Medical Issues and Opinions of Obstetrics Regarding Abortion Law Amendment

There have been ongoing social discussions on revision of the abortion law since the Constitutional Court ruled it nonconformity to the constitution on April 11, 2019. Thus, Korean Society of Obstetrics and Gynecology, Korean Society of Maternal Fetal Medicine, Korean College of Obstetricians and Gynecologists, and Korean Association of Obstetricians and Gynecologists organized 'special committee for abortion law' to support social discussion on the revision of the abortion law, and they prepared official opinions of obstetrics for medical issues including doctors' right to refuse abortion. In the future, the committee will continue to adapt to changes of medical environment especially after the revision of the abortion law by collecting its members' feedbacks.

Medical Issues and Opinions of Obstetrics Regarding Abortion Law Amendment

There have been ongoing social discussions on revision of the abortion law since the Constitutional Court ruled it nonconformity to the constitution on April 11, 2019. Thus, Korean Society of Obstetrics and Gynecology, Korean Society of Maternal Fetal Medicine, Korean College of Obstetricians and Gynecologists, and Korean Association of Obstetricians and Gynecologists organized 'special committee for abortion law' to support social discussion on the revision of the abortion law, and they prepared official opinions of obstetrics for medical issues including doctors' right to refuse abortion. In the future, the committee will continue to adapt to changes of medical environment especially after the revision of the abortion law by collecting its members' feedbacks.

A case of Ebstein's anomaly prenatally diagnosed by fetal sonography / 대한산부인과학회잡지

We experienced a case of Ebstein's anomaly prenatally by fetal sonography. Ebstein's anomaly is a rare congenital heart defect characterized by abnormally downward displacement of the septal and posterior leaflets of the tricuspid valve. In the absence of tricuspid regurgitation, this condition may be completely asymptomatic. On the other hand, symptomatic newborns often develop life-threatening congestive heart failure. A 30-year-old multiparous woman was referred for the evaluation of fetal cardiac defect at 26th gestational week from a private clinic. Fetal ultrasonography showed markedly enlarged right atrium and downward displacement of tricuspid valve into the right ventricle. After discussion with the patient, the pregnancy was terminated and Ebstein's anomaly was confirmed by autopsy.

Evaluation of efficacy and safety of fentanyl-TTS in adult patients with cancer-related pain / 대한내과학회지

The transdermal administration of narcotics is one of the alternative ways of providing adequate pain relief for the patients with chronic cancer pain. A Phase 4 trial was conducted to evaluate the efficacy and safety of Fentanyl-TTS in adult patients with cancer-related pain in Korea. METHODS: Patients with histologically confirmed malignancy, who have pain related to the cancer and/or therapy, pain necessitating the use of opoid analgesics, age of 18 yr or older, ability to communicate effectively with study personnel, and signed on informed consent were included. The patients were titrated with a short-acting narcotic to control their cancer pain before they are converted to a fentanyl-transdermal therapeutic system(TTS). Short acting parenteral morphine and MS contin were used as rescue medications. All patients were evaluated initially and were followed up with a pain visual analogue scale(VAS), quality of life(QOL)-VAS. Patients were asked to keep the daily record for 21 days about pain VAS, QOL-VAS, amount of rescue morphine used, and side effects. RESULTS: Twenth two patients were enrolled from January 1996 to October 1997. The dose of fentanyl-TTS required, ranged between 25 and 75 ug/hr (25 microgram/hr in 13, 50 microgram/hr in 4, and 75 microgram/hr in 2). The mean dose of morphine required before the use of the fentanyl-TTS was 135.3 mg (20-285 mg/day), but it was decreased after the use of the fentanyl-TTS. Pain VAS and QOL-VAS were in adquate level during the fentanyl- TTS treatment. Patients favored continuous use of fentanyl after the study was finished. Side effect of fentanyl-TTS was minimal. CONCLUSION: Transdermal fentanyl seems to be a convenient and effective analgesic for the control of cancer related pain in Korean. A controlled trial comparing fentanyl-TTS to morphine needs to be followed.

