A study for Pertinence in Emergent Cesarean Section / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to analyze the inclination, pertinence and influential factor in emergent cesarean section according to the assortment and analysis of the indication of emergent cesarean section. METHODS: The retrospective study was performed with the review of 360 emergent cesarean section cases from January 2003 to December 2003. RESULTS: The indication of cesarean section was followed by the order of progress failure (47.5%), previous cesarean section (19.2%), and fetal distress (15.8%). The improper operation of emergent cesarean section was done in fetal distress (28.1%), progress failure (8.6%), and induction failure (16.7%). The absence of acceleration with prolonged bradycardia was the most common (50.0%) type of fetal distress. The emergent cesarean section were done more commonly on Tuesday and Friday during weekdays and it was the peak time in a whole day of cesarean section from 11 o'clock to 12 o'clock and 16 o'clock to 17 o'clock. CONCLUSION: It was proved that twenty six (7.2%) cases of emergent cesarean section were done improperly. Now, work through the non-medical factors are considered more important to reduce improper section rate.

Evaluation of the BacT/Alert Blood Culture System for Culturing Sterile Body Fluids other than Blood / 대한진단검사의학회지

BACKGROUND: Many invasive and life-threatening infections are diagnosed by the culture of normally sterile body fluids. Because microorganisms are present in very low concentrations, and these infections are often caused by fastidious or slow-growing microorganisms, they may not be detected by conventional culture methods. The present study was designed to assess the performance of the BacT/Alert blood culture system in order to recover microorganism with standard aerobic and anaerobic bottles and FAN aerobic and anaerobic bottles versus conventional culture methods for culturing normally sterile body fluids other than blood. METHODS: Between February and April 2003, sterile body fluids, such as cerebrospinal fluids (CSF), pleural fluids, peritoneal fluids, continuous ambulatory peritoneal dialysate (CAPD), and other fluids submitted to the microbiology laboratory for culture were entered into the study. Only specimens with a minimum volume of 3.0 mL were included, and the specimens were divided equally among three arms of the study. All BacT/Alert bottles were monitored for up to 5 days. Conventional blood agar plate and thioglycollate broth were incubated for up to 3 days before being discarded as negative, while anaerobic cultures were maintained for a minimum of 5 days. Bacterial identification and antimicrobial susceptibility tests were performed using standard laboratory protocols. RESULTS: A total of 247 specimens (CSF 85, pleural fluids 68, peritoneal fluids 71, CAPD 17, others 6) were included in this study, with 45 isolates recovered from 43 specimens. The recovery rates for each method were standard bottles 65.1% (28/43), FAN bottles 79.1% (34/43), and conventional culture 48.9% (21/43). For CSF and peritoneal fluids, more isolates were recovered from the FAN bottles compared to the conventional culture or standard bottles. The FAN bottles recovered more coagulase negative staphylococci than those from the conventional culture or standard bottles. CONCLUSIONS: Even though the BacT/Alert system using FAN bottles improved the recovery rate for CSF and peritoneal fluids compared to either the standard bottles or conventional culture, coagulase negative staphylococci were also frequently recovered. Therefore, further evaluations are required to assess the clinical usefulness of culturing sterile body fluids using the Bact/Alert blood culture system.

