Anaphylactic shock to vaginal misoprostol: a rare adverse reaction to a frequently used drug

Misoprostol is widely used in daily practice for induction of labor and cervical dilatation prior to intrauterine procedures, including dilatation and curettage or hysteroscopy. Anaphylactic shock to intravaginal misoprostol can occur not only in pregnant women, as reported in 2 previous cases, but also in a non-pregnant, perimenopausal woman, as in the case described herein. A 49-year-old woman received vaginal misoprostol for cervical ripening prior to hysteroscopic myomectomy and experienced anaphylactic shock. Two 400 μg doses of misoprostol 6 hours apart caused uncontrolled shaking and high fever followed by shock. In conclusion, the possibility of anaphylactic shock should be considered in patients with sudden hypotension following misoprostol administration. Prompt identification and management are crucial to prevent morbidity and mortality following an anaphylactic shock to misoprostol.

Bone Mineral Density of Young Korean Women and Its Correlation with Thyroid Stimulating Hormone / 대한골다공증학회지

OBJECTIVES: The bone mineral density (BMD) of young aged women was not fully investigated because of the limited indication of BMD test. This study was to investigate mean Z-score of BMD in healthy young aged Korean women and to find out factors influencing the BMD score in her twenties and thirties. METHODS: A total 876 young aged (20-40 years) women who had taken dual energy X-ray absorptiometry (DXA) for BMD screening from 2010 to 2014 were analyzed retrospectively using demographic data including body mass index (BMI), waist circumference (WC), thyroid stimulating hormone (TSH), and serum lipid profile. We compared the two age groups, in her twenties and thirties, regarding BMD and other parameters.

Factors related to dysmenorrhea among Vietnamese and Vietnamese marriage immigrant women in South Korea

OBJECTIVE: To find factors associated with dysmenorrhea, we surveyed the obstetric and gynecologic histories as well as socioeconomic factors of Vietnamese female residents in Can Tho (southern part of Vietnam) and Bavi (northern part of Vietnam) and Vietnamese female marriage immigrants living in South Korea. METHODS: From March 2010 to March 2011, 3,017 Vietnamese women aged 17 to 42 years (mean, 25.5 years) were recruited. Socioeconomic factors as well as baseline characteristics, including gynecologic history and menstrual patterns, were collected using questionnaires. The relationships between these factors and dysmenorrhea were analyzed using chi-square test, independent t-test and logistic regression analysis. RESULTS: Dysmenorrhea was found in 58.8% of all women. The mean age and the age at menarche were younger in the women with dysmenorrhea. A longer duration of menstrual flow and severe menstrual volume increased the risk of dysmenorrhea. The prevalence of dysmenorrhea was lower in women who had experienced pregnancy, term delivery and breastfeeding. The prevalence of dysmenorrhea in Vietnamese women was also different according to their educational status. When participants were divided according to their religious preferences, atheist women showed a lower prevalence with 55%, and women who were religious had a higher prevalence of dysmenorrhea. The body mass index, menstrual cycle length, monthly income, and duration of residency in Korea were not related with the prevalence of dysmenorrhea. CONCLUSION: Socioeconomic factors as well as age, menstrual pattern and obstetric history were related with dysmenorrhea in Vietnamese women.

Sonographic Findings of Ruptured Endometrioma

PURPOSE: To evaluate the characteristic sonographic findings of ruptured endometrioma in comparison with unruptured endometrioma. MATERIALS AND METHODS: Fifty nine cases of pathologically proven endometrioma were categorized as the ruptured endometrioma group and the unruptured endometrioma group on the basis of the operation records. The sonographic findings such as locularity, the internal echotexture, the size and the wall thickness of the cyst and the presence of a fluid-fluid level, fibrin strands, a retracting clot and fluid in the pelvic cavity were retrospectively evaluated using logistic regression analysis. RESULTS: On univariate analysis, the sonographic finding of a thin wall (odds ratio, 4.1; 95% confidence interval: 1.2-13.8) and a fluid-fluid level (odds ratio, 9.0; 95% confidence interval: 2.4-33.6) were significantly different between the ruptured endometrioma group and the unruptured endometrioma group. Logistic regression analysis showed that a thin wall (odds ratio, 7.5; 95% confidence interval: 1.6-34.4) and a fluid-fluid level (odds ratio, 14.7; 95% confidence interval: 3.1-70.2) were both independent variables significantly associated with unruptured endometrioma. CONCLUSION: The characteristic sonographic findings of ruptured endometrioma are a thin cystic wall and a fluid-fluid level in the cyst, as compared with those of unruptured endometrioma.

