Uterine Artery Embolization as an Effective Management and Diagnostic Tool for Puerperal Uterine Inversion with Severe Postpartum Bleeding: A Case Report

Acute puerperal uterine inversion is a rare postpartum obstetric complication; however, without rapid diagnosis and appropriate management, it is life-threatening. Substantial bleeding hinders the verification of a partially inverted uterus, possibly delaying the treatment. Herein, we present the report of a 32-year-old female presenting with massive postpartum bleeding managed by uterine artery embolization. The peculiar course of the uterine artery bowing inferiorly along the inverted fundus during embolization could uncover the uterine inversion, which was not diagnosed by physical examination and CT. In conclusion, uterine artery embolization is not only an effective therapeutic strategy for postpartum hemorrhage but also a valuable tool for diagnosing uterine inversion.

Correlation between postpartum depression and premenstrual dysphoric disorder: Single center study

OBJECTIVE: To describe the prevalence and correlates of the postpartum depression and premenstrual dysphoric disorder. METHODS: One hundred sixty six women were assessed around 10th to 14th days after delivery in Gangneung Asan Hospital, Korea, from September 2011 to March 2012. We checked their risk factors for postpartum depressive disorders using the Beck Depression Inventory and the Edinburgh Postnatal Depression Scale. Premenstrual dysphoric disorder was evaluated retrospectively and was defined as having more than 5 of the following 10 symptoms: breast tenderness, bloating, headache, peripheral edema (hand and foot), depressive symptoms, anger, irritability, anxiety, oversensitivity, and exaggerated mood swings. RESULTS: The prevalence rate of postpartum depression using the Edinburgh Postnatal Depression Scale > or =10 and Beck Depression Inventory > or =10 was 13.9% (23/166). We found statistical differences (P<0.01) between the postpartum depression group and the postpartum non-depression group in smoking history, past history of psychiatric problems, and level of marital satisfaction. The prevalence rate of premenstrual syndrome (PMS) was 9% (15/166) and among 23 women in the postpartum depression group, eight were determined to have premenstrual dysphoric disorder, yielding a prevalence rate of 34.8% (8/23). Among 143 women in the postpartum non-depression group, seven were determined to have PMS, yielding a prevalence rate of 4.9% (7/143). A correlation between postpartum depression and PMS was thus found (P<0.01). CONCLUSION: PMS appears to be associated with postpartum depression. This means that a hormone-related etiology appears to be one risk factor for postpartum depression.

Successful management of maternal factor VII deficiency in a cesarean section

Factor VII (FVII) deficiency is an infrequent hereditary bleeding disorder that can make excessive bleeding in surgical interventions, such as a postpartum hemorrhage in a cesarean section. Although a recombinant form of activated FVII has been applied for bleeding control in FVII-deficient patients, its applications in the field of obstetrics are still limited, especially in Korea. Replacement of blood products is still preferred as first-line therapy, with antifibrinolytic agents used as adjunctive therapy. We report herein the case of a successful cesarean section in an 18-year-old woman with FVII deficiency.

Clinical characteristics and perinatal outcomes of fetal omphalocele / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to describe the clinical characteristics and perinatal outcomes of fetuses with omphalocele. METHODS: The study enrolled all fetuses diagnosed prenatally with omphalocele at a single institution, from August 1996 to April 2008. Data were collected retrospectively by reviewing the maternal and neonatal medical records. RESULTS: The study population consisted of 54 cases with prenatally diagnosed omphalocele. In all, 15 fetuses were live-born, 29 were terminated, four died in utero, and six were lost to follow-up. Associated anomalies were found in 72.9% (35/48). Abnormal karyotype was found in 33.3% (16/48). In the live births, associated major anomalies were present in 46.7% (7/15) and were associated with increased neonatal morbidity. The rate of severe neonatal morbidity was 53.3% (8/15). In one case, death followed prolonged hospitalization with complications related to associated anomalies. The neonatal mortality rate was 6.7% (1/15) with no postoperative deaths. CONCLUSION: In this study, the neonatal mortality rates were low in the absence of associated anomalies or genetic defects. The results emphasize the importance of identifying both those fetuses with a potentially positive prognosis and favorable outcome and those which are likely to have a fatal outcome.

A case of pulmonary endometriosis presenting with catamenial pneumothorax / 대한산부인과학회지

Endometriosis is a relatively common gynecologic disease. However thoracic endometriosis syndrome is exceedingly rare among various types of external endometriosis. We experienced a case of 35-year-old woman who presented with recurrent episodes of spontaneous right-sided pneumothorax that occurred during her menstrual periods. After the localization of the disease site by means of chest radiography and computed tomography of the thorax, a chest tube was inserted after which bullectomy and pleurodesis using doxycycline were performed. A hormonal treatment with gonadotropin-releasing hormone (GnRH) agonist for 12-months was also conducted. However, right-sided pneumothorax recurred two times after these procedures. Subsequently, surgical excision of diaphragmatic lesion along with pleurodesis was underwent. To prevent recurrence, we maintained long-term GnRH agonist administration with add back therapy using low dose estrogen-progesterone. Menstruation stopped, and the chest pain disappeared. During a 19-months follow-up period, pneumothorax did not recur. We report this case with a brief review of the concerned literatures.

The efficacy and toxicity of docetaxel in patients with recurrent or persistent epithelial ovarian cancer / 대한산부인과학회지

OBJECTIVE: The aim of this study is to determine the efficacy and toxicity of docetaxel in patients with recurrent or persistent epithelial ovarian cancer, previously treated with paclitaxel and platinum combination chemotherapy. METHODS: Forty patients with recurrent or persistent epithelial ovarian cancer, had been treated with docetaxel combination chemotherapy at Asan Medical Center from May 1989 to December 2006. They received docetaxel (75 mg/m2) only or docetaxel (75 mg/m2) and platinum (carboplatin AUC5 or cisplatin 75 mg/m2) on day 1. The administration was repeated every 3 or 4 weeks. The response of patients was evaluated with CA-125 response criteria and RECIST criteria. The toxicities were defined according to the NCI common toxicity criteria. RESULTS: Twenty patients had been evaluated by RECIST criteria and twenty patients had been evaluated by CA-125 response criteria. The overall response rate was 35% (14/40). Eleven patients were belonged to complete response (CR), and three patients were belonged to partial response (PR). The mean response duration (RD) was 11.29 months (4 to 20.7 months) and the mean time to progression (TTP) was 6.91 months (1 to 23 months). The response rate in the platinum-sensitive patients was 38.7% but in the platinum-resistant patients was 22.2%. The platinum-sensitive patients showed more favorable response rate, but that was not significant statistically. Heavily treated group, more than three prior regimens were used, had poor outcome. The common toxicities were alopecia and gastrointestinal toxicities (anorexia and nausea). Bone marrow suppression was the most serious drug toxicity, however, it was tolerable. CONCLUSION: The docetaxel is a considerable 2nd line chemotherapy with acceptable efficacy and toxicity in patients with recurrent or persistent epithelial ovarian cancer previously treated with paclitaxel and platinum combination chemotherapy.