Study on the Insulin Resistance According to Obesity in the Patients with Polycystic Ovarian Syndrome / 대한산부인과학회잡지

OBJECTIVE: Polycystic ovarian syndrome (PCOS) is a heterogenous dysfunctional endocrinologic disorder with unknown etiology, clinically characterized by obesity, chronic anovulation, masculinization and infertility. Recently, the association between polycystic ovarian syndrome and insulin resistance have been brought up and insulin resistance is one of the most important factor related to the development of obesity. However, not all polycystic ovarian syndrome patients are obese, it would give a clue to understanding pathophysiology of obesity and PCOS if insulin resistance could be classified according to the degree of obesity in PCOS. Thus, we performed this prospective study to know the relationship between insulin resistance and obesity in the patients with PCOS. METHODS: Fourty eight polycystic ovary patients were included at Samsung Cheil Hospital from April to October 2002. These patients were grouped according to obeseness. HOMA index was used to evaluate insulin resistance calculated by using fasting blood sugar and serum insulin level. RESULTS: Twenty patients (41%) were classified as obese group, twenty eight patients (59%) had normal body mass index. Increased insulin resistance was observed in the patients with polycystic ovarian syndrome. And it was significantly higher in the obese patients compared to the patients with normal body mass index (6.8+/-2.8 vs. 2.7+/-0.9, t-test, p<0.01). CONCLUSION: For increased insulin resistance, immediate management would be needed in the patients of polycystic ovarian syndrome, especially combined with obesity.

Midtrimester pregnancy termination with prostaglandin E1 Misoprostol compared with physician-chosen combination method; A prospective randomized trial / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to determine the effectiveness and safety of misoprostol in termination of pregnancy. MATERIALS & METHODS: 38 women who presented with indication for termination of pregnancy were assigned randomly to receive either 200 microgram of misoprostol orally every 4 hours as needed, or medication according to the our established protocol (physician-chosen combinations of Sulprostone infusion every 6 hours with vaginal PGE2 or Laminaria). Exclusion criteria were history of asthma, glaucoma, cardiac or hepatic disease, or chorioamnionitis. Unless delivery had occurred or was imminent after 24 hours with medication, the case was considered to have failed. The induction to delivery time and influencing factors were analyzed in both group using t-test, chi-square test or Fisher`s exact test, Kaplan-Meier and Cox regression. RESULTS: The success rate of termination of pregnancy within 12 hours and 24 hours were 67% and 93% with misoprostol (n=15) versus 5% and 43% with physician-chosen combination (n=21) (p<0.05). Among 3 cases failed with misoprostol within 24 hours, two cases crossed to the alternative method after 24 hours of misoprostol, so, the 2 cases were excluded. The mean dosage and frequency of misoprostol was 540 microgram and 2.8 times. The mean induction to delivery time ( mean +/- standard deviation) with oral misoprostol (n=15) was 640+/-590 minutes versus 1670+/-750 minutes with physician-chosen combination (n=21) (p<0.001). Reanalyzed in selected cases of Bishop score

The role of human leukocyte antigen (HLA)-G gene in chorionic villi during the early stage of pregnancy / 대한산부인과학회잡지

