Prediction Model for Massive Transfusion in Placenta Previa during Cesarean Section

0.05). The area under the receiver operating characteristics curve (AUC) was 0.922 [95% confidence interval (CI) 0.89–0.95]. In external validation, the discrimination was good, with an AUC value of 0.833 (95% CI 0.70–0.92) for this model. Nomogram calibration plots indicated good agreement between the predicted and observed outcomes, exhibiting close approximation between the predicted and observed probability.CONCLUSION: We constructed a scoring model for predicting massive transfusion during cesarean section in women with placenta previa. This model may help in determining the need to prepare an appropriate amount of blood products and the optimal timing of blood transfusion.

Scheduled injection of ramosetron for prevention of nausea and vomiting following single-port access total laparoscopic hysterectomy: a prospective randomized study

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of scheduled ramosetron injections for controlling postoperative nausea and vomiting (PONV) after single-port access total laparoscopic hysterectomy (SPA-TLH). METHODS: Ninety patients who underwent SPA-TLH at the Korean National Health Insurance Service Ilsan Hospital between June 2013 and July 2014 were enrolled in this prospective, randomized, double-blinded, placebo-controlled study. The patients were divided into 2 groups as follows: the ramosetron group (0.3 mg intravenously [IV]; n=45) and the placebo group (normal saline IV; n=45). Both groups received their respective injections 12 and 24 hours post surgery. The incidence and severity of PONV (numerical rating scale, 0–10), and the use of rescue antiemetics post surgery were evaluated. RESULTS: Demographic and perioperative statistically significant differences were not observed between the 2 groups. The incidence of PONV in the ramosetron and placebo groups was 46.7% and 51.1%, respectively (P=0.51). We found significant differences in the severity of PONV between the 24- to 48-hour postoperative periods in both groups (ramosetron group, P=0.04 and placebo group, P=0.03). The use of rescue antiemetics was significantly lower in the ramosetron group than in the placebo group (P=0.02). CONCLUSION: After general anesthesia, scheduled injections of ramosetron 12 and 24 hours after SPA-TLH reduced the severity of PONV and the use of rescue antiemetics. Administration of ramosetron can be considered not only immediately after SPA-TLH but also during the first 24-hour recovery period. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT 02011659

Comparison of the clinical outcome of frozen-thawed embryo transfer with and without pretreatment with a gonadotropin-releasing hormone agonist

OBJECTIVE: To describe the clinical outcomes of frozen-thawed embryo transfer (FET) with artificial preparation of the endometrium, using a combination of estrogen (E2) and progesterone (P4) with or without a gonadotropin-releasing hormone agonist (GnRHa), and the modified natural cycle (MNC) with human chorionic gonadotropin (hCG) trigger. METHODS: In this retrospective study, we evaluated 187 patients during 3 years (February 2012–April 2015). The patients were allocated to the following treatment groups: group A, comprising 113 patients (181 cycles) who received GnRHa+E2+P4; group B, comprising 49 patients (88 cycles) who received E2+P4; and group C, comprising 25 patients (42 cycles) who received hCG+P4. The inclusion criteria were regular menstrual cycles (length 24–35 days) and age 21–45 years. RESULTS: The primary outcome of the study — implantation rate (IR) per embryo transferred — was not statistically different among the 3 groups. Similar results were found for the IRs with fetal heartbeat per embryo transferred (68/181 [37.6%] in group A vs. 22/88 [25.0%] in group B vs. 14/42 [33.3%] in group C) and for the live birth rates (LBRs) per embryo transferred (56/181 [30.9%] in group A vs. 18/88 [20.5%] in group B vs. 11/42 [26.2%] in group C). CONCLUSION: Although the pregnancy outcomes were better in the hormone therapy with GnRHa group, hormone therapy FET with GnRHa for pituitary suppression did not result in significantly improved IRs and LBRs when compared with hormone therapy FET without GnRHa or MNC FET.

A selective hemostatic suturing technique for placental site bleeding: a case report / 대한산부인과학회지

In postpartum hemorrhage, many clinicians should often consider hysterectomy after delivery. Many surgeons have suggested conservative surgical procedures such as uterine, ovarian and internal iliac artery ligation for preserving future childbearing potential. Recently, B-Lynch surgical technique and hemostatic multiple square suture technique were suggested to compress the entire uterine walls as another methods. The individual choice between these procedures depend on several factors including the general condition of patient and the experience of surgeon. Here, we introduce a case of the selective hemostatic suturing technique which was used to a patient with placenta previa at 20 weeks' gestation. The suturing technique could be used to a patient with massive bleeding from the placental separation site with normal uterine contraction during cesarean delivery.

