Women with Endometriosis, Especially Those Who Conceived with Assisted Reproductive Technology, Have Increased Risk of Placenta Previa: Meta-analyses

BACKGROUND: Many women with endometriosis have become pregnant through assisted reproductive technology (ART), and have often experienced placenta previa (PP) during pregnancy. The objective of this study was to assess the association between women with endometriosis, especially those who conceived with ART, and the risk of PP. METHODS: Two reviewers independently determined studies that were considered suitable for meta-analyses published in various medicine-related databases from March 1, 2004 through July 31, 2017 without language restrictions. Eight studies met the inclusion criteria, with a combined sample size of 21,930 women. Of these 21,930 pregnancies, 6,256 had endometriosis (endometriosis) and 15,674 had no endometriosis. Four of these studies included 8,161 women who conceived with ART, 1,640 of whom had endometriosis (endometriosis + ART), and 6,521 of whom did not have endometriosis. Meta-analyses were estimated with odds ratios (ORs) and 95% confidence intervals (CIs) using random effect analysis according to heterogeneity of studies. RESULTS: These meta-analyses showed women with endometriosis (endometriosis) have an increased risk of PP (OR, 4.038; 95% CI, 2.291–7.116; P = 0.000). These results showed women who conceived with ART (endometriosis + ART), have a substantially increased risk of PP (OR, 5.543; 95% CI, 1.659–18.523; P = 0.005). CONCLUSION: These meta-analyses demonstrate women with endometriosis have an increased risk of PP.

Acute Sheehan's Syndrome Associated with Postpartum Hemorrhage

Sheehan's syndrome is postpartum hypopituitarism due to the necrosis of the pituitary gland. Usually, it is the result of severe hypotension caused by massive hemorrhage during or after delivery. A 40-year-old woman who had been performed cesarean section delivery was complicated by hemorrhage due to uterine atony. After transfusion and hysterectomy, she is gradually recovering her general condition. On 16th day after operation, she visited emergency room in critical condition with nausea, vomiting, and general weakness and laboratory finding was hyponatremia. So, we medicated her with hydrocortisone and thyroxine. Sheehan's syndrome should be considered in the differential diagnosis of hyponatremia in the early postpartum period.

A Case of Thrombotic Thrombocytopenic Purpura associated with Clopidogrel in a Patient with Acute Cerebral Infarction / 대한내과학회지

Clopidogrel is an antiplatelet agent prescribed widely to prevent stent thrombosis after coronary or peripheral vascular interventions and for stroke prophylaxis. The side effects of this drug include gastrointestinal symptoms, such as nausea, abdominal pain, vomiting, and bleeding. Thrombotic thrombocytopenia purpura (TTP) is a rare complication of this drug. Here, we report a case of clopidogrel-associated TTP in a patient with cerebral infarction. To our knowledge, it is first reported case of clopidogrel-associated TTP in Korea.

A Case of Thrombotic Thrombocytopenic Purpura associated with Clopidogrel in a Patient with Acute Cerebral Infarction / 대한내과학회지

Clopidogrel is an antiplatelet agent prescribed widely to prevent stent thrombosis after coronary or peripheral vascular interventions and for stroke prophylaxis. The side effects of this drug include gastrointestinal symptoms, such as nausea, abdominal pain, vomiting, and bleeding. Thrombotic thrombocytopenia purpura (TTP) is a rare complication of this drug. Here, we report a case of clopidogrel-associated TTP in a patient with cerebral infarction. To our knowledge, it is first reported case of clopidogrel-associated TTP in Korea.