnostic methods used for preterm premature rupture of membrane (PPROM). METHODS: The study population was composed of pregnant women who visited delivery room at our hospital due to vaginal watery discharge from 1 March 2002 to 28 February 2003. The gestational age was between 15 and 36+6/7 weeks of gestation. The study group was composed of 74 pregnant women. The rupture of membrane was tested by nitrazine test, ROM-check test and actim PROM test. It was regarded true positive that normal spontaneous preterm delivery was occurred within 72 hrs. The detection rates of each test were analyzed. RESULTS: There were positive results in 65 cases of nitrazine test, 23 cases of ROM-check test and 53 cases of actim PROM test. Of these positive cases, cases that delivered within 72 hours were in 33 cases of nitrazine test, 13 cases of ROM-check test and 30 cases of actim PROM test. Among three diagnostic methods, the sensitivity is highest for nitrazine test (86.8%) and the specificity is highest for ROM- check test (72.2%). The positive predictive value shows no significant difference among three methods and the negative predictive value is highest for actim PROM test (61.9%). The combination of ROM-check test and actim PROM test shows most accurate detection rates for diagnosis of preterm premature rupture of the membranes (sensitivity 84.2%, specificity 42.3%, positive predictive value 56.1%, negative predictive value 64.7%). CONCLUSION: Our data shows that combination of diagnostic methods might improve detection rate for PPROM. Future studies remain to improve detection rate of PPROM.

A Case of Harlequin Ichthyosis / 대한주산의학회잡지

Harlequin ichthyosis, which is one of lamellar ichthyosis, is a severe and fatal congenital keratinization disorder with autosomal recessive inheritance. The cause of this disorder is not clear but related to transglutaminase-1 gene mutation. It is characterized by an extremely thickened keratin layer of skin, flattened ears and diffuse platelike scales. Pathologic findings include prominent hyperkeratosis and severe acanthosis. Prenatal sonographic diagnosis has been described, with findings of a persistantly open mouth, echogenic amnionic fluid and fixed flexion of the extremities. We experienced a case of Harlequin infant who showed typical clinical and pathologic findings but non-specific antenatal studies performed in other hospital. We report the case of Harlequin ichthyosis with a brief review of the literature.

Prenatal Diagnosis of Yq Deletion by Cytogenetic and Fluorescence in Situ Hybridization / 대한주산의학회잡지

OBJECTIVE: The accurate evaluation of a marker chromosome has been limited during prenatal karyotyping. We proposed a method of step-by-step approach to evaluate the origin of a marker chromosome. METHODS: A patient with 19 weeks of gestation was transferred to our hospital for karyotyping due to abnormal Triple test. Karyotyping of amniotic fluid was performed. NOR (nucleolar organizer region) banding and FISH (fluorescence in situ hybridization) using two types of sex chromosome probes: chromosome X alpha satellite probe (DXZI) & chromosome Y alpha satellite probe (DYZ3)(Cytocell, Bambury, UK) and CEP X/Y (Xp11.1-q11.1 CEP X alpha satellite & Yq12 CEP Y satellite III)(Vysis, IL, USA) were done. RESULTS: The routine chromosomal analysis showed 46,X,+mar. As the result of NOR banding, we supposed that the marker chromosome was less likely originated from acrocentric chromosomes. FISH analysis revealed Y centromere signal on marker chromosome, but Yq12 signal was not detected. Therefore the marker chromosome was identified as Y chromosome formed by deletion at Yq11.2. CONCLUSION: This study demonstrated that FISH and NOR banding technique is more effective method for a marker chromosome evaluation during prenatal karyotyping.

A Case of Vaginal Prolapse after McIndoe Operation Managed by Transvaginal Sacrospinous Colpopexy / 대한산부인과학회잡지

McIndoe procedure using the colonic segment has been used in treatment of patients with Mullerian agenesis. Prolapse of a colonic neovagina is rare condition and its treatment is not yet standardized. We experienced a case of neovaginal prolapse following McIndoe procedure using colonic segment. A 51-year-old woman developed prolapse of a neovagina 17 years after the McIndoe operation. She had been diagnosed to have Mullerian agenesis and was managed by McIndoe operation using colonic segment. The prolapse was successfully managed with transvaginal sacrospinous colpopexy. She has no sign of recurrent prolapse and is satisfied with sexual intercourse. Patients with neovaginal prolapse following McIndoe procedure can be treated successfully with transvaginal sacrospinous colpopexy.