Socioeconomic burden of the polycystic ovary syndrome / 대한산부인과학회지

OBJECTIVE: The objective of the study was to estimate socioeconomic burden of polycystic ovary syndrome (PCOS) during the reproductive life span using current definitions and prevalence or incidence data. METHODS: Questionnaires were given to 8,588 reproductive women reviewed at Ewha Womans University Mokdong hospital. The PCOS affected approximately 10.4% of reproductive-aged women (11 million women in Korea, prevalence rate according to 1990 National Institutes of Health PCOS diagnosis criteria). We tied general societal cost data for the different health consequences to reproductive-age PCOS costs, using prevalence data. RESULTS: We estimated the mean annual cost of the initial evaluation to be 76 hundred million won, that of hormonally treating menstrual dysfunction, providing infertility care, diagnosis/treatment of endometrial hyperplasia, GDM, type 2 DM, and hypertension to be 280 billion won. The total annual socioeconomic cost of evaluating and providing care to reproductive-aged PCOS women in Korea is 350 billion won. CONCLUSION: Because the cost of the diagnostic evaluation accounted for a relatively minor part of the total socioeconomic costs, more widespread screening for PCOS appears be a cost-effective strategy, leading to earlier diagnosis and intervention and possibly the amelioration and prevention of serious sequelae.

Marternal Plasma ADMA Level, Placenta eNOS and Placenta Antioxidant Marker According to the Presence or Absence of Uterine Artery Notch on Color Doppler in the Third Trimester Pregnancies / 대한주산의학회잡지

PURPOSE: We examined pregnancy outcomes and maternal plasma asymmetric dimethylarginine (ADMA) concentrations in the presence or absence of uterine artery notch, and analyzed their relationships to the expression of placental endothelial nitric oxide synthase (eNOS) and antioxidant enzymes, including manganese superoxide dismutase (MnSOD), glutathione peroxidase (GPX), and catalase. METHODS: We assessed uterine artery doppler waveforms in 30 women who had been hospitalized for delivery. Plasma concentrations of ADMA were also measured. Tissue samples of placentas were obtained from 15 patients with diastolic notch and 15 patients without diastolic notch, according to uterine Doppler velocimetry analysis. We evaluated the placental expression of eNOS, MnSOD, GPX and catalase with Western blot analysis and eNOS with immunohistochemistry. RESULTS: The maternal plasma ADMA concentration increased significantly in the group with bilateral Uterine artery notch compared with the group without uterine artery notch (P=0.04). The expression of eNOS in the placenta significantly increased and the expression of MnSOD and GPX decreased significantly in the group with uterine artery notch at the third trimester. CONCLUSION: Uterine artery diastolic notch in pregnant women is associated with high maternal plasma ADMA, increased placental eNOS, and decreased MnSOD and GPX.

Clinical efficiency of 50 g oral glucose challenge test, 75 g and 100 g oral glucose tolerance test for screening and diagnosis of gestational diabetes / 대한주산의학회잡지