A Case of Retroperitoneal Leiomyoma developing after total abdominal hysterectomy / 대한산부인과학회지

Leiomyomas are very common tumors in the uterus and related adjacent structures but rare in the retroperitoneal space. Retroperitoneal leiomyomas are extremely rare and have a good prognosis. Long-term follow-up reveals no metastasis but small potential for local recurrences cannot be ruled out. We report a 44-years-old woman with retroperitoneal leiomyomas who had undergone total abdominal hysterectomy and left salpingooophorectomy 8 years ago due to uterine leiomyomas. Laparotomy was performed, and mass excision was successful.

A Case of Primary Signet Ring Cell Adenocarcinoma of the Uterine Cervix / 대한산부인과학회지

Signet ring cell adenocarcinoma of the cervix is most commonly considered to be metastatic in origin. We describe one case of primary signet ring cell adenocarcinoma of the cervix occuring in 49-year-old patient. The lesion was located at the posterior lip of the cervix and about 3 cm in size. This case was parametrium thickening in pelvic examination and positive for HPV type 18. CCRT (concurrent chemoradiotherapy) was done for clinical FIGO stage II B adenocarcinoma of the cervix. The patient is alive for 6month since diagnosis and disappear lesion of the cervix. A upper gastroenteroscopy, colonoscopy, cystoscopy, intravenous pyelogram, abdominal pelvic CT, PET CT, mammogram were reported negative. Therefore we concluded this case for a primary cervical origin of signet ring cell adenocarcinoma of the uterine cervix.

Fetal Therapy / 대한산부인과학회지

Since fetal therapy is a newly developed field as a pioneer during the last few decades, initial activity before the year 2002 was based on successful case reports and case series. However, multicenter randomized controlled trial with the comparison to the previous standard treat should be needed for the establishment of new therapy. This philosophy of evidence-based clinical practice is now accepted after 2002. New randomized trials are being published in the literature. (eq. fetal endoscopic tracheal occlusion for congenital diaphrag-matic hernia and laser treatment of the twin-to-twin transfusion syndrome) Another trends of fetal therapy are efficacy after the evaluation of long-term outcomes and minimal invasive access methods in both diagnosis and surgery. The option of middle cerebral artery doppler examination for the diagnosis of fetal anemia is newly available besides invasive repeated-cordocentesis. Measurement of cell-free fetal DNA levels in the maternal circulation rather than invasive chorionic villi sampling is gradually phasing into clinical use for non-invasive method to diagnose fetal single gene disorders. In Utero Hematopoietic Stem Cell Transplantation offers a potential way to treat fetuses with immunodeficiency diseases among the congenital hematologic disorders. Successful Stem Cell Transplantation for other congenital hematologic disorders and specific gene therapy will hopefully come true in the near future after further developmental expansion of ethical, technical fields.

A Case of Pelvic Actinomycosis with Right Ureter Obstruction and Hydronephrosis / 대한산부인과학회지

Pelvic actinomycosis is a rare infectious disease in female genital organ, which occurs most commonly with intrauterine device. Because of it's diverse clinical manifestation and progress, the diagnosis is made postoperatively by pathologic confirm in most cases and adequate medical treatment is required. Ureter obstruction is one of the common complication of pelvic actinomycosis, but it's management has been very variable by cases. If physician operate this after adequate management of ureter and preoperative antibiotics therapy, the risk of pelvic structure injury is reduced and then a patient can be saved from an extensive surgical procedure. We experienced a case of pelvic actinomycosis complicated by tubo-ovarian abscess with ureter obstruction and hydronephrosis, improving by Double J catheter insertion and preoperative antibiotics therapy and report it with brief review of literatures.