Clinical Analysis of Third Cesarean Section and 2nd Cesarean Section / 대한주산의학회잡지

OBJECTIVE: To compare the second and third cesarean section by clinical and statistical analysis. METHODS: From June 1993 to February 1997, we experienced 296 cases of the third cesarean section and 541 cases of the second cesarean section. We analyzed their incidence, age distribution, gestational week at operation, weight distribution of baby at birth, hemoglobin change, estimated blood loss during operation, obstetrical complication, combined operation, and degree of pelvic adhesion, presence of wound dehisence of uterus, post operative complication. RESULTS: Of the total deliveries, overall incidence of cesarean section was 51.4%, while the incidence of the second cesarean section was 16.0%, and that of the third cesarean section was 1.1%. In the third cesarean section the age group of 31-35 was most common(49.7%), and the most common gestational week at operation was 39th week(43.9%). In the third cesarean section, the hemoglobin change of 1.0g% less was most common(95.2%), and the most common amount of estimated blood loss was 400-600ml(61.0%). There was statistically significant difference of the blood transfusion rate between the third cesarean section(41 cases, 13.8%, p=0.04) and second cesarean section(27 cases, 5.0%). The most common combined operation in the third cesarean section was tubal ligation(51.7%), and the others were bladder wall repair(2.0%), cesarean hysterectomy(1.7%). In the third cesarean section, the incidence of mild intraabdominal adhesion was 16. 9% and that of severe adhesion was 11.8%. It was statistically significant compared to the second cesarean section. Among the complications of the third cesarean section, there were 9 cases of placenta accreta(3.0%), 4 cases of placenta previa totalis(1.4%), and 1 case of uterine rupture, uterine atony, uterine arterial rupture(0.3% each other), and did not proved statistical significance. CONCLUSION: In this study, we found that the rate of blood transfusion, cesarean hysterectomy, bladder wall repair, and the degree of intraabdominal adhesion were more common in the third cesarean section than second section. But, if pre- & postoperative management is adequate, maternal mobidity and neonatal mobidity is not affected.

A Clinical Study of Nulliparous Women Aged 40 Years and Older / 대한주산의학회잡지

OBJECTIVE: Our purpose was to compare the pregnancy outcomes of nulliparous women aged 40 years and older with those of nulliparous women under 35 years of age. METHODS: From January 1989 to December 1998 total 57,563 deliveries were seen in Gachon Gil Medical Center. Among them we experienced 59 cases of nulliparas at 40 years and older. These women were compared with 188 young nulliparas under 35 years of age as the control group. The statistical analysis was performed using Chi-square tests, and statistical significance was defined as p<0.05. RESULTS: The incidence rate of elderly nulliparas aged 40 years and older was increased from 0.04% in 1989 to 0.30% in 1998. The age distribution was from 40 years to 45 years. The gravidity of eldery nulliparas was 2.2 in comparison with 1.6 in control group. The incidence of uterine myoma, gestational DM, IUGR and oligohydramnios was significantly high rate in elderly nulliparas. There was significantly high rate of cesarean section in elderly nulliparas(88.1%) in comparison with control group(40.4%). The reasons of cesarean section were her demand(39.0%), CPD(15.3%) and breech presentation(13.6%) in decreasing order. The preterm delivery rate was 10.2% in elderly nulliparas in comparison with 4.3% in the control group. Placenta accreta and uterine atony were significantly high in elderly nulliparas and mean estimated blood loss was also high. There was no difference in 5-minute Apgar score between both group, but there were more cases of neonatal intensive care unit admission in neonates of elderly nulliparas(6.8% vs 0%). CONCLUSION: The incidence of elderly nulliparas is continuously increasing. The elderly nulliparas and their babies are at greater risk than young women. Therefore all elderly nulliparas aged 40 years and older can be regarded as high risk patients and they must be managed with careful attention.