Pregnancy Outcome in Renal Transplant Recipients: A Retrospective Study / 대한주산의학회잡지

OBJECTIVE: The aim of our study was to identify graft, obstetric and maternal outcomes of pregnancies in renal transplant recipients at our center. METHODS: A 14-year retrospective study between January 1990 and December 2003, 224 women 15 to 45 years of age had transplantation and were analyzed the outcomes of pregnancies, obstetric complications and graft function. RESULTS: Thirty-four pregnancies occurred in 21 of 224 patients. The mean age at the time of conception was 29.5 years (21 to 36 years) with a mean interval of 61.9 months (one to 162 months). In the pregnancy outcome, there were the 23 live births (67.6%) included 13 preterm and 10 term deliveries, 3 spontaneous abortions (8.8%), 7 artificial abortions (20.5%) and one case of ectopic pregnancy (2.9%). Obstetric complications were; preeclampsia (39.1%), preterm labor (43.4%), urinary tract infections (38.2%) and gestational diabetes (8.6%). Nine pregnancies within 2 years of transplantation had the permissible obstetric outcomes comparing with the others after 2 years (spontaneous abortion: p=0.77, artificial abortion: p=0.88, live birth: p=0.36). In twelve pregnancies appearing renal dysfunction associated with pregnancy, the abortion rate was increased comparing the others with stable renal function (p=0.006). Pre-pregnancy serum creatinine > or =1.4 mg/dl was associated with increased preterm delivery, but not significant (50.0% vs 28.5%, p=0.30). In graft function, serum creatinine 3~6 postpartum was significantly increased comparing pre-pregnancy levels (p=0.04). Five cases of 7 patients with acute rejection episode associated with pregnancy conceived after 4 years of transplantation. Two-year graft survival after delivery was 95.2% (20/21) and chronic rejection and graft failure was diagnosed in one case at postpartum 14 months. CONCLUSION: These findings suggest that, if the graft function is stable, pregnancy within 2 years after renal transplantation might be safe. Pregnancy does not appear to have adverse effects on long term graft survival.

Uterine arteriovenous malformations associated with pregnancy: An uncommon cause of severe uterine bleeding / 대한산부인과학회지

Uterine arteriovenous malformations are considered very rare conditions, potentially life-threatening lesions combined with various degrees of menorrhagia, postpartum bleeding, postmenopausal bleeding, an asymptomatic mass, and congestive heart failure. Clinical suspicion is essential for a prompt diagnosis and treatment. They may be diagnosed by gray-scale ultrasonography and Color Doppler imaging. Additionally, they can be detected using contrast material-enhanced computed tomography (CT), conventional angiography, hysteroscopy and hysterosalpingogram. More recently, diagnosis of uterine AVM with magnetic resonance imaging (MRI) has been reported. In the past, laparotomy with uterine artery ligation or hysterectomy was the only treatment available. However, successful conservative management with embolization of the affected vessels or methylergonovine maleate has been reported recently. A 37-year-old woman, gravida 3, para 1, presented with massive uterine bleeding that started abruptly four weeks after D and C. We promptly performed non-invasive diagnositic evaluations including color Doppler, MRI and MRA, with a clinical impression of uterine AVM. In this case, we describe the appropriate diagnosis and management of uterine AVMs with literatures.

Acute appendicitis in pregnancy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical course and pregnancy outcome, according to perforation or no perforation of appendix, in the patients who went through the appendectomy for acute appendicitis during pregnancy. METHODS: We reviewed the chart of paients who went through the appendectomy for acute appendicitis during pregnancy in department of general surgery of the Catholic University of Korea Holy Family Hospital and St. mary's Hospital from January 1994 to May 2004. RESULTS: The incidence rate of acute appendicitis during pregnancy (56.1%) was highest at the 2nd trimester of pregnancy. There was not significant difference in clinical course, subjective symptoms, physical examination results, and the incidence rate of leukocytosis between non-perforated appendicitis (NPAPP) group and perforated appendicits (PAPP) group. The incidence rate of pregnancy loss that was spontaneous abortion and intrauterine fetal death, was 2.9% in NPAPP group and 7.7% in PAPP group, but, there was not significant differnence between two groups. There was not also significant difference in the incidence rate of low birth weight for gestational age. We could find nothing for fetal anomaly. Finally, the term delivery rate was 92.8% and 92.3% in each of the two groups, and patients had no obstetrical and surgical complications. CONCLUSION: In this study, we could find that perforation or no perforation of appendix wieghed with the clinical course, objective symptoms, examination results, and pregnancy outcome of patients. But, we thought that the larger population of perforation group would be needed for more accurate results.

A Case of Fetal Skin Bullae after Amnioinfusion / 대한산부인과학회잡지

Premature rupture of membrane generally leads to a poor perinatal outcome. For better perinatal survival, transabdominal prophylatic amnioinfusion and active expectant management was performed. We experienced a case of fetal right arm multiple skin bullae and stomach perforation after amnioinfusion. Underskin bullae was to disappear within a few days and stomach perforation site was treated by primary closure.

The risk factors of residual disease after conization / 대한산부인과학회잡지

OBJECTIVE: Conization is used for diagnosis and treatment of cervical neoplasia. Our purpose of this investigation is to determine the efficacy of loop conization for the treatment of cervical dysplasia and the significance of the clinical and histological factors used to predict residual dysplasia after loop conization. METHODS: We reviewed the charts of patients who were received conization and subsequently total hysterectomy at Kangnam St Mary Hospital during 1989 and 2000. Logistic regression and Chi-square test were used for analysis. RESULTS: Total 257 patients were included. The mean age of the patients was 44.7 years. Of these patients, 87 (33.8%) had residual disease in the hysterectomy specimens. Age, the involvement of cut surface of endocervix and exocervix, severity and extent of the lesion, and scattering lesion were associated with the residual disease. But preoperative HPV infection, which is known as the cause of cervical neoplasia was not associated with the residual disease. CONCLUSION: When the high risk factors are present, the validity of conservative treatment should be considered and more careful follow up with pap smear, HPV test and colposcopy is necessary. Because about one thirds of patient has residual disease after conization, LEEP conization should be used for diagnosis of cervical neoplasia rather than treatment.