The risk factors of emergency cesarean hysterectomy for placenta previa / 대한산부인과학회지

OBJECTIVES: The purpose of this study is to investigate the clinical risk factors of emergency cesarean hysterectomy in patients with pregnancies complicated by placenta previa and whether the third trimester transvaginal ultrasonographic findings of placenta previa would predict emergency cesarean hysterectomy. MATERIALS AND METHODS: Between January 1995 and March 2005, we retrospectively reviewed the records and compared between patients with pregnancies complicated by placenta previa who underwent cesarean hysterectomy and patients with pregnancies complicated by placenta previa who did not undergo cesarean hysterectomy. RESULTS: There were 314 had placenta previa and 34 patients were performed cesarean hysterectomy (10.83%). There were significant differences on the basis of maternal age (31.53+/-4.41 vs 34.06+/-4.12, p<0.05), parity (0.81+/-0.70 vs 1.29+/-0.63, p<0.05) , the number of cesarean section (0.36+/-0.56 vs 0.91+/-0.75, p<0.05), previous history of placenta previa and presence of placenta accreta, but not on the basis of gestational age, the number of antenatal vaginal bleeding, the number of abortions and emergency operation between two groups. On the basis of third trimester transvaginal ultrasonographic findings, significant differences were found on the distances from the internal os of cervix (1.18+/-3.66 vs 2.67+/-2.94, p<0.05) and thickness of lower placental edge. However, the presence of lacuna in the lower placenta was not associated with emergency hysterectomy. CONCLUSIONS: Patients with placenta previa are at a higher risk of undergoing cesarean hysterectomy when they are associated with placenta accreta, thick lower placenta edge, and positively longer distance to the internal os of cervix. The other clinical factors such as maternal age, parity, the number of cesarean section and previous history of placenta previa might be associated the risk of cesarean hysterectomy.

Prognostic outcome of patients with clinical stage I-II endometrial cancer according to bilateral salpino-oophorectomy / 대한산부인과학회지

OBJECTIVE: The aim of this study is to verify the clinical outcome of staging surgery with and (or) without bilateral salpingo-oophorectomy (BSO) in clinical stage I-II endometrial cancer patients. METHODS: We reviewed the medical records of 178 surgically treated patients in clinical stage I-II endometrial cancer between January 1994 and December 2004. Overall survival (OS) and disease free survival (DFS) were analyzed by using data gathered from the National Statistics Office. The clinical outcome was compared between patients who underwent hysterectomy with and without BSO. RESULTS: One hundred sixty patients were in clinical stage I, and 18 patients were in clinical stage II. Most of the cases showed endometrioid (93.8%) in histology and G1 (56.1%) in differentiation. BSO was performed in 142 patients. Surgico-pathological features of two group are not different but the group without BSO were younger (40.7 vs. 55.8 years old) and less myometrial invasion than the group with BSO. After mean 39.27 months follow up, we found no difference in OS and DFS between the two groups with BSO and without BSO. No factors except stage were significantly related with OS and DFS by multivariate Cox regression analysis. The rate of pelvic and paraaortic lymph node metastasis was not different between two groups. CONCLUSION: The retrospective data in the study reveals that staging surgery with and without BSO does not affect OS and DFS in clinical stage I-II endometrial cancer patients. In limited cases, such as young women, omitting BSO can be considered carefully.

Study of Obstetric Outcomes in Congenital Uterine Malformations / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to establish the distribution and obstetric outcomes in women with congenital uterine malformations. METHODS: A review of the medical records from the department of obstetrics and gynecology from January 1995 to June 2004 were diagnosed 79 patients with congenital uterine malformations. All of the cases were divided into groups according to classification of ASRM (American Society for Reproductive Medicine), which is based on the degree of failure of normal development of the female genital tact. The obstetric outcomes were compared between the groups. Statistical processing of the material was carried with Pearson chi square test. RESULTS: 79 patientss with congenital uterine malformations were diