The perinatal outcomes of pregnant women with cardiac disease / 대한산부인과학회지

OBJECTIVES: The aims of the study show the effect of cardiac disease of pregnant women on the perinatal complications and pregnancy outcomes. METHODS: From Jan. 2001 to Nov. 2005, 29 cases of pregnant women with cardiac disease were enrolled and classified by the NYHA (New York Heart Association) classes under the supervision of cardiologist and cardiothoracic surgeon. The average age of all cases is 29.9 years olds and it consists of 13 primigravida and 16 multigravida. For the examination of cardiac function during the pregnancy, the echocardiography was performed. We evaluated the cardiac disease of pregnant woman with the underlying causes, clinical manifestations during the pregnancy, delivery mode, gestational age at birth, birth weight, Apgar score and perinatal complication. RESULTS: All 29 cases with cardiac diseases are composed of 21 cases of NYHA class I (72.7%), 4 case of NYHA class II (13.7%) and 4 cases of NYHA class III (13.7%). There are 11 cases with congenital heart disease (37.9%), 6 cases with acquired heart disease (20.6%), 9 cases with arrhythmia (31.0%), and 3 cases with other cardiac disease (10.3%). Before the pregnancy, 6 cases of 11 cases with congenital heart disease and 5 cases of 6 cases with acquired heart disease performed the corrected cardiac surgery. Echocardiography was performed on 24 cases. It showed average ejection fraction in left ventricle of NYHA class I (13 cases) and NYHA class II, III (8 cases) were 61.5% and 52.6%, respectively. 7 cases of NYHA class I and 1 case of class II was done on the vaginal delivery. 14 cases of class I pregnant woman were performed the cesarean section according to obstetric indications but 3 cases of class II were performed the cesarean section for the prevention of cardiac risks. 4 cases of class III were performed the cesarean section according to obstetrics indications (2 cases) and for the prevention of cardiac risks (2 cases). For gestational age at birth, the average of NYHA class I was 38.1 weeks and the average of NYHA class II, III was 35.4 weeks. The average birth weight showed 3,022 gm in class I and 2,446 gm in class II and class III. Preterm birth were 3 cases (class II; 1 case, class III ; 2 cases). Low birth weight infant were 5 cases (class I; 3 cases, class II 2 cases). Intrauterine fetal death was a case (class I). Congenital abnormalities at birth were not observed in our study. Although no maternal mortality was observed, 2 cases of pulmonary edema caused by cardiomyopathy in NYHA class III and 1 case of Eisenmenger Syndrome caused by PDA in NYHA class II were developed during the labor. CONCLUSION: In this study, the majority of pregnant women with cardiac disease had the congenital heart diseases. It also showed that they can expect good perinatal outcomes by the adequate prenatal care including cardiac surgery before the pregnancy.

Prognostic factors of cervical cancer stage IB2 treated surgically / 대한산부인과학회지

OBJECTIVE: This study was performed to identify pathologic and clinical risk factors that predicted survival in cervical cancer stage IB2 patients treated surgically. METHODS: The records of 52 patients with cervical cancer IB2 who underwent radical hysterectomy with pelvic lymph node dissection from 1997 to 2003 were reviewed retrospectively. Clinical and pathologic variables included age, tumor size (TS), histologic type, involvement of resection margin, parametrium invasion, lymph node metastasis (LN), lymph-vascular space invasion, depth of invasion, treatment modality and adjuvant radiation therapy (RTx). Survival analyses were performed by the Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by Cox's proportional hazards model. RESULTS: In the present study, median follow up was 46.5 months. With regard to the 2-year disease free survival rate and the 5-year survival rate, univariate analysis revealed no significant differences in subgroups according to age, histologic type, resection margin, parametrium, lymph-vascular space invasion, depth of invasion and treatment modality. Tumor size (p=0.0024), lymph node metastasis (p=0.0007) and radiation therapy (p=0.0398) significantly affected the 2-year disease free survival rate in univariate analysis. They (TS: p=0.0001, LN: p=0.0023, RTx: p=0.0428) also significantly affected 5-year survival rate in univariate analysis. Tumor size (RR 35.87, CI 2.94-438.26, p=0.01) and lymph node metastasis (RR 16.6, CI 1.36-202.05, p=0.03) affected 5-year survival rate in multivariate analysis. CONCLUSION: In patients with cervical cancer stage IB2 who underwent operation regardless adjuvant radiation therapy, the important independent prognostic factors were tumor size and LN metastasis.

The analysis of prognostic factors in endometrial cancer managed with surgical staging / 부인종양

OBJECTIVE: To determine pathologic variables associated with overall survival and disease free survival of patients with endometrial cancer. METHODS: Survival of 81 endometrial cancer patients treated with primary surgery between January 1997 and December 2003 at our center was compared about various histopathologic variables. All patients underwent complete surgical staging including pelvic +/- paraaortic lymph node dissection. Survival analyses were performed by the Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by Cox's proportional hazards model using likelihood-ratio statistics based on the conditional parameter estimate (Conditional). RESULTS: With regard to disease free survival, univariate analysis revealed no significant differences in subgroups according to age category, grade and adjuvant radiotherapy. However, significant differences in disease free survival were found between stage I+II and stage III, and between endometrioid type and the others type. Among these significant subgroups, the Cox-proportional hazards model showed that stage was the only independent prognostic factor. There were no significant differences in the overall survival of patients in subgroups according to age category and adjuvant radiotherapy. But, significant differences in overall survival were found in subgroups according to stage, histology and grade. Multivariate analysis revealed that stage was the only independent significant adverse prognostic effect. CONCLUSION: Our results showed that only stage was an independent prognostic factor of disease free survival and overall survival in endometrial cancer patients.