Feasibility of laparoscopic salpingectomy using one port in tubal pregnancy / 대한산부인과내시경학회지

OBJECTIVE: To evaluate the feasibility of laparoscopic salpingectomy using one-port in tubal pregnancy compared to conventional laparoscopic surgery. METHODS: From June 2008 to June 2011, 63 women were treated with laparoscopic salpingectomy due to tubal pregnancy, which was diagnosed by ultrasonography. These patients were divided into two groups. Of these 63 patients, 32 women were treated with conventional laparoscopic salpingectomy (CLS) in group I, 31 women underwent laparoscopic salpingectomy using one port (OPLS) in group II. In group I, rigid 0degrees or 30degrees, 10 mm laparoscope, rigid instruments were used. In group II, 30degrees, 10 mm laparoscope, rigid or flexible angulated tip instruments were used during the surgery. We reviewed and compared clinical characteristics, clinical outcomes of these patients. RESULTS: Patients in Group I were compatible with the patients in group II in clinical characteristics. Clinical outcomes were not different between two groups in terms of Hemoglobin change (g/dL), hospital stay (days), hemoperitoneum (mL), transfusion. Mean operative time was significantly longer in group II (59.7+/-15.7 min vs. 46.5+/-15.0 min, p=0.001). The mean length of skin incision was obviously shorter in group II; the difference was highly statistically significant (15.5+/-3.0 mm vs 23.5+/-3.0 mm, p<0.001). CONCLUSION: It seems that OPLS is feasible alternative to CLS to treat hemodynamically stable patients without complications. Additionally, this technique also results in better cosmetic outcomes than CLS. Randomized prospective clinical studies with larger scale are necessary in the future to confirm these results.

A Case of Primary Ovarian Pregnancy / 대한산부인과학회지

Primary ovarian ectopic pregnancy has remained a rare event. It is difficult preoperatively to diagnose and differentiate ovarian pregnancy from hemorrhagic ovarian cyst and tubal ectopic pregnancy. However, improved diagnosis of acute hemoperitoneum of ovarian origin may reveal a higher incidence than reported earlier. The diagnostic criteria were described in 1878 by Spiegelberg, which comprise that the pregnancy is in the ovary and does not involve the tube. Ovarian pregnancy occurs within the ovary and on the corpus luteum, usually with rupture of the ovary and a massive hemoperitoneum. We report a relatively intact primary ovarian pregnancy with a brief review of the literatures.

Study of the Diagnostic Criteria for Gestational Diabetes Mellitus / 대한산부인과학회잡지

OBJECTIVE: To determine the effect of lowering the cutoff values of 3-hour oral glucose tolerance test (OGTT) for gestational diabetes mellitus (GDM). METHODS: Patients with an abnormal 50 gm glucose challenge test (GCT) of more than 130 mg/dL at 24-28 weeks of gestation underwent a 3-hour OGTT at 28-32 weeks of gestation. Patients were divided into four groups according to the criteria recommended by Carpenter-Coustan or National Diabetes Data Group (NDDG) (Control: 50 gm GCT negative [n=268], Borderline: 2 or more abnormal values met or exceeded Carpenter-Coustan criteria but not the NDDG criteria [n=100], NDDG I: 2 or more abnormal values met or exceeded NDDG criteria, [treated, n=70], NDDG II: [not treated, n=42]). Obstetric and perinatal outcomes were analyzed retrospectively. RESULTS: Of 5,827 pregnant women screened for GDM, 112 (1.9%) met the NDDG criteria, whereas 212 (3.6%) met the Carpenter-Coustan criteria. The incidences of poor maternal outcomes were 20.1%, 28.0%, 47.1%, 21.4%, and the incidences of poor neonatal outcomes were 3.7%, 6.0%, 14.3%, 16.7% in the four groups (p<0.05). Multivariable logistic regression analysis showed that 1) NDDG I showed an independent risk factor for poor maternal outcome (OR, 3.37), but the borderline group did not, 2) NDDG I showed an independent risk factor for poor neonatal outcome (OR, 3.87), but the borderline group did not, 3) the borderline group showed an independent risk factor for preterm delivery (OR, 2.67). CONCLUSION: Lowering the cutoff values would increase the number of pregnant women with GDM, while only minimally affecting the perinatal outcomes. Further large-scale prospective studies for Korean pregnant women may be needed.

