A Study on the Perinatal Outcomes of Natural Childbirth Led by Midwives: A Retrospective Study

Purpose@#The purpose of this study was to suggest the importance of natural childbirth by investigating the results of midwife-led perinatal periods and whether they were positive experiences for both individual women and their families. @*Methods@#This retrospective study aimed to confirm the perinatal outcomes of midwife-attended vaginal births. Among 1,127 women who gave midwife-led birth in Gyeonggi-do, Seoul between January 1, 2019 and December 31, 2021, data were collected for 829 women. Records were excluded that were missing necessary data. Data on childbirth were analyzed using frequency, percentage, mean, standard deviation, and the chi-square test. @*Results@#Among the mothers who underwent natural childbirth, 549 (66.2%) were multiparous. In addition, all 829 patients (100%) breast-fed their infants. First-degree perineal lacerations occurred in 29.2% of patients, and second-degree lacerations occurred in 48%. Non–high-risk subjects made up 56.0% of the study sample. The average bleeding amount was 281.44±4.50, and the average 1-minute Apgar score for infants was 8.25±0.02. @*Conclusion@#Compared to childbirth in a hospital, natural childbirth was associated with a lower risk of birth canal laceration, postpartum bleeding, and Cesarean section. In addition, the health statuses of the newborns were confirmed to be good . Based on the results of this study, there is a need for a strategy in which midwife-led natural childbirth is integrated into the local medical system, as well as a need to raise women's awareness of natural childbirth and positively influence the experience.

Association between hair mineral and age, BMI and nutrient intakes among Korean female adults

This study was performed to investigate the association between hair mineral levels and nutrient intakes, age, and BMI in female adults who visited a woman's clinic located in Seoul. Dietary intakes were assessed by food frequency questionnaire and mineral levels were measured in collected hairs, and the relationship between these was examined. The average daily nutrient intakes of subjects were compared to those of the KDRIs, and the energy intake status was fair. The average intake of calcium in women of 50 years and over was 91.35% of KDRIs and the potassium intake was greatly below the recommended levels in all age groups. In the average hair mineral contents in subjects, calcium and copper exceeded far more than the reference range while selenium was very low with 85.19% of subjects being lower than the reference value. In addition, the concentrations of sodium, potassium, iron, and manganese in the hair were below the reference ranges in over 15% of subjects. The concentrations of sodium, chromium, sulfur, and cadmium in the hair showed positive correlations (P < 0.05) with age, but the hair zinc level showed a negative correlation (P < 0.05) with age. The concentrations of sodium, potassium, chromium, and cadmium in the hair showed positive correlations (P < 0.05) with BMI. Some mineral levels in subjects of this study showed significant correlations with nutrient intakes, but it seems that the hair mineral content is not directly influenced by each mineral intake. As described above, some hair mineral levels in female adults deviated from the normal range, and it is considered that nutritional intervention to control the imbalance of mineral nutrition is required. Also, as some correlations were shown between hair mineral levels and age, BMI, and nutrient intakes, the possibility of utilizing hair mineral analysis for specific purposes in the future is suggested.

Antioxidant Vitamins and Lipid Peroxidation in Patients with Cervical Intraepithelial Neoplasia

The purpose of this study was to investigate the implications of dietary intake and the level of plasma antioxidant, lipid peroxidation, and antioxidant capacity in Korean women with cervical intraepithelial neoplasia (CIN). From October 2002 to March 2003, 58 patients diagnosed with CIN (confirmed with colposcopy directed biopsy) and 86 patients without any cervical disease as control group were enrolled in the study at the Department of Gynecology cancer center at Samsung Cheil Hospital. The intake of antioxidant vitamins in both groups exceeded the amount recommended by the Korea RDA, 7th edition. The plasma concentration of Vitamin C was significantly lower in the CIN group (0.36 mg/dL) than in the control group (0.48 mg/dL) (p<0.05). The two groups showed similar plasma concentrations of beta-carotene, alpha-tocopherol, and retinol. The average concentration of malondialdehydes in the CIN group, 7.23 mmol/mL, was significantly higher than in the control group, 5.18 mmol/mL (p<0.01). The total radical trapping antioxidant potential concentration of plasma was significantly higher in the CIN group (1.15 mM) than in the control group (1.25 mM) (p<0.05). These results suggest that there is a possible correlation between cervical intraepithelial neoplastic processes and changes in the plasma antioxidative system.

Radical Radiotherapy for Locally Advanced Cancer of Uterine Cervix / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was performed to evaluate the treatment results, prognostic factors and complication rates in patients with locally advanced cancer of uterine cervix after radiotherapy with high-dose rate (HDR) brachytherapy. MATERIALS AND METHODS: One hundred and twenty patients with a locally advanced (stages IIB~IVA according to FIGO classification) carcinoma of the uterine cervix were treated with radiotherapy at the Department of Radiation Oncology, Samsung Medical Center between September 1994 and December 2001. The median age of the patients was 61 years (range 29 to 81). Sixty-one, 56 and 3 patients had FIGO stage IIB, III, and IV diseases, respectively. All patients were given external beam radiotherapy over the whole pelvis (median 50.4 Gy) and HDR intracavitary brachytherapy, with a median of 4 Gy per fraction, to point A. Twenty-one patients received chemotherapy, of which 13 and 21 received neoadjuvant chemotherapy and concurrent chemotherapy, respectively, during the first and fourth weeks of external beam radiotherapy. The chemotherapy was not randomly assigned and the median follow-up time was 28.5 months (range: 6~100 months). RESULTS: The three- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 64.4 and 57.0%, and 63.7 and 60.2%, respectively. The 5-year OS and DFS rates of the patients at stages IIB, III and IV were 602, 57.9 and 33.3%, and 57.4, 65.4 and 33.3%, respectively. Univariate analysis indicated that the FIGO stage, overall treatment time (OTT) and treatment response were significant variables for the OS (p=0.035, p=0.0649 and p=0.0009) and of the DFS (p=0.0009, p=0.0359 and p=0.0363). Multivariate analysis showed that the treatment response was the only significant variable for the OS (p=0.0018) and OTT for the DFS (p=0.0360). The overall incidence of late complications in the rectum and bladder were 11.7 and 6.7%, respectively. In addition, insufficiency fractures were observed in 7 patients (5.8%). CONCLUSION: The results of this study suggest that radical radiotherapy with HDR brachytherapy was appropriate for the treatment of locally advanced uterine cervix cancer. Also, the response after treatment and OTT are significant prognostic factors.

Clinical Outcomes of Patients treated for Cervical Pregnancy with or without Methotrexate

The objective of this study is to describe the clinical outcomes of patients treated for cervical pregnancy with or without methotrexate (MTX) and to evaluate the effects of MTX in the treatment of cervical pregnancy. Between January 1993 and February 2000, 31 patients were diagnosed with cervical pregnancy. Twenty-two patients were treated with MTX chemotherapy and nine patients were treated with surgical procedures without MTX treatment. In the non-MTX treatment group, three patients underwent total abdominal hysterectomy, five required adjuvant procedures to control the bleeding during dilatation and curettage (D&C) and only one patient was treated with a simple D&C. In the MTX treatment group, fourteen (63.6%) patients were treated with only MTX and eight (36.4%) cases underwent concomitant procedures (simple curettage, curettage and Foley catheter tamponade, cer-vical cerclage, ligation of the descending branches of uterine arteries, or ligation of hypogastric arteries). The uterus was preserved in all cases and three women delivered healthy babies in their subsequent pregnancy. In conclusion, early diagnosis, appropriate MTX regimen in combination of necessary adjuvant conservative procedures could contribute to successful treatment with preservation of the uterus and future reproductive ability.

Antioxidant Vitamins Intake and Antioxidant System in Exfoliated Cervicovaginal Cells of the Patient with Cervical Intraepithelial Neoplasia / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to investigate the dietary intake of antioxidant vitamins, the level of antioxidant vitamins (retinol, beta-carotene, alpha-tocopherol), lipid peroxidation, and the capacity of antioxidants in exfoliated cervicovaginal cells by lavage technique in normal women and patients with cervical intraepithelial neoplasia (CIN) in Korea. METHODS: The study included 56 patients with histopathologically diagnosed CIN and 63 healthy women as control in the Department of Gynecology Cancer Center in Samsung Cheil Hospital and Women's Healthcare Center between December 2002 and March 2003. Data on dietary intake were collected with semiquantitative frequency questionnaire method. Retinol, beta-carotene and alpha-tocopherol were assayed with high pressure liquid chromatography (HPLC). The levels of lipid peroxidation (MDA) and antioxidant capacity (TRAP) were determined by fluorometric method and inhibition assay method. RESULTS: The intake of antioxidant vitamins in both groups exceeds the amount recommended by the Korea dietary recommendation 7th ed, which was relatively good. Cervicovaginal cells beta-carotene levels were found to be significantly decreased (p<0.001), and alpha-tocopherol, and retinol levels were significantly increased in patients with CIN as compare with controls (p<0.05). The average concentration of cervicovaginal cellular malondialdehydes (MDA) in the patients was significantly higher (p<0.001) than the control group and total radical trapping antioxidant potential (TRAP) concentration was significantly lower than the control group (p<0.001). CONCLUSION: This study demonstrates that the levels of in situ beta-carotene, alpha-tocopherol, retinol, malondialdehydes, and total radical trapping antioxidant potential concentration were measurable in samples of exfoliated epithelial cells obtained by cervicovaginal lavage technique. These findings support to hypothesis that changes of cervicovaginal cellular antioxidants vitamins lipid peroxidation may have an etiologic role in the pathogenesis of cervical intraepithelial neoplasia.

Clinico-pathologic Profiles and 5-year Survival Rate of 2209 Patients with Invasive Cancer of the Uterine Cervix / 대한산부인과학회잡지

OBJECTIVE: This study was performed to investigate the clinico-pathologic characteristics and to analyze the 5-year survival rate and prognostic factors for invasive cancer of the uterine cervix. METHODS: From May 1982 to October 2000, 2209 patients with invasive cancer of the uterine cervix were diagnosed and treated at Samsung Cheil Hospital. In this retrospective study, we studied the clinico- pathologic characteristics (age, resident area, delivery type, FIGO stage, histologic type, nodal metastasis, lymph-vascular space invasion, endometrial extension), treatment modalities and 5-year survival rate. RESULTS: The mean age was 50.3 years (24-85) and the median age was 50.0 years old. The most common subsets of patients were found in the group of FIGO stage I b (41.9%) and age between 41 and 50 (30.0%). Surgery was the main treatment in stage I a, I b, II a and radiation in stage II b or more. Pelvic and para-aortic nodal metastasis were surgically identified in 1.9% and 0% of stage I a, 18.1% and 4.4% of stage I b, 22.6% and 5.7% of stage II a, 51.4% and 17.1% of stage II b, 14.3% and 0% of stage III/IV. Overall 5-year survival rate was 85.7%; stage I a (93.9%), I b (91.5%), II a (80.7%), II b (68.5%), III/IV (53.7%). The 5-year survival rate according to pelvic lymph node status in surgically confirmed patients were 95.4% in negative patients and 78.1% in positive patients respectively (P=0.0000). 5-year survival rate was significantly different according to age (P=0.0000), FIGO stage (P=0.0000), lymph-vascular space invasion (P=0.0001), endometrial extension (P=0.0199), pelvic (P=0.0000) and para-aortic nodal metastasis (P=0.0000). However, resident area, delivery type, histologic type did not show any significant differences in survival. CONCLUSION: Overall 5-year survival rate of 2209 patients with invasive cancer of the cervix who were diagnosed at Samsung Cheil Hospital from May 1982 to October 2000 was 85.7%. Five-year survival rate was different according to age, FIGO stage, lymph-vascular space invasion, endometrial extension, pelvic and para-aortic nodal metastasis.

Primary Invasive Carcinoma of the Vulva: A Clinical Review / 대한산부인과학회잡지

OBJECTIVE AND METHOD: Vulvar cancer is known to be a relatively rare malignancy among female population. Because of rare incidences and poor interests in malignancy of female genital tract, no sufficient clinical study has been accomplished and therefore clinical significance underestimated. However, a recent increase of vulvar cancer rate receives more attention because of the rapid growth in senile female population, such lesion becomes more accessible and thus early detection and treatment are highly required. In this report, we have investigated a retrospective clinical study on 13 patients diagnosed as primary invasive vulvar carcinoma at Samsung Cheil Hospital from 1988 to 2000. RESULTS: The mean age was 54.0 years (40-68). The most common symptom was found to be a palpable mass (92.3%). The lesion was observed mostly in labia minora (38.5%), followed by labia majora (30.8%) and clitoris (15.4%). Of 61.5% of the patients, a left-sided tendency in the occurrence of the lesion was noticeable. Among the patients who underwent surgery, stage II (55.5%) and histopathologically squamous cell carcinoma (69.2%) was dominant. Surgical complications were noted at 55.5% but no death was reported. There were 3 cases with invasion of the margin and 2 cases with radiotherapy and 1 case with chemotherapy. Mean follow-up was 56.9 (18-160) months and no deaths were reported during the follow-up. Recurrence was observed in only one case after 20 months of surgical operation. CONCLUSIONS : To decrease morbidity without compromising survival, a more conservative surgery should be considered for the management of selected patients with primary invasive vulvar cancer.

Preoperative Pap Smears in Endometrial Carcinoma: The Clinicopathologic Relevance / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the correlation between preoperative Pap smears and known poor prognostic factors in patients with endometrial carcinoma. METHODS: Between January 1989 and June 2000, preoperative evaluation of Pap smears were done in 163 patients with endometrial carcinoma who underwent total abdominal hysterectomy with bilateral salpingo- oophorectomy, peritoneal cytology, and pelvic and/or para-aortic lymphadenectomy. All Pap smears and histologic sections were reviewed. Pathologic parameters of hysterectomy specimens were evaluated and correlated with the findings of Pap smears. Chi-square test was used for statistical analysis. p-values<0.05 were considered significant. RESULTS: The mean age of patients was 49 years with range between 24 and 75 years old. 72 patients (44.2%) had normal, 38 patients (23.3%) had atypical glandular cells of undetermined significance (AGUS), and 53 (32.5%) had adenocarcinoma on preoperative Pap smears. Statistically significant associations were found between Pap smears and age (p=.014), histologic grade (p=.000), cervical involvement (p=.015), depth of myometrial invasion (p=.000), lymph-vascular space invasion (p=.000), and surgical stage (p=.049). Patients with malignant cytology were more likely to have older age, poorly differentiated malignancies, deeper myometrial invasion, cervical metastases, lymphvascular invasion and higher surgical stage. However, histologic subtypes (p=.328), peritoneal cytology (p=.067), adnexal involvement (p=.602) and pelvic and/or para-aortic lymph node metastases (p=.266 and p=.220) were not statistically significant. CONCLUSION: This study revealed that preoperative abnormal Pap smears in patients with endometrial carcinoma were significantly associated with age, histologic grade, cervical involvement, depth of myometrial invasion, lymphvascular space invasion and surgical stage. Therefore, Pap smears could be an important part of the preoperative evaluation in patients with endometrial carcinoma.

Diastasis of the Symphysis Pubis After Cesarean Section / 대한산부인과학회잡지

No abstract available.

Clinical Evaluation of Women with Low Grade Squamous Intraepithelial Lesion on Pap Smears / 대한부인종양콜포스코피학회잡지

The purpose of this study was for clinical evaluating those women with low grade squamous intraepithelial lesions (LSIL) who have been detected on Pap smears. We analyzed 279,270 Pap smears, from January 1994 to August 1997, of which 703 cases were identified as LSIL, and their medical records were reviewed retrospectively. Among them, 616 cases were able to follow-up by altered methods (repeated Pap smear only vs. histologic examination) and their efficacy for detecting more significant lesion (high grade squamous intraepithelial lesion: HSIL or invasive cancer) were also compared. The results were as follows; 1. The frequency of LSIL on Pap smears was approximately 0.25%. 2. The mean age was 39 years (range 18 ~70 years). 3. Most of the gross finding of the cervix were normal or mild erosion. 4. Most of symptom was asymptomatic, or nonspecific. 5. Eighty-seven women with LSIL on initial Pap smears, have performed repeated Pap smears. 74 (85.1%) was normal, 7 (8.0%) was ASCUS, 6 (6.9%) was LSIL. Remained 529 women had subsequently histologic examination such as colposcopic directed biopsy or cone knife biopsy. These histologic results showed 192 (36.3%) with normal, 258 (48.8%) with LSIL, 77 (14.6%) with HSIL, 2 (0.4%) with microinvasive carcinoma. Based on the results in this study, we emphasize the importance of regular screening procedures for early detection of cervical lesions because there was no specific clinical characteristics in women with cytologic diagnosis of LSIL. In addition, we recommened colpo-scopic directed biopsy or cone knife biopsy as follow-up evaluation method in women with LSIL on initial Pap smear for detecting more significant cervical lesion.

Clinical Evaluation of Women with Low Grade Squamous Intraepithelial Lesion on Pap Smears / 대한부인종양콜포스코피학회잡지

The purpose of this study was for clinical evaluating those women with low grade squamous intraepithelial lesions (LSIL) who have been detected on Pap smears. We analyzed 279,270 Pap smears, from January 1994 to August 1997, of which 703 cases were identified as LSIL, and their medical records were reviewed retrospectively. Among them, 616 cases were able to follow-up by altered methods (repeated Pap smear only vs. histologic examination) and their efficacy for detecting more significant lesion (high grade squamous intraepithelial lesion: HSIL or invasive cancer) were also compared. The results were as follows; 1. The frequency of LSIL on Pap smears was approximately 0.25%. 2. The mean age was 39 years (range 18 ~70 years). 3. Most of the gross finding of the cervix were normal or mild erosion. 4. Most of symptom was asymptomatic, or nonspecific. 5. Eighty-seven women with LSIL on initial Pap smears, have performed repeated Pap smears. 74 (85.1%) was normal, 7 (8.0%) was ASCUS, 6 (6.9%) was LSIL. Remained 529 women had subsequently histologic examination such as colposcopic directed biopsy or cone knife biopsy. These histologic results showed 192 (36.3%) with normal, 258 (48.8%) with LSIL, 77 (14.6%) with HSIL, 2 (0.4%) with microinvasive carcinoma. Based on the results in this study, we emphasize the importance of regular screening procedures for early detection of cervical lesions because there was no specific clinical characteristics in women with cytologic diagnosis of LSIL. In addition, we recommened colpo-scopic directed biopsy or cone knife biopsy as follow-up evaluation method in women with LSIL on initial Pap smear for detecting more significant cervical lesion.

Clinical Evaluation of Follow-Up Methods and Results of Atypical Glandular Cells of Undetermined Significance (AGUS) on Cervicovaginal Pap Smears / 대한부인종양콜포스코피학회잡지

OBJECTIVE: To evaluate the efficacy of the follow up methods and results of AGUS detected on cervicovaginal Pap smears. METHODS: From May 1991 to December 1996, we have performed 407,451 cervicovaginal Pap smears, of which 326 patients were identified as AGUS. Out of them, 268 patients were followed by repeated Pap smears, colposcopy, cone biopsy or endometrial curettage. RESULTS: The incidence of AGUS on Pap smears is approximately 0.08%. The mean patient age was 43 years (range 22~79 years). The most common complaint was abnormal vaginal bleeding. The gross findings of the cervix were normal or mild erosion. The past histories of patients that could effect the AGUS results on Pap smears were as follows: 30 had cone biopsy, 21 had Pap smear on pregnancy or within 8 weeks after delivery, 3 had hormone replacement therapy, 2 had intrauterine device for contraception, and 5 were in the process of a follow up after a treatment of cervical cancer. The benign lesions detected during follow up periods were 6 microglandular hyperplasia of the cervix, 5 atypical squamous metaplasia of the cervix, 2 cervical endometriosis, 2 tubal metaplasia, 10 cervical myoma, 11 cervical polyp, 9 endometrial polyp, 3 uterine myoma, 1 pelvic endometriosis, 1 ovarian endometriosis, and 4 uterine adenomyosis. The premalignant or malignant lesions of the cervix were 4 low grade squamous intraepithelial lesion, 24 high grade squamous intraepithelial lesion, 8 glandular atypia/dysplasia, 5 adenocarcinoma in situ, 3 microinvasive denocarcinoma, and 4 invasive adenocarcinoma. The neoplastic lesions of the uterus were 6 endometrial hyperplasia, 11 endometrial adenocarcinoma, 1 malignant mixed M?lerian tumor, and 1 metastatic endometrial adenocarcinoma. Sixty seven (25%) among 268 patients followed up were identified to have clinically significant lesions of the cervix or uterus. The detection rates of abnormal lesions were 3.1% with repeated Pap smears (3/98), 28.4% with colposcopy-directed biopsy (31/109), 63.6% with cone biopsy (35/55), and 29.7% with endometrial curettage (19/64). CONCLUSION: AGUS on Pap smears showed various benign and malignant lesions of the cervix or uterus. The clinicians must communicate with the pathologists regarding the clinical informations of the patient as well as the origin of atypical glandular cells in Pap smears. We recommend that the patients with AGUS on Pap smear should undergo immediate intensive diagnostic studies, including colposcopy with endocervical curettage or cone biopsy in order to detect the lesion of the cervix and endometrial curettage in order to detect the endometrial lesions.

Clinical study on lymphocyte immunization in recurrent abortion / 대한산부인과학회잡지

No abstract available.