OBJECTIVE: Habitual abortion(HA) is postulated to be due to several factors including immunogenetic mechanisms. Many studies have been conducted on the effect of the major histocompatibility(MHC) region in the reproductive phenomena suggesting an immunological or genetic involvement in HA. HLA-G is a nonclassical class I MHC molecule, with evidence of protecting cells against natural killer cell lysis and not stimulating an allogeneic response by peripheral blood T cells. These features suggest that expression of HLA-G could be a crucial factor for fetal survival in the face of a potentially hostile maternal immune system. The goal of this study was to investigate the immunogenetic role of HLA-G gene in the early pregnancy loss. This is the first report in Korea about the HLA-G gene in the patients of habitual abortion. METHODS: Twenty-one chorionic villi (study group) in the women with habitual abortion (at least 3 spontaneous abortion) and 10 normal chorionic villi (control group) in the women with therapeutic abortion were included in this study. The expression of HLA-G gene in placental extravillous cytotrophoblasts were made by reverse transcription-polymerase chain reaction(RT-PCR) and chromosomal analysis was done by ordinary GTG-banding method. Chi-square and Fisher's exact tests were used for the statistical analysis. RESULT: As a result, HLA-G mRNA was expressed in 52.4%(11/21) of study group, in 70%(7/10) of control group and there was no statistical significance. In study group, positive rate of HLA-G mRNA was 57.1%(4/7) in the patients with normal chromosome, and 50.0%(7/14) in the patients with abnormal chromosome and there was no statistical significance. CONCLUSION: Thus, these results suggest that HLA-G gene might not be a immunogentic marker of early pregnancy loss. But further large scale of study would be needed to reveal the role of HLA-G in habitual abortion.

Fetal outcome following transabdominal amnioinfusion in various causes of oligohydramnios / 대한산부인과학회잡지

OBJECTIVE: To evaluate the efficiency and fetal outcome following antepartum transabdominal amnioinfusion in various causes of oligohydramnios. MATERIALS AND METHODS: Forty four transabdominal amnioinfusion were performed in twenty seven cases of singleton pregnancy with severe oligohydramnios. Severe oligohyadrmnios defined as amnionic fliud index of 5cm or less than. In all cases, high resolution sonographies were done before and after amnioinfusion in order to detect fetal anomalies. Transabdominal amnioinfusion was performed through a closed system with warmed normal saline. RESULTS: Infusion (mean volume 435.9ml) of normal saline significantly increased the amniotic fluid index from 3.2cm to 7.5cm. The causes of oligohydramnios were as follows, premature rupture of membranes was 8 cases (29.6%), intrauterine growth restriction was 10 cases (37.0%), congenital anomaly was 4 cases (14.8%) and idiopathic was 5 cases (18.5%). The gestational weeks were prolonged significantly from 26.8 weeks to 29.5 weeks. The overall survival rate except congenital anomalies was 67%. Babies with idiopathic oligohydramnios were heavier and required less hospitalization dates than those of badies with oligohydramnios of other causes, but it was not statistically significant. There were several complications as follows, chorioamnionitis 2 cases, neonatal sepsis 2 cases, meconium aspiration syndrome 2 cases and fetal bradycardia 1 case. All of the babies discharged healthy without sequele. CONCLUSION: These results show that antepartum transabdominal amnioinfusion is a relatively safe procedure. And it can significantly increase the amnionic fluid index and prolong the gestational age which is optimal for neonatal survival in oligohydramnios of idiopathic cause or with intrauterine growth restriction.

A Cytogenetic Survey of 1788 Genetic Amniocenteses / 대한산부인과학회잡지

No abstract available.

Prediction of preterm delivery by measurement of cervical length / 대한산부인과학회잡지

No abstract available.

A Clinical Analysis of Unruptured Ectopic Pregnancies with the Treatment of Intramuscular Methotrexate Injiction / 대한주산의학회잡지