OBJECTIVE: The purpose of this study was to compare the clinical efficiency of 75 g oral glucose tolerance test (OGTT) with those of 100 g OGTT for diagnosing gestational diabetes mellitus (GDM) after abnormal 50 g oral glucose challenge test (OGCT). METHODS: Data of 616 pregnant women delivered at Ewha Womans University Dongdaemoon hospital from January, 2003 to June, 2007 was reviewed and analyzed retrospectively. The positive diagnostic rate of GDM for the group resulted in the range of 130 and 140 mg/dl and in 140 mg/dl and higher on the 50 g OGCT group was analyzed. Pregnancy and fetal outcomes were compared for the women who showed positive results in the 75 g and 100 g OGTT. RESULTS: Of the 28 pregnant women whose results were in the range of 130 and 140 mg/dL on the 50 g OGCT, three women (10.7%) were diagnosed as GDM. Among women who showed the results of 140 mg/dL and higher, positive rate of GDM by 75 g OGTT (51.6%) was significantly higher than those by 100 g OGTT (31.6%) (p=0.047). The positive result group of 75 g and 100 g OGTT did not show significant differences in pregnancy and fetal outcomes except that BMI of 100 g OGTT positive group was more increased at early pregnancy (25.2+/-3.53 kg/m2 vs 22.9+/-3.26 kg/m2, p=0.043). CONCLUSION: 75 g OGTT may be a more convenient and useful tool in the diagnosis of GDM to protect for adverse outcomes in untreated gravidas with minimal hyperglycemia.

Premenstrual syndrome (PMS): Clinical approach of diagnosis and treatment / 대한산부인과학회지

The large number and variety of premenstrual symptoms reported have made premenstrual disorders difficult to characterize. Premenstrual disorders can have a significant negative impact on a woman's quality of life and work productivity. But women diagnosed as premenstrual syndrome (PMS) seldom seek a medical advice and commonly use non prescribing medicines. The pathophysiology of the wide range of PMS/premenstrual dysphoric disorder (PMDD) symptoms may be explained by multiple mechanisms. Clinicians need to recognize the diagnostic criteria for PMS/PMDD. The many and varied treatments used for premenstrual disorders can be a source of confusion. These practical treatment algorithms in women with PMS/PMDD would be helpful. It is important for clinicians practicing in women's health to be familiar with the various approaches to treating premenstrual disorders and their relative efficacy.

Black Cohosh and St. John's Wort (GYNO-Plus(R)) for Climacteric Symptoms

PURPOSE: This study was conducted to investigate the efficacy of black cohosh (Cimicifuga racemosa) and St. John's wort (Hypericum perforatum) in women with climacteric symptoms, and to assess their effects on vaginal atrophy, hormone levels, and lipid profiles. MATERIALS AND METHODS: In this double-blind randomized, placebo-controlled, multicenter study, 89 peri- or postmenopausal women experiencing climacteric symptoms were treated with St. John's wort and black cohosh extract (Gynoplus

Clinical Guidelines for Methotrexate in Conservative Treatment for Ectopic Pregnancy / 대한산부인과학회지

OBJECTIVE: To provide more useful guidelines for methotrexate (MTX) treatment in ectopic pregnancy, including patient selection, therapeutic dose, and reproductive outcome. METHODS: Retrospectively, records of 54 patients treated for ectopic pregnancy with systemic MTX were reviewed. MTX was administered 1.0 mg/kg intramuscularly, alternatively with leucovorin 0.1 mg/kg intramuscularly for up to four daily doses of each drug. Samples for beta-hCG detection were obtained on days +3, +7 after beginning of the therapy and then weekly until values were undetectable. RESULTS: 50 patients (92.6%) were treated successfully. 4 patients (7.4%) for whom MTX therapy failed, were treated surgically. The endometrial thickness significantly increased in the failed group, compared to the successful group (14.3+/-4.0 mm vs 7.0+/-2.8 mm, P=0.0001). The serum hemoglobin levels significantly changed in the failed group, compared to the successful group (2.1+/-0.9 g/dL vs 1.0+/-0.8 g/dL, P=0.044). Patients were divided into increasing group and decreasing group according to beta-hCG levels on day 0, that were higher or lower than day -2 level. The resolution time of beta-hCG between increasing group and decreasing group was significantly different (27.6+/-14.0 days vs 17.7+/-8.6 days, p=0.016). In 8 patients (15.1%), an immediate rise of beta-hCG was recorded on day 3 after MTX treatment, but on day 7, a rapid decrease was recorded. Women were treated with significantly different therapeutic dose of MTX according to initial level of serum beta-hCG (p=0.021). There were mild complications (12%). MTX treatment preserved the fallopian tube and thus preserved fertility (70%). CONCLUSION: Systemic MTX use with the dose according to initial level of serum beta-hCG is a safe and highly effective treatment in clinically stable ectopic pregnancy.