The Significance of Normal 100 gm Oral Glucose Tolerance Test on Perinatal Outcomes / 대한산부인과학회잡지

OBJECTIVE: To evaluate perinatal outcomes in patients with abnormal 50 gm challenge test followed by normal 100 gm oral glucose tolerance test (OGTT) value. METHODS: We examined the pregnancy outcomes of 423 women classified as the study group with abnormal 50 gm oral glucose challenge test (OGCT) followed by normal 100 gm OGTT based on NDDG criteria. If the 1-hour plasma glucose value of 50 gm OGCT was over 130 mg/dL, the patient was scheduled for a full 3-hour 100 gm OGTT. 50 gm OGCT and 100 gm OGTT were administered at 24-28 and 28-32 weeks' gestation, respectively. The control group constituted of 467 age- and body mass index (BMI)-matched negative screenees. We defined poor maternal outcomes as those suffering from any one of hydramnios or oligohydramnios, preeclampsia, cesarean delivery due to cephalopelvic disproportion, dystocia, or fetal distress. We also defined poor neonatal outcomes as those suffering from any one of hyperbilirubinemia, hypoglycemia, congenital anomaly, admission to neonatal intensive care unit due to respiratory distress syndrome, or perinatal mortality. Retrospective review of outcomes of these patients was performed. Student t-test, Fisher's exact test and chi-square test were used to determine the statistical significance. RESULTS: There were no significant differences in demographic and obstetric characteristics between the control group and the study group. There were no significant differences in gestational age (38.7+/-1.5 vs 38.5+/-1.5 weeks), birth weight (3189.2+/-420.9 vs 3236.7+/-423.1 gm), between the groups. And there were no significant differences in preterm birth (6.2% vs 7.4%), large for gestational age births (4.5% vs 5.0%), intrauterine growth restriction (5.4% vs 4.3%) between the groups. There were no significant differences in poor maternal outcomes (15.6% vs 18.7%) and poor neonatal outcomes (3.9% vs 5.7%) between the groups. CONCLUSION: We conclude that abnormal value on 50 gm challenge test followed by normal 100 gm OGTT is not associated with adverse perinatal outcomes.

Intrauterine Intussusception Presenting as Transient Fetal Ascites / 대한주산의학회잡지

No abstract available.

Clinical outcomes of pregnancy showing one abnormal glucose tolerance test value / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical outcomes of pregnancies showing one abnormal glucose tolerance test value. Method: We performed 50 gm glucose challenge test in 5,019 pregnant women at 24-28 weeks of gestation. In 1,170 women with plasma glucose levels over 130 mg/dL, 100 gm oral glucose tolerance tests (OGTTs) were performed at 28-32 weeks of gestation. In the 888 cases who were followed up, according to the National Diabetes Data Group (NDDG) criteria, 122 cases with one abnormal 100 gm OGTT value were divided into three groups (groups 1, 2, 3 : abnormal value after 1, 2, 3 hours, respectively). These were compared with 577 cases (control group) with normal 100 gm OGTT value, retrospectively. Result: The incidence of one abnormal glucose tolerance test value was 2.6%, and there were no cases where the fasting plasma glucose level only was elevated. The incidence (control, group 1, group 2, group 3 : 19.4%, 43.8%, 25.7%, 29.6%) of poor maternal outcomes which contain any one of preeclampsia, hydramnios, cesarean delivery for cephalopelvic disproportion or failure to progress or fetal distress was highest in group 1 (p=0.025). The incidence (15.8%, 43.1%, 14.3%, 21.1%) of poor perinatal outcomes which contain any one of fetal distress, Apgar score of 5 minute < 7, hypoglycemia, respiratory distress syndrome, small for gestational age, perinatal death was also highest in group 1 (p=0.009). Logistic regression analysis for poor maternal outcomes showed odds ratio of 2.83 (95% confidence interval 1.02-7.87) in group 1 and 2.08 (95% confidence interval 1.22-3.55) in group 3, and for poor perinatal outcomes odds ratio of 4.24 (95% confidence interval 1.02-17.52) in group 1 and 3.30 (95% confidence interval 1.45- 7.48) in group 3. CONCLUSION: Pregnancies complicated with one abnormal glucose tolerance test value, particularly the group showing abnormal glucose tolerance test value after 1 or 3 hour exhibited adverse maternal and perinatal outcomes.