The incidence of ectopic pregnancy is a marked increase in both the absolute number and rate in recent years. But dramatic decrease in death from ectopic pregnancies probably due to improved diagnosis and management. The aim of the study was to investigate the effect of intramuscular Methotrexate(MTX) injection on the treatment of ectopic pregnancy. The method of the study was made by the retrospective clinical observations on the 32 cases of unruptured ectopic pregnancies in Chung Goo Sung Sim hospital, department of Obstetrics & Gynecology. The results were as follows: 1) The most frequent age group was 25-29 year group(37.5%). 2) Nullipara was 31.3% and the case who experienced artificial abortion was 75%. 3) A previous history of abdominal or pelvic surgery was in 40.6% and pelvic inflammatory in 6.3%. 4) The mean ectopic gestational week was 6.4 weeks, 5) On symptomatological analysis, lower abdominal pain was encounted 53.1%, vaginal spotting was 40.6%. 6) The resolution of patients was obtained in 29 cases(90.6%)of 32 unruptured tubal pregnancies with intramuscular methotrexate treatment. 7) The mean resolution duration was 23.8 days. 8) The side effects of methotrexate were observed in 10 cases(31.2%)of 32 unruptured tubal pregnancies, but the severity of symptoms was mild. Consequently, tveatment by intramuscular injection of MTX expects to be one of the therapies alternating to surgery. However success rate remained 90.6% with and toxicity rate 31.2% with MTX injection. Therefore patients selection criteria and MTX dosage adjustment are more stricdy required for rising success rate and avoidance of toxic complication.

Computerized Quantitative Analysis of Fetal Heart Rate after Acoustic Stimulation in Preterm Pregnancies / 대한주산의학회잡지

Acoustic stimulation test(AST), is currently being used as an alternative tool of nonstress test (NST). However, there are no standard guideline for analysis of AST. Computerized numerical analysis of AST would be helpful for development of diagnostic criteria of AST. Fifty-one normal pre-term pregnancies entered to this study after conventional 20-minutes NST and 10-minutes AST. Acoustic stimulations were performed using Fetal Acoustic Stimulator (Model 146, Corometrics, US). We analyzed the FHR response after acoustic stimulation using our on-line computerized FHR analysis system, HYFM-I & II software. The changes of loss of signal, baseline FHR, variability, number of fetal movements, and number of FHR accelerations were analyzed numerically. The loss of signal was increased about 2 fold(122.61%). The baseline FHR was increased from 144.57bpm to 156.81bpm(8.5%) after acoustic stimulation. Number of fetal movements was increased about 2 fold(from 2.1 to 4.12/10 minutes). FHR variability was also increased from 17.81 bpm to 26.37 bpm. After AST, number of FHR accelaration was increased 55.47%(10sec 10bpm) and 68.42%(15sec 15bpm), respectively. In this study, we acrumulated elemental FHR data using computerized system after AST. These data would be helpful in the accurate analysis of AST and also enable us to develop the objective interpretation system for AST.

A Study of Frequency, Indications and Complications on Peripartum Hysterectomy / 대한주산의학회잡지

By means of hospital-based data over 8 years we sought to evaluate the clinical indications and incidence of emergency peripartum hysterectomy by demographic characteristic and reproduction history. From the obstetric record of all deliveries at Chung Goo Hospital between Jan. 1, 1990, and Nov. 31, 1997, we identified all women undergoing emergency cesarean hysterectomy, calculated incidence rates, conducted statistical tests of linear trends and heterogenety, and observed the clinical indicatons preceding the onset of this procedure. There were 16731 deliveries during this period, Cesarean hysterectomy was performed in 24 of 5993 cesarean sections(0.40%) and in 10 of 10738 vaginal deleveries(0.09%), so more frequently after cesarean section than vaginal delivery. The age of patients varied from 22 to 40 years old. The higher the age and the parity of patients, the higher incidence of cesarean hysterectomy was noted. The most common indication of cesarean hysterectomy was uterine atony(52.94%) followed by placental disorders(41.18%), uterine myoma with pregnancy(2.9%) and uterine rupture (2.9%). All patients who had hysterectomy received transfusion from 1 pint to 57 pints. The postoperative complications were bladder injury, febrile morbidity, disseminated intravascular coaguolopathy and wound disruption. There were three maternal deaths, the cause was disseminated intravascular coaguolopathy and amniotic embolism. The data identifiy uterine atony as the primary cause for gravid hysterctomy. The data also illustrated how the incidence of emergency peripartum hysterectomy increases significantly with increasing parity, especially when influenced by a current placenta previa or a prior cesarean section. Maternal morbidity remained high.