Cell Cycle Signaling Pathway by Cyclins-CDKs and CDKIs in Endometriosis / 대한산부인과학회잡지

OBJECTIVE: This study was undertaken to evaluate the cell cycle signaling pathway by cyclins-cyclin dependent kinases (CDKs) and cyclin dependent kinase inhibitors (CDKIs) in endometriosis. METHODS: 38 women with endometriosis were recruited. Endometrioma and the normal ovarian tissues were obtained during laparoscopic surgery on the follicular phase of menstrual cycle. And then, the normal endometrial tissues were taken by currettage. Nuclear proteins (cyclin D1, cyclin E etc), CDK molecules and CDK inhibitors (p27(kip1), p21 etc) were quantitated on transcriptional and translational levels by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot analysis. RESULTS: In RT-PCR analysis, the expression of cyclin D1-CDK6, cyclin E-CDK2 of endometrioma and eutopic endometrium was increased, and the expression of p27(kip1) was decreased compared with normal ovary. The mRNA expression of cyclins-CDKs and p27(kip1) was not significantly different between endometrioma and eutopic endometrium. In Western blot analysis, the expression of cyclin D1-CDK6, cyclin E-CDK2 was significantly increased and the expression of p27(kip1) was significantly decreased in endometrioma and eutopic endometrium compared with normal ovary. And, the expression of p27(kip1) in endometrioma was further decreased than that of eutopic endometrium. CONCLUSION: These results suggest that p27(kip1) on the translational level, in the cell cycle signaling pathway, was closely related to endometriosis. In future, further experimental studies will be needed for the understanding of the cell cycle signaling pathway in endometriosis.

Cell Cycle Signaling Pathway by Cyclins-CDKs and CDKIs in Endometriosis / 대한산부인과학회잡지

OBJECTIVE: This study was undertaken to evaluate the cell cycle signaling pathway by cyclins-cyclin dependent kinases (CDKs) and cyclin dependent kinase inhibitors (CDKIs) in endometriosis. METHODS: 38 women with endometriosis were recruited. Endometrioma and the normal ovarian tissues were obtained during laparoscopic surgery on the follicular phase of menstrual cycle. And then, the normal endometrial tissues were taken by currettage. Nuclear proteins (cyclin D1, cyclin E etc), CDK molecules and CDK inhibitors (p27(kip1), p21 etc) were quantitated on transcriptional and translational levels by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot analysis. RESULTS: In RT-PCR analysis, the expression of cyclin D1-CDK6, cyclin E-CDK2 of endometrioma and eutopic endometrium was increased, and the expression of p27(kip1) was decreased compared with normal ovary. The mRNA expression of cyclins-CDKs and p27(kip1) was not significantly different between endometrioma and eutopic endometrium. In Western blot analysis, the expression of cyclin D1-CDK6, cyclin E-CDK2 was significantly increased and the expression of p27(kip1) was significantly decreased in endometrioma and eutopic endometrium compared with normal ovary. And, the expression of p27(kip1) in endometrioma was further decreased than that of eutopic endometrium. CONCLUSION: These results suggest that p27(kip1) on the translational level, in the cell cycle signaling pathway, was closely related to endometriosis. In future, further experimental studies will be needed for the understanding of the cell cycle signaling pathway in endometriosis.

Treatment Outcomes of Uterine Artery Embolization and Laparoscopic Uterine Artery Ligation for Uterine Myoma