Clinical profiles of peripartum cardiomyopathy / 대한산부인과학회지

OBJECTIVE: To analyze the clinical characteristic of peripartum cardiomyopathy. METHODS: A retrospective review was undertaken on records of women who were diagnosed with peripartum cardiomyopathy at Yonsei University, Wonju College of Medicine, Wonju Christian Hospital between January 1994 and December 2004. We made criteria for its diagnosis, namely: (1) developement of heart failure in the last month of pregnancy or within 5 months after delivery, (2) absence of a determinable etiology for the cardiac failure, and (3) absence of demonstrable heart disease prior to the last month of pregnancy. (4) ejection fraction less than 45%. RESULTS: During the research period, 8 pregnant women were documented as peripartum cardiomyopathy. All of the women undertook echocardiography. Three women were complicated with pregnancy induced hypertension. One woman was in cardiogenic shock. CONCLUSION: Early diagnosis of the peripartum cardiomyopathy is extremely important. The echocardiography can provide helpful information on disease progression.

The comparison of the pregnancy outcomes according to the types of placenta previa / 대한산부인과학회지

OBJECTIVE: To suggest the pregnancy outcome data according to the types of placenta previa in order to establish the optimal management of placenta previa. METHODS: A retrospective review of the clinical records of 179 women delivered with the diagnosis of placenta previa over 25 gestational weeks during the 6-year period from January 1, 1995 to December 31, 2000, at the Wonju Christian Hospital. We divided each groups into total, partial and marginal placenta previa in order to compare pregnancy outcomes. RESULTS: There were significant differences in the numbers of gravida, prior abortion, number of previous cesarean section between marginal and total placenta previa group. There were no significant differences in the gestational weeks at delivery, blood transfusion units, birth weight and placenta/birth weight ratio among each group. Statistically significant frequent hysterectomy in case of partial palcenta previa in comparison to marginal placenta previa was performed. Significant differences of the prior cesarean section (86.4% vs 3.8%) and placenta accreta (45.4% vs 37.5%) were noted between hysterectomy group and no hysterectomy group. CONCLUSION: Previous cesarean section history is strongly associated with cesarean hysterectomy. Women with placenta previa and history of previous cesarean section have more risk of placenta accreta. So, we should prepare sufficiently for cesarean hysterectomy in such cases.

Patterns of Normal Change in Fetal Cerebral Artery Doppler by Fetal Gender / 대한산부인과학회지

OBJECTIVE: To establish the normal range of the fetal cerebral artery pulsatility index (PI) throughout pregnancy and to determine if there are any gender differences. METHODS: Doppler ultrasonographic examination was performed to measure the fetal middle cerebral artery (MCA) and anterior cerebral artery (ACA) PI in 71 normal pregnancies between 25 and 39 weeks gestation. Gender determination was possible in 44 fetuses by either a postnatal examination or genetic amniocentesis. The gestational weeks were grouped into 4-week sections. Group I ranged from 28 to 31 gestational weeks. Group II and III ranged from 32 to 35 and from 36 to 39 weeks, respectively. RESULTS: The ACA PI of the male fetuses decreased with increasing gestational time (group I, II and III: 1.79+/-0.35, 1.57+/-0.67 and 1.30+/-0.35; P<0.05). The ACA PI of the female fetuses also decreased significantly (group I, II and III: 1.97+/-0.59, 1.68+/-0.41 and 1.33+/-0.21; P<0.05). The MCA PI of the male fetuses decreased (group I, II and III: 2.02+/-0.58, 1.88+/-0.43 and 1.53+/-0.47; P<0.05). However, there was no significant decrease in the MCA PI of female fetuses (group I, II and III: 2.14+/-0.60, 1.87+/-0.56 and 1.88+/-0.40; P=0.83). CONCLUSION: These data demonstrate that female fetuses show a relatively constant middle cerebral artery PI regardless of the gestational time.

A Case of Cantrell's Pentalogy with Anencephaly Diagnosed by Prenatal Ultrasonography / 대한산부인과학회잡지

Pentalogy of Cantrell was very rare congenital anomaly and represent a regional prevalence of 5.5/1 million live births. The syndrome, Cantrell's pentalogy is characterized by defects in the lower sternum with ectopia cordis, anterior diaphragm defects, midline supraumbilical abdominal wall defects, defects in the diaphragmatic pericardium, and various intracardiac defects. Anencephaly involves acrania with a degenerated mass of brain tissue. Combination of both conditions are extremely rare. We experienced a case of Cantrell's pentalogy with anencephaly detected by ultrasonography at 15 weeks 1 day menstural age and confirmed at autopsy. Thus we report a case with brief review of the literature.