A Clinical Review of the HELLP Syndrome / 대한주산의학회잡지

No abstract available.

A Case of Unruptured Non - communicating Rudimentary Horn Pregnancy Progressed to the Third Trimester of Pregnancy / 대한산부인과학회잡지

The uterus with rudimentary horn occurs as a result of a lack of development during fetal life of the middle and lower parts of one of the Miillerian ducts, in which there is a failure of fusion of the two ducts, The incidence of this uterine anomaly is rare. Many cases of rudimentary uterine horn are not discovered since they do not become involved in a pregnancy, and thus remain symptomless and uncomplicated, and the diagnosis usually being made only with pregnancy with rupture. In this presentation, we describe a case of diagnosis and management of unruptured non-communicating rudimentary uterine horn pregnancy at the third trimester. The patient diagnosed by ultrasonography and MRI, was hospitalized for further evaluation and delivery under the impression of unruptured non-communicating rudimentary horn pregnancy. A living male infant weighing 1,930 gm was delivered by cesarean section at 33+l weeks due to impending preterm labor. Some articles concerned this subject were reviewed briefly to discuss relevant method of diagnosis, treatment, and clinical characteristics.

Clinical Analysis of 1,068 Cases of Mid-trimester Genetic Amniocentesis / 대한산부인과학회잡지

OBJECTIVES: The objective of this study is to analyze 1,068 cases of prenatal genetic amniocentesis and to compare the results with reported studies. METHOD: We analyzed 1,068 cases of midtrimester prenatal genetic amniocenteses from September 1994 to February 1999, and investigated the fetal chromosomal abnormality, obstetric outcomes and complications by the indications of genetic amniocentesis and prophylactic antibiotic use at the Department of Obstetrics and Gynecology, Ajou University School of Medicine. RESULTS: Abnormal maternal serum markers were the most common indication of amniocentesis (57.7%) and the most common age distribution was 25-29 years (39.2%). One case of early amniocentesis (14 gestational weeks) was performed. The overall incidence of chromosomal aberration was 5.2% (56/1,068), of which there were 28 cases (50.0%; 28/56) of numerical aberrations and 28 cases (50.0%; 28/56) of structural aberrations. There were 50 cases (4.7%) of autosomal chromosomal aberrations and 6 cases (0.6%) of sex chromosomal aberrations. The pregnancy outcome was full-term delivery in 86.5%, preterm delivery in 7.6%, termination of pregnancy in 4.0%. There were no cases of serious complications including fetal death except for a case of self-limited amniotic fluid leakage(high leakage) in which the pregnancy was maintained. There were no significant differences between prophylactic antibiotics user group and non-user group in obstetric complications and outcomes. CONCLUSION: We could confirm that the trend in the indication of genetic amniocentesis had changed from advanced maternal age(35 year-old) toward abnormal maternal serum marker(triple test), and we recognized the importance of genetic amniocentesis according to the various antenatal screening tests of maternal serum marker, antenatal ultrasound, past history of fetal anomaly or family history of fetal chromosomal anomaly in the younger age groups(< 35 year-old) that are involved in more than half of the chromosomal anomaly. Further study will be needed to elucidate the efficacy of using prophylactic antibiotics in amniocentesis.