Diffuse Large B-cell Lymphoma Successfully Treated in a Pregnant Patient / 대한산부인과학회잡지

The concurrence of lymphoma with pregnancy has been rare but is most commonly associated with an aggressive histology and disseminated disease. Thus, extensive staging is required, and either local radiotherapy or systemic chemotherapy is indicated as soon as possible. We have experienced a case of diffuse, large B-cell lymphoma, stage III2 diagnosed at 31 weeks of gestational age. During pregnancy period, CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy was performed and complete remission of disease was attained. The infant was successfully delivered at 34 weeks in gestation without any gross anomaly or combined disease. We report a case of diffuse large B-cell lymphoma successfully treated with combination chemotherapy during pregnancy and a brief review of the literatures.

The clinical efficacy and cost-effectiveness of Lamellar body count in fetal lung maturation test / 대한산부인과학회잡지

OBJECTIVE: To evaluate the availability and efficacy of the Lamellar body count as a predictor of fetal lung maturity METHODS: Amniocentesis was performed for evaluation of fetal lung maturity status within 72 hours of delivery in 32 patients. A Lamellar body count in clean amniotic fluid (AF) was analyzed right after amniocentesis. In case of contaminated AF with meconium or blood, samples was centrifuged for 3 minutes and divided into three. The average of three samples was analyzed successively from Coulter counter. RESULTS: The incidence of RDS showed significant relation with gestational age, 1-minute and 5-minute Apgar Score. Using a value greater than 30,000/ l to indicate pulmonary maturity, the Lamellar body count predicted all lung-maturated cases with no false-negative results (100% negative predictive value). All 4 cases of RDS demonstrated Lamellar body count less than 30,000/microl. By using a lower cutoff of 10,000/microl to predict pulmonary immaturity. Positive predictive value was 100% in RDS patients. CONCLUSION: In high risk pregnancy, fetal lung maturity test from amniotic fluid lamellar body count is a rapid, simple and reliable method in making a decision of delivery-time. And also it has universal availability with cost-effectiveness when we consider the reality of korean medical situation

Influence of Hepatocyte Growth Factor on Matrix Metalloproteinase Expression in HT cell line / 대한산부인과학회잡지

OBJECTIVE: This study was performed to investigate the influence of hepatocyte growth factor (HGF) on matrix metalloproteinase (MMP), which are related in the lysis process of tissue during the invasion of trophoblasts. METHOD: HT cell line was treated with recombinant HGF (rHGF) of different concentration (0, 10, 50 and 100 ng/mL) and was cultured for 24 hours to check the changes in the expression of MMP-2 and MMP-9. Also, HT cell line was treated with recombinant HGF 50 ng/mL and was cultured for 24, 36, 48, and 72 hours to check the changes in the expression of MMPs according to the different time span. Total RNA were extracted from each cultured sample and RT-PCR and Western blotting were used to analyze the expression of MMP-2 and MMP-9. RESULTS: MMP-2 mRNA expression with treated rHGF showed increase of 2, 2.5 and 2.2 times with the increase of concentration level of 10, 50 and 100 ng/mL accordingly, while MMP-2 protein expression were increased 1.4 and 1.5 times in 50 ng/mL and 100 ng/mL of rHGF respectively compared with that of normal control. MMP-9 mRNA showed no significant changes in its expression with all different levels of concentration, while MMP-9 protein showed 1.5 times increase with 10 ng/mL rHGF but 0.4 times decrease with 100 ng/mL. MMP-2 mRNA expression treated with recombinat HGF were increased 1.6 times with 24 hour culture and 2.3 times with 36 hour culture. MMP-2 protein showed 1.9 times increase only for the case of 24 hour culture. MMP-9 mRNA expression of recombinant HGF-treated groups was decreased 0.7 times compared with that of control group in 36 hours. MMP-9 protein expression were increased by 1.2, 1.6 and 1.9 times as culture time increase to 36, 48, and 72 hours accordingly, compared with that of normal control. CONCLUSION: This result suggests that the HGF might partially regulate the invasion of trophoblasts through MMP-2 and MMP-9.