In treating women with leiomyoma and who wish to preserve their uterus, laparoscopic uterine artery ligation or uterine artery embolization should be considered as possible options. This study was performed to evaluate the efficacy of laparoscopic uterine artery ligation and uterine artery embolization in treating uterine myoma. The treatment outcomes of 23 patients who underwent uterine artery embolization and 17 laparoscopic uterine artery ligation were evaluated. The uterine volume reduced 3 months after uterine artery embolization, but thereafter no significant changes were observed. On the other hand, the uterine volumes were only slightly reduced 3 months after laparoscopic uterine artery ligation, and slightly more reduced 6 months later. The average reduction in the case of laparoscopic uterine artery ligation was about 58.5%. After laparoscopic uterine artery ligation, 20% of the patients complained of vaginal spotting. Furthermore, the mechanism of volume reduction was evaluated using specimens obtained from a biopsy taken after each procedure. The results suggested that laparoscopic uterine artery ligation results mainly in physiologic cell death, that is apoptosis, whereas, the corresponding result is cell necrosis for uterine artery embolization. Uterine artery embolization and laparoscopic uterine artery ligation are both effective in relieving the symptoms caused by uterine myoma, and therefore both procedures can be used in place of hysterectomy or myomectomy.

Hysteroscopic Endometrial Ablation as a Treatment of Abnormal Uterine Bleeding in Renal Transplant Patients / 대한산부인과학회잡지

OBJECTIVE: To assess the effectiveness and safety of hysteroscopic endometrial ablation as a surgical management of abnormal uterine bleeding developed in renal transplant patients. METHODS: Data were collected retrospectively from 62 patients referred to Department of Obstetrics and Gynecology, Yonsei University Medical Center from January 1999 to December 2001 for abnormal uterine bleeding with prior history of renal transplantation who subsequently received hysteroscopic endometrial ablation. Hormonal status of these patients were evaluated before the operation by sampling estradiol (E2), lutenizing hormone (LH), follicle-stimulating hormone (FSH), thyroid stimulating hormone (TSH), and prolactin. Mean follow-up duration was 6 months. Levonorgestrel-releasing intrauterine system (LNG-IUS)s were inserted in those who experienced recurrent bleeding. RESULTS: Mean age of patients was 34.6+/-6.7 years and mean duration from renal transplant to onset of abnormal uterine bleeding was 4.5+/-2.5 years. All hormone levels (E2, LH, FSH, TSH, prolactin) were within normal range. 54 out of 62 patients (87.0%) who underwent hysteroscopic endometrial ablation reported decreased bleeding: amenorrhea in 25 (40.3%), spotting in 19 (30.6%), and eumenorrhea in 10 (16.1%). None reported complications related to the procedure. LNG-IUSs were inserted into 8 patients who experienced continuous bleeding, 5 out of whom showed symptomatic improvement: spotting in 3 (4.9%) and eumenorrhea in 2 (3.2%). 3 patients in whom LNG-IUS had no effect received total abdominal hysterectomy. CONCLUSION: Hysteroscopic endometrial ablation as a surgical management of abnormal uterine bleeding developed in renal transplant patients is an effective and safe procedure.

Uterine Arterial Embolization for the Treatment of Uterine Leiomyomas

OBJECTIVE: The purpose of this study was to establish guidelines for using uterine artery embolization for the treatment of uterine leiomyomas accompanied by adenomyosis in Korea. This study was performed to investigate 1) the effects of uterine embolization on leiomyoma accompanied by adenomyosis, 2) the outcome of uterine embolization according to the embolization materials used, 3) the relationship between the Resistance Index (RI) and the change in uterine volume. MATERIALS AND METHODS: We performed a retrospective study on 37 women who had uterine leiomyomas accompanied by adenomyosis. Bilateral uterine artery embolization was performed over a period of 17 months in 37 patients (age range 25 - 65) experiencing pain, hypermenorrhea, urinary frequency, etc. due to leiomyomas. Ultrasound imaging was performed before the procedure and at mean 6.9 months after the procedure. RESULTS: All procedures were technically successful. Mean clinical follow-up time was 12.8 months. Minor complications occurred in 82% patients following the procedure. After follow-up imaging, the median uterine volume decreased by 34.4% and the dominant myoma volume decreased by 86%. There was no statistical difference in the uterine volume reduction and the dominant myoma size reduction, whether the occluding agent was polyvinyl alcohol, polyvinyl alcohol plus gelfoam, or gelfoam, and whether the ultrasound measured Resistance Index value before the procedure was low or high. CONCLUSION: Primary candidates for uterine artery embolization include those with symptomatic uterine leiomyomas, who no longer desire fertility, but who wish to avoid surgery or are poor surgical risks. According to the results of our study, adenomyosis should not be considered as a contraindication for uterine artery embolization. However, because little data is available about the subsequent reproductive potential following this procedure, it should not be routinely advocated for infertile women. Further investigation is warranted regarding the choice of occluding agent and the role of the Resistance Index.