Clinical Analysis on Emergency Postpartum Hysterectomy / 대한주산의학회잡지

OBJECTIVE: To analyze incidence, indications, risk factors, complications, and neonatal outcomes of emergency postpartum hysterectomies performed at EulJi University Medical Center. METHODS: A retrospective study of all cases of postpartum hysterectomies between May. 1996 and Dec. 2000. was carried out. RESULTS: 37 cases of postpartum hysterectomies during this period were performed, for overall incidnce of 2.3 per 1000 deliveries. Incidence after vaginal delivery and cesarean section was 0.03% and 0.52% respectively. The rate of postpartum hysterectomy increased with increasing age and parity. The main indications were placental disorders(54.1%) including placenta previa and adherent placenta, uterine atony(37.8%), uterine myoma(5.4%) and uterine rupture(2.7%) in order. The relative risk of postpartum hysterectomy according to the risk factors was 97.6(95% confidence interval 52.17-184.06) for placental disorders, 16.3(95% confidence interval 4.94-52.31) for cesarean section and 2.4(95% confidence interval 1.21-4.76) for previous cesarean section. The mean amount of transfuion was 17.1 pints. Although no maternal mortality had occurred, 16 patients(43.2%) had complica-ions including respiratory complication(13.5%), hemorrhagic complication(10.8%), infection(8.1%) and urologic injury(8.1%). Regarding fetal outcome, 2 of 38 infants(1 case, twin) were stillborn (5.3%) and 10 infants(26.3%) were suffered from various illness including prematurity, sepsis, meningitis, and brain hemorrhage. CONCLUSION: The data identifies placental disorders are the leading cause of postpartum hysterectomy. Although postpartum hysterectomy is a necessary life-saving operation, maternal morbidity remained high.

A Case of metastatic choriocarcinoma diagnosed at 34th week of pregnancy / 대한산부인과학회잡지

Choriocarcinoma associated with a normal pregnancy is rare. Especially, choriocarcinoma coexistent with a viable pregnancy is even rarer and commonly presents with widespread metastatic disease. We experienced a patient at 34th week of pregnancy with dyspnea and sputum production due to pulmonary metastasis of choriocarcinoma. The serum B-hCG level was extremely elevated and the placenta had multifocal choriocarcinoma. After vaginal delivery, the patient was successfully treated with combination chemotherapy (EMA-CO). The patient is receiving follow up with monthly measurement of hCG values. We report one case of metastatic choriocarcinoma with viable pregnancy with review of literature.

A Clinical Study on the Incompetent Internal Os of the Cervix / 대한산부인과학회잡지

OBJECTIVE:Our goal was to evaluate the clinical characteristics and statistical analysis in incompetent internal os of the cervix(IIOC) METHOD: At Department of Obstetrics and Gynecology, Eulgi Hospital and Eulgi university Hospital from January 1, 1991 to December 31, 1997, 296 cases of IIOC were admitted and treated with McDonald operation or modified Shirodkar operation. Of this, 38cases were follow up lost, so 252 cases were analayzed. Diagnostic criteria was previous history of painless cervical dilatation, followed by spontaneous abortion or preterm birth, and acceptance without resistance at the internal os of No. 8 Hegar dilator. RESULT: Incidence of IIOC was 1.61%, 1 in 60 deliveries. Most frequent age group was in 28-30 years old group and mean age was 30 years old. Total number and mean number of gravida was 818 and 3.2. The most common contributing factor was previous artificial abortion(77%), and cervix dilatation(9%), old cervical laceration(4.3%) etc, was followed. Operation methods were McDonald operation(56%) and modified Shirodkar operation(44%). The Success rate of McDonald and modified Shirodkar was 78.1% and 88.1%. Successful fetal salvage rate was 82.5%, and the highest success rate was 86.9% in 14-18th weeks of gestation group. The more cervix dilate, the more failure occured. Causes of operation failure was premature rupture of membrane(54.5%), preterm labor(43.2%) and fetal death in utero(2.3%). Delivery method after operation was vaginal delivery(146cases, 70.9%) and cesarean delivery(60cases, 29.1%). Cause of cesarean delivery was previous cesarean section(43.3%), breech presentation(16.7%), cephalopelvic disproportion(15%), prolonged labor(6.7%), fetal disttess(6.7%), twin(5%), placenta previa(3,3%) and abruptio placenta(3.3%). CONCLUSION: The 14-18th weeks of gestation group & no cervical dilatation group has higher success rate, which indicate early diagnosis and appropriate timing of operation is probably associated with a greater operation