Chylous ascites, following radical hysterectomy with pelvic lymph node dissection in a patient with cervical cancer / 대한산부인과학회지

Chylous ascites is a disorder caused by various diseases and conditions that interfere with the abdominal or retroperitoneal lymphatics. There are several gynecologic reports on chylous ascites with radiation therapy and para-aortic lymph node dissection. However, the report of chylous ascites caused by performing only pelvic lymph node dissection was extremely rare. In most cases after surgical trauma, it is resolved after dietary managements but it may be associated with serious nutritional and immunologic consequences due to the constant loss of protein and lymphocytes. The authors experienced a 42-year-old woman with cervical cancer Ib1 who presented with chylous ascites after a radical hysterectomy and bilateral pelvic lymph node dissection. She was successfully managed by fasting and low fat diet. We report this case of chylous ascites following pelvic lymph node dissection with a brief review of literature.

Clinical study of unusual ectopic pregnancies / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the clinical characteristics and the management of the unusual ectopic pregnancies. METHODS: Sixty one patients who were diagnosed as unusual ectopic pregnancies in the Department of Obstetrics and Gynecology, Inje University Ilsan Paik Hospital from December 1999 to June 2006, were retrospectively analyzed. The chief complaints, past histories, time of diagnosis, serum beta-hCG concentrations and method of the management were reviewed. RESULTS: During the designated study period, the incidence rate of the ectopic pregnancy was 9.5% of the all deliveries and that of the unusual ectopic pregnancy was 18.8% of the total ectopic pregnancies. In twenty two cases, implantation sites were not found out exactly by sonography at initial diagnosis. Theses ectopic pregnancies were cornual pregnancy (3 cases), ovarian pregnancy (6 cases), abdominal pregnancy (3 cases), and unclassified unusual ectopic pregnancy (10 cases). Unusual ectopic pregnancies which were diagnosed before six weeks of gestation were eleven cases. These unusual ectopic pregnancies were 6 cases in cervical pregnancy, 1 case in abdominal pregnancy, and 4 cases in unclassified unusual ectopic pregnancy. Initial mean serum beta-hCG concentration was the highest in cornual pregnancies and the lowest in abdominal pregnancies. MTX (methotrexate) was administered in seven cases, operation was done in forty six cases, and expectant management was done in nine cases. All initial treatment was successful except one case with cornual pregnancy, which was MTX administered with alternative regimen. CONCLUSIONS: In our study the diagnostic accuracy of the unusual ectopic pregnancy was 63.9% and the successful treatment was done in 98.3% of them. There were significant statistical differences between the serum beta-hCG concentrations and the kinds of unusual ectopic pregnancies (p<0.001).

Sonographic Diagnosis of Fetal Intracranial Hemorrhage in a Gravida on Warfarin Therapy

A 34-year-old Korean woman who had been taking warfarin for 14 years after mitral valve replacement became pregnant. She was heparinized betwen 6 and14 weeks of gestation and was then restarted on oral anticoagulants. At 32 weeks of gestation, fetal ultrasonography revealed overt enlargement of the left lateral ventricles. There was an echogenic mass in the right hemisphere with mild ventricular enlargement. An elective repeat cesarean section was performed. Three days later, the neonate underwent a Burr-hole procedure, from which bloody fluid was drained and the intracranial hemorrhage was confirmed. We must keep in mind the severe adverse fetal outcomes associated with warfarin-induced fetal intracranial hemorrhage during pregnancy. Despite its therapeutic advantages, regular fetal monitoring, ultrasonography, and management of prothrombin time are needed.

A retrospective cohort study of maternal and perinatal risk factors on intrauterine fetal death / 대한산부인과학회지

OBJECTIVES: The purpose of this study was to investigate the clinical characteristics and the risk factors of Intrauterine fetal death (IUFD). METHODS: We did retrospective review and investigated the risk factors from medical records of the 62 pregnancies with IUFD between January 2000 and December 2007. Also we statistically analyzed that maternal and perinatal risk factors compared with 3,887 live-birth pregnancies. RESULTS: The overall incidence of IUFD was 1.57%. The age distribution of mother with IUFD was between 21 to 41, and was highest in the 30 to 34 year old age group (41.94%). There were 29 cases (46.78%) with nulliparous and 5 cases (8.06%) with previous IUFD. IUFD was the most prevalent (48.39%) at 20-29 weeks of gestation and the sex ratio of male versus female fetus was 1.03:1. Most of cases (80.64%) were delivered vaginally (spontaneous labor: 62.90%, labor induction: 17.74%), and laparotomy was 19.35%. Risk factors were maternal obesity, infection, placental abnormality, advanced maternal age (> or =35), and unexplained cause in that order. 50 cases included more than two risk factors. The risk analysis showed statistically significant risk in preeclampsia (OR 2.733; 95% CI 1.408-5.306) and placental abruption (OR 5.190; 95% CI 2.165-12.441). CONCLUSION: Identification of risk factors for IUFD assists the clinician in performing a risk assessment for each patient. Clinicians need to be able to assess each patient's risk for IUFD and to have a low threshold to evaluate fetal growth in at-risk pregnancies.