Endometriosis in an Adolescent Population: the Severance Hospital in Korean Experience

The records of adolescent patients (10-21), who were admitted to the severance hospital between 1990 and 1999, were reviewed retrospectively to evaluate the age distribution, diagnosis, clinical stage, and treatment for endometriosis in adolescents. Thirty-nine patients who had undergone a laparotomy or laparoscopy and were diagnosed with endometriosis were identified. Endometriosis was classified according to the revised American Fertility Society classification (AFS). The chief symptoms leading to the diagnosis, clinical stage, age distribution, and treatment modality were reviewed. All patients, whose average age of menarche was 14.2, were diagnosed with endometriosis with an average interval of 5.9 years after menarche. The chief symptoms leading to the diagnosis were chronic pelvic pain (27%), acute pelvic pain (21%), a palpable pelvic mass (21%), and dysmenorrhea (18%). A laparoscopy was performed in 20 (51%). The majority of patients (44%) presented with the revised AFS classification stage II. Four patients (10%) presented with stage I, 11 (28%) with stage III and 7 (18%) with stage IV. Management after surgery included GnRH agonists (64.1%), expectant managements (25.7%), OCPs (5.1%) and danazol (5.1%). In adolescents with chronic pelvic pain, endometriosis is not rare. Therefore, early referal to a gynecologist to diagnose the etiology of the pelvic pain and initiate appropriate therapy is recommended.

Effect of Hysterectomy on Conserved Ovarian Function

The aim of this study was to assess the impact of premenopausal Total Abdominal Hysterectomy (TAH) on the function of the remaining ovaries by reviewing the menopausal age in TAH treated patients. We retrospectively reviewed the medical records of 510 women who had previously undergone TAH, either with or without unilateral salpingo-oophorectomy, due to benign disease at the department of Obstetrics and Gynecology, Yonsei University College of Medicine, between Jan 1989 and Dec 1992. Out of the 510 women, the 94 who were throughly followed up were included in the study, and their menopausal age based on patient symptoms was compared to that of the control group. The mean menopausal age in TAH treated patients was significantly lower than that of the control group (P < 0.001). There was a positive correlation between age at operation and menopausal age. From this study, we could conclude that TAH accelerated ovarian dysfunction, and that the younger the patient was at the time of operation, the earlier the onset of menopause. It is hence apparent that women treated with TAH are at risk of early menopause and should receive adequate hormone replacement therapy.

Carotid Intima Media Thickness (IMT) in Relation to Subclinical Atherosclerosis in Turner Syndrome / 대한산부인과학회잡지

OBJECTIVE: This study was undertaken to determine whether women with Turner syndrome have greater subclinical atherosclerosis and evaluate the relationship to risk factors for atherosclerosis. METHODS: 18 Women with Turner syndrome and 18 women as control group were measured the intima media thickness (IMT) of common carotid artery by B-mode ultrasound. We compared the IMT between cases and controls, and analyzed risk factors which affect the IMT. RESULTS: There are no differences between the groups in age and body mass index (BMI). The height was shorter (147.8+/-7.9 vs 160.3+/-5.9, p<0.001) and the waist-hip ratio (WHR) was significantly increased in Turner syndrome (0.86+/-0.04 vs 0.78+/-0.04, p<0.001). Fasting blood sugar (FBS) (90.1+/-9.9 vs 79.4+/-4.4 mg/dl, p<0.001), fasting insulin (9.5+/-3.0 vs 4.7+/-1.0 IU/ml, p=0.009), total cholesterol (187.1+/-21.3 vs 154.8+/-21.8 mg/dl, p=0.014), and LDL (111.3+/-10.0 vs 82.8+/-16.4 mg/dl, p=0.009) were significantly higher in Turner syndrome. Compare to control, the IMT was significantly increased in Turner syndrome (0.61+/-0.09 vs 0.49+/-0.02 mm, p=0.002). In the analysis of correlation between the IMT and clinical & biochemical characteristics, Turner syndrome status, WHR, FBS and fasting insulin were significantly affecting factors (Coefficients of correlation: 0.720, p<0.001; 0.671, P<0.001; 0.445, p=0.020; 0.904, p<0.001). CONCLUSION: These results suggested that women with Turner syndrome might have an increased risk of subclinical atherosclerosis and insulin resistance was most important risk factor.

