Effectiveness of Sengstaken-Blankemore tube to control postpartum hemorrhage / 대한산부인과학회지

OBJECTIVE: To evaluate the effectiveness and identify the role of interventional procedure of tamponade treatment with modified Sengstaken-Blankemore (S-B) tube on control of postpartum hemorrhage (PPH) unresponsive to conventional medical treatment. METHODS: This study was performed retrospectively on the clinical records of 90 patients who had experienced PPH at the department of Obstetrics and Gynecology of OO University Hospital from February, 2000 to September, 2005. We have actively applied tamponade balloon since 2004. As a result, tamponade balloon were applied to 17 patients. Medical records were reviewed such as clinical status, cause of bleeding, volume of balloon, duration of balloon, complication, success rate and additional treatment. RESULTS: We have overall success rate of tamponade balloon in 11 (64.7%) of 17 patients of PPH. The causes of bleeding were subinvolution of uterus (100%), uterine atony (80%) and abnormal placentation (20%) in order of success rate. There was no major complication related to the tamponade procedure. We had compared final treatment during two period (before tamponade use v.s after tamponade use). 15 (33.3%) received invasive procedure and 8 (17.8%) received hysterectomy before tamponade use. However 10 (22.2%) received invasive procedure and just 1 (2.2%) received hysterectomy after tamponade use. CONCLUSION: Tamponade with modified S-B tube is effective on PPH unresponsive to conventional medical treatment and cuts down additional invasive procedure when tamponade treatment failed.

A case of abdominal pregnancy confirmed by laparoscopy / 대한산부인과학회지

Approximately 1% of ectopic pregnancies are abdominal pregnancies and these may cause life-threatening bleeding and complications. Because of it's high maternal mortality and morbidity, early diagnosis and prompt decision making is important. But the clinical manifestation and physical examination is not specific, so early diagnosis and management is difficult. Presented here is a case of primary abdominal pregnancy. A 31-year-old woman presented with lower abdominal pain at 8 weeks of gestation. Diagnostic transvaginal ultrasound revealed large amount of peritoneal fluid, no intrauterine sac, and mass on left adnexa. Laparoscopy was performed and abdominal pregnancy on the rectal serosa was confirmed. We experienced a case of abdominal pregnancy which treated with laparoscopy without complications and present it with a review of the literature.

Comparison of Hospital stay and Cost-effectiveness between Treatment Modalities in Ectopic Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the hospital stay and cost-effectiveness between treatment modalities in ectopic pregnancy for proper management. METHODS: In this study, the authors studied 121 cases retrospectively who had been admitted and treated at Department of Obstetrics and Gynecology, Konyang University Hospital from February 1, 2000 to August 31, 2003. We analyzed clinical features, treatment modality, hospital stay and cost-effectiveness between each groups. One-way ANOVA test was used and p<0.05 was regarded as statistically significant. RESULTS: There was no difference in clinical features between treatment modalites. Of total 121 cases, operative procedures were done in 105 cases (explo-laparotomy in 58, laparoscopy in 43, dilatation and curettage in 4) and medical treatment in 16 cases (Multiple dose methotrexate protocol in 11, Single dose methotrexate protocol in 5). Average of length of hospital stay was 5.3 +/- 0.2 days in explo-laparotomy, 3.8 +/- 0.2 days in laparoscopy, 2.8 +/- 1.4 days in dilatation and curettage, 6.5 +/- 0.5 days in multiple dose methotrexate protocol, 2.4 +/- 0.4 days in single dose methotrexate protocol. According to treatment modality, there was significant difference in total cost and cost sharing. Total cost in explo-laparotomy (875,324 +/- 25,977 Won) was more expensive than that of laparoscopy (734,375 +/- 35,179 Won). But, cost sharing in explo-laparotomy (156,543 +/- 9,583 Won) was less expensive than laparoscopy (319,493 +/- 26,255 Won). Total cost and cost sharing in multiple dose methotrexate protocol (323,231 +/- 33,972 Won, 184,465 +/- 17,344 Won) was more expensive than that of Single methotrexate protocol (192,495 +/- 31,180 Won, 68,793 +/- 13,422 Won). CONCLUSION: Based on these results, it is very important that we should have an interest in ectopic pregnancy for early detection and proper management. Consequently, Achievement of precise decision and successful methotrexate treatment can be possible to decrease hospital stay and cost-effectiveness.