Influence of Hepatocyte Growth Factor on Matrix Metalloproteinase Expression in HT cell line / 대한산부인과학회잡지

OBJECTIVE: This study was performed to investigate the influence of hepatocyte growth factor (HGF) on matrix metalloproteinase (MMP), which are related in the lysis process of tissue during the invasion of trophoblasts. METHOD: HT cell line was treated with recombinant HGF (rHGF) of different concentration (0, 10, 50 and 100 ng/mL) and was cultured for 24 hours to check the changes in the expression of MMP-2 and MMP-9. Also, HT cell line was treated with recombinant HGF 50 ng/mL and was cultured for 24, 36, 48, and 72 hours to check the changes in the expression of MMPs according to the different time span. Total RNA were extracted from each cultured sample and RT-PCR and Western blotting were used to analyze the expression of MMP-2 and MMP-9. RESULTS: MMP-2 mRNA expression with treated rHGF showed increase of 2, 2.5 and 2.2 times with the increase of concentration level of 10, 50 and 100 ng/mL accordingly, while MMP-2 protein expression were increased 1.4 and 1.5 times in 50 ng/mL and 100 ng/mL of rHGF respectively compared with that of normal control. MMP-9 mRNA showed no significant changes in its expression with all different levels of concentration, while MMP-9 protein showed 1.5 times increase with 10 ng/mL rHGF but 0.4 times decrease with 100 ng/mL. MMP-2 mRNA expression treated with recombinat HGF were increased 1.6 times with 24 hour culture and 2.3 times with 36 hour culture. MMP-2 protein showed 1.9 times increase only for the case of 24 hour culture. MMP-9 mRNA expression of recombinant HGF-treated groups was decreased 0.7 times compared with that of control group in 36 hours. MMP-9 protein expression were increased by 1.2, 1.6 and 1.9 times as culture time increase to 36, 48, and 72 hours accordingly, compared with that of normal control. CONCLUSION: This result suggests that the HGF might partially regulate the invasion of trophoblasts through MMP-2 and MMP-9.

Nonlinear Dynamic and Chaotic Analysis of Fetal Heart Rate in Fetal Distress / 대한산부인과학회잡지

OBJECTIVES: For estimating the antenatal fetal wellbeing to develop new analysis method of fetal heart rate(FHR) with electronic Fetal Heart Rate Monitoring(eFHRM) and computer. METHODS: Heart rate signal is received from distressed fetus using eFHRM. It is necessary to carry out low pass filtering as a preprocess for the nonlinear method. Nonlinear parameters are calculated and classified to investigate the relations between these parameters and values of umbilical cord blood gas. RESULTS: By dividing values of the umbilical cord blood gas into 5 fetuses of acidemic group and 17 fetuses of non-acidemic group after 22 neonates who presented fetal distress were born, the following results as compared with nonlinear chaotic analysis result were obtained. 1. Delay time through AMI for acidemic group was 16.80+/-3.11, and was higher than 15.41+/-2.27 for non-acidemic group, and is not significant in statistics. 2. Embedding Dimension calculated with FNN method was 5.60+/-2.07 for acidemic group, and 4.71+/-1.26 for non-acidemic group, and it was not significant statistically. 3. Correlation dimension for acidemic group was 1.41+/-0.20, and was higher than 1.10+/-0.38 for non-acidemic group, and is not significant in statistics. 4. Mean crossing value by isoangular return map was 28.80+/-11.34 for acidemic group, and 16.65+/-7.00 for non-acidemic group, and it was significant statistically(P=0.008). 5. In comparison of information entropy in 1-D ED, acidemic group was 6.32+/-0.38 and non-acidemic group was 6.20+/-0.28 and it was not significant statistically. Also, in comparison of value in 2-D ED, acidemic group was 10.20+/-0.34. It was higher than non-acidemic group of 9.51+/-0.43 significantly in statistics(P=0.004). But, in comparison of value in 2-D EP, acidemic group was 8.78+/-0.86 and non-acidemic group is of 9.22+/-0.74 and it wasn't significant statistically. And, 2-D ED(DI) value was 10.64+/-0.14 for acidemic group and 10.51+/-0.18 for non-acidemic group, and it wasn't significant statistically. CONCLUSIONS: By the above result, nonliner dynamics and chaotic analysis of heart rate data with computer can serve as a new diagnosis method which may estimate the fetal wellbeing with real time. Through further studies for establishment of diagnosis standard and computer programming, real time diagnosis method shall be applied to clinical practice.

The Influence of Choice of Pain Control Method on Analgesic effect and Postoperative Progress after Cesarean Section / 대한산부인과학회잡지

OBJECTIVE: We investigated influence of choice of pain control method on analgesic effect and postoperative course after cesarean section. METHODS: Ninety parturients were randomly allocated to three groups and each group had 30 women. The postoperative pain was controlled with classical intramuscular injection in IM group and PCA (patient-controlled analgesia)device in meperidine (D) and meperidine+diclofenac (DV) group for up to 48 hours after Cesarean section when the parturients awoke and complained pain. The parturients received intramuscular diclofenac 75 mg every 12 hours in DV group. We evaluated usefulness and safety of each pain control method on postoperative opioid requirement, numerical rating score of pain, side effect and first ambulation time for 48 hours after operation. RESULTS: Total opioid requirement was decreased almost 40-50% in DV group. Pain score lowered significantly at 6, 12 and 24 hours in DV group(p<0.05). Nausea,Vomiting and Dizziness were increased in IM group than PCA group(p<0.05). There was no difference in laboratory data including hemoglobin, hematocrit, platelet count and bleeding time in diclofenac used group. Ambulation was started earlier significalty in DV group after Cesarean section(p<0.05). CONCLUSION: We concluded that diclofenac combined PCA is the most effective and safe method in pain control after cesarean section. But it is necessary to try further evaluation of hemostatic effect of diclofenac.

Comparison of Cost Efficacy of Ectopic Pregnancy Management / 대한산부인과학회잡지

The incidence of ectpic pregnancy has increased rapidly over the past decade. Currently, the complications of this disorder make it one of the leading causes of maternal mortality and morbidity. In the late 1980s, reports of successful use of methotrexate (MTX) as a non surgical treatment for ectopic pregnancy (EP) also began to appear in the literature. With MTX emerging as a possible alternative management of selected women with an EP, an analysis of its comparative costs is now needed. We examined retrospectively the costs associated with management of EP in our hospital. We selected 30 women with EPand divided them into two groups of MTX treated group (n= l0) and surgically treated group (n=20). There were no statistically significant differences in the doctors fee, room, charge and cost of laboratory and radiologic examination between two groups. But We found significant reduction in cost with regard to pharmacy, injection, procedure and operation of MTX treated group compared to surgically treated group (p<0.05). Consequently the use of MTX for EP should still be considered investigational; we recognize and agree that the evolution of this remedial option should be based primarily on its ability to decrease morbidity and mortality rather than on its ability to reduce costs. If medical treatment proves to be effective, the potential cost savings demonstrated in this report will become an important influential factor on selecting alternative remedy.

Comparison of Distribution of Fibronectin and Fibrinogen in Placenta between Normotensive and Preeclamptic Pregnancies / 대한산부인과학회잡지

In order to find out the distribution of fibronectin and fibrinogen in placenta among pregnancy induced hypertensive (PIH) patients, 6 normotensive pregnancies and 17 PIH patients were chosen. The placentas were obtained right after delivery and soaked in the 10% formalin solution. The score was measured in terms of the positiveness of the stain in immunohistochemical stain by using I antibody with the rabbit antihuman fibronectin and the rabbit anti-human fibrinogen. Comparison between two groups are as following: 1.The placenta of PIH patients showed significantly reduced positiveness of fibronectin in their fetal villous vessels and villous stroma. 2. In the PIH patients, the positiveness was reduced in the group giving the birth to intrauterine fetal growth retardation compared to giving birth to normal baby. 3. In both normotensive and PIH patients, the villous basement membrane did not show the staining response to fibronectin, while showing heavy staining response to fibrinogen. 4. The positiveness of fibrinogen in fetal vessels, villous basement membrane, intervillous space and stroma were almost same in both normotensive and PIH patients. From above results, we can conclude that there is abnormality in the distribution of fibronectin especially in the fetal vessels and the villous stroma of placenta among PIH patients. The cause of this result needs further study.