Chromosomal Abnormality of Spontaneous Abortus in Relation to Transvaginal Ultrasonographic Finding / 대한산부인과학회잡지

OBJECTIVE: To investigate the importance of transvaginal ultrasonographic findings of spontaneous abortion and the relation of transvaginal ultrasonographic finding and the karyotype of abortus. MATERIALS AND METHODS: Transvaginal sonography was undergone to 48 subjects with spontaneous abortion in their early pregnancies who had visited Ewha Womans University Mokdong Hospital, from March 1996 to June 1999. A chromosome analysis of their aborted products was done. RESULTS: The frequency of chromosome abnormalities of abortus was 47.9%. Among the chromosomal abnormalities, trisomy was 31.2%(simple trisomy 27.0%, double trisomy 4.2%), monosomy X 8.4%, poliploidy 8.4%(tripoidy 4.2%, tetraploidy 4.2%). The average maternal age for trisomy was 30.2+/-4.9, and their past number of spontaneous abortions was 1.0+/-0.9, with trisomy 16 most frequent with 23.0%. In the case with trisomy 5, 22, and double trisomy, the average maternal age was increased with 38.0, 36.0+/-2.8, 35.5+/-5.0, respectively. However, no significant relevance could be found. The average maternal age for polyploidy was 30.5+/-3.7, and their past number of spontaneous abortions was 1.0+/-2.0. No significant relevance could be found compared with normal karyotypes. The average maternal age for monosomy X was 27.5+/-1.7, which is lower than the average maternal age for normal karyotypes, but not significantly so. The mean number of past abortions was no different with 1.0+/-0.8. No significant relevance could be found between ultrasonographic findings and chromosomal abnormalities. The measured/expected crown-rump length ratio of the aborted group was smaller than those of the control group. CONCLUSION: Serial ultrasonographic findings in early pregnancies help to diagnose spontaneous abortion, but not efficient to diagnose chromosomal abnormalities in the aborted group.

Uterine Arterial Embolization for the Treatment of Leiomyomas Accompanying with Adenomyosis / 대한불임학회지

OBJECTIVE: The purpose of this study was to make a guideline of uterine artery embolization for the treatment of uterine leiomyomas accompanying with adenomyosis in Korea. MATERIALS AND METHODS: We performed the retrospective study for 37 women who had uterine leiomyomas accompanying with adenomyosis. Bilateral uterine artery embolization was performed in 37 patients (age range 25-65) during 17 months with pain, hypermenorrhea, urinary frequency etc due to leiomyomas. Ultrasound imaging was performed before the procedure and at mean 6.9 months after the procedure. RESULTS: All procedures were technically successful. Mean clinical follow-up was 12.8 months. Minor complication occurred in 82% patients after the procedure. After imaging follow-up (mean, 6.9 months postprocedure), median uterine volume decreased 34.4%, and dominant myoma volume decreased 86%. There was no statistical difference in uterine volume reduction and dominant myoma size reduction whether occluding agents was polyvinyl alcohol, polyvinyl alcohol plus gelfoam, and gelfoam, and whether ultrasound measured Resistance Index value before the procedure was low or high. CONCLUSION: Primary candidates for uterine artery embolization include those with symptomatic uterine leiomyomas who no longer desire fertility but wish to avoid surgery or are poor surgical risks. To our study, uterine volume reduction and dominant myoma size reduction in patients who had adenomyosis were similar to previous other studies in patients who had not adenomyosis. Therefore adenomyosis should not be considered as a contraindication for uterine artery embolization. Because there is little data about subsequent reproductive potential after this procedure, it should not be routinely advocated for infertile women. Further investigation is warranted for occluding agents and Resistance Index.