Expression of TRAIL (Apo-2L)/TRAIL Receptor System Related to Apoptosis at the Human Extraembryonic Tissues and Gestational Trophoblastic Disease / 대한산부인과학회잡지

Human uterus has been known as a immune privileged site for the product of conception. At the feto-maternal interface, Fas system is a underlying main mechanism of maternal immune acceptance. To date, the TRAIL (TNF-related apoptosis-inducing ligand) system is known to be another pivotal mechanism. OBJECTIVE: To clarify the protein expression of TRAIL ligand and receptors in the normal and pathologic (preeclampsia, hydatidiform mole) placenta, chorioamnion, decidua. METHODS: we investigated the expression of TRAIL system in the above-mentioned tissues by using Western Hybridization. RESULTS: All tissues expressed TRAIL ligand and only a DcR2 among TRAIL receptors (DR4, DR5, DcR1, DcR2). CONCLUSION: we demonstrated the expression of TRAIL ligand and DcR2 protein at the feto-maternal interface of the normal and pathologic pregnancies. Further study regarding the expression of other receptors and quantitative analysis between normal and pathologic pregnancies should be followed.

A Case of Spontaneous Umbilical Cord Hematoma with Antepartum Fetal Distress / 대한산부인과학회잡지

Spontaneous umbilical cord hematoma is a rare cause of fetal distress and intrauterine fetal death. The perinatal mortality rate approaches 50%. Various causes of the cord hematoma have been suggested as congenital abnormalities, short cord, trauma, cord around neck, torsion, syphilis, or postmature pregnancy. We have experienced one case of the fetal distress from umbilical cord hematoma, which is presented with a brief review of the literatures.

Clinical Analysis of 896 Cases of Midtrimester Amniocentesis / 대한산부인과학회잡지

OBJECTIVE: We report our experience with midtrimester amniocentesis. METHODS: This study was retrospectively reviewed 896 cases of midtrimester genetic amniocentesis from January 1997 to October 2003 in Yonsei university, Wonju Colleage of medicine. We analyzed the indications, distributions of gestational age, cytogenetic results, and the safety. RESULTS: The most common Indications for amniocentesis were abnormal maternal serum marker (52.7%) and advanced maternal age (36.6%). Most amniocentesis has been performed during second trimester from 16 to 20 weeks. The incidence of chromosomal abnormality was 3.9% (35 cases). There were 26 cases of numerical aberration, 6 cases of structural aberration and 3 cases of mosaicism. In chromosomal aberration, there was 9.0% (2/22) of chromosomal abnormalities in abnormal ultrasonographic finding group and 6.9% (2/29) in previous chromosomal anomaly. There were 3 cases of fetal loss (0.3%) after amniocentesis. CONCLUSION: Midtrimester amniocentesis is a useful and safe technique for the prenatal detection of genetic disorder.

The Efficacy of Computed Tomography in the Staging of Carcinoma of the Uterine Cervix / 대한산부인과학회잡지

OBJECTIVE: The authors have aimed to compare the efficacy of the computed tomography with other study methods, and to investigate if replacement by computed tomography is possible METHODS: From January 1998 to December 2002, 203 cervical cancer patients underwent pre-staging studies including computed tomography. The positive predictive values, negative predictive values, sensitivity, specificity of each method of study were compared. RESULTS: 1. Compared computed tomography with intravenous pyelonephrography. Each values of computed tomography for hydronephrosis or non visualization of kidney were sensitivity 91.7%, specificity 97.8%, positive predictive values 84.6%, negative predictive values 98.9%. 2. Compared computed tomography with cystoscopy. Each values of computed tomography for bladder invasion were sensitivity 90%, specificity 95.8%, positive predictive values 52.9%, negative predictive values 99.4%. 3. Compared computed tomography with sigmoidoscopy. Each values of computed tomography for rectal invasion were sensitivity 80%, specificity 94.4%, positive predictive values 26.6%, negative predictive values 99.4%. CONCLUSION: Rather than routine examination for staging of invasive cervical cancer in all patients, it is more ideal to first take a non invasive technique. then perform on intravenous pyelonephrography, cystoscopy and sigmoidoscopy only in patient showing positive findings of hydronephrosis or non visualization of kidney, bladder or rectal invasion on computed tomography.

The role of Interferon-gamma on the Expression of Class I Human Leukocyte Antigens in a Human First Trimester Trophoblast Cell Line / 대한산부인과학회잡지

Precise mechanism which the fetus can escape from mother's immune rejection is not well understood yet during last 50 years. The clarification of immune mechanism at the feto-maternal interface is very important, because this can be a common pathogenesis of various pathologic conditions including spontaneous abortion and habitual abortion. The pivot of this mechanism is cross-talk between the expression of HLA-C, E, G on the extravillous cytotrophoblasts and their receptors on decidual NK (natural killer) cell. The mechanism through which HLA-C, E, G regulation on the extravillous trophoblast is poorly understood. The IFN-gamma is known to be harmful to the successful maintenance of early pregnancy. OBJECTIVE: To clarify whether the IFN-gamma could be involved in the regulation of the HTR-8/SVneo human first trimester cell line. METHODS: We investigated the effects of IFN-gamma only or with other cytokines on the HLA-C, E, G transcripts in human first trimester trophoblast cell-line by using Reverse Transcription Polymerase Chain Reaction (RT-PCR). RESULTS: The trophoblast cells expressed HLA-C, E constitutively. When cultured in the presence of IFN-gamma only or with other cytokines, HLA-C, E transcripts were not significantly affected. CONCLUSION: These results suggest that harmful IFN-gamma to maintain early pregnancy may affect through another mechanism besides regulation of HLA-C, E on the extravillous cytotrophoblasts at the feto-maternal interface.

A Case of Intramural Pregnancy / 대한산부인과학회잡지

Intramural pregnancy is one of the rarest forms of ectopic pregnancy. The pathologic diagnosis of the intramural ectopic pregnancy requires that the myometrium surrounds the products of conception separated from the endometrial cavity or fallopian tubes. Because the early diagnosis is very difficult, most cases are found after the onset of complications such as a uterine rupture or hemoperitoneum. The previous histories of curettage, cesarean section, myomectomy, salpingectomy and manual removal of the placenta are known as possible etiology of the intramural pregnancy. We have recently experienced a case of intramural pregnancy after 10 times of curettages and are reporting with a brief review of the literatures.

Successful Vaginal Delivery Following Immunologic Thrombocytopenic Purpuric Woman: Case Report With Prior History / 대한산부인과학회잡지

Thrombocytopenia is hematologic disorder commonly occurs during pregnancy (5%) with different severity. It doesn't cause severe problem during pregnancy and after the delivery if it is not below certain level which will cause spontaneous bleeding. But in this case, patient was previous cesarean section status and platelet number didn't arise more than 20,000/microliter even after transfusion which will cause spontaneous bleeding. Vaginal delivery was done because transverse cesarean section was considered relatively safe although there was the risk of rupture of uterus, and was successful-both mother and baby is in good health condition. Here now we report this case because vaginal delivery of Immunologic thrombocytopenic purpuric woman with prior history of cesarean section has not reported.

Relation of placental size to large-for-gestational-age infants in women with gestational diabetes mellitus controlled with insulin / 대한산부인과학회잡지

OBJECTIVE: To determine if the placental size is disproportionately increased in the large-for-gestational age infants in pregnancies complicated by impaired glucose tolerance controlled with insulin. PATIENS AND METHODS: A retrospective study was performed on 104 singleton pregnancies complicated by gestational impaired glucose tolerance controlled with insulin. The cases were categorized by the infant birthweight percentile into three groups, i.e. small-for-gestational age (90th percentile). Maternal and infant anthropometric data, glycemic status, and placental weight-to-birthweight ratio were compared among three groups. RESULTS: The maternal glucose level just after delivery, infant body mass index and placental weight showed a significant increment from the small-for-gestational age to the large-for-gestational age groups (p<0.05). The placental weight-to-birthweight ratio was significantly higher in the small-for-gestational group. On the other hand, there was no significant difference in the values of the oral glucose test, hemoglobin A1c and maternal body mass index among three groups. Maternal body mass index showed a increasing trend from the small-for gestational age to the large-for-gestational age groups. Placental weight-to-birthweight ratio was not significantly correlate with maternal glucose level. CONCLUSIONS: The results indicate that the placenta is disproportionately bigger, and rigid control of maternal blood glucose does not prevent the development of placental overgrowth. Maternal obesity in well- controlled gestational diabetes mellitus may be more significant than glucose control in the development of large-for-gestational-age infants. Different management strategies for women with gestational diabetes mellitus with different pregravid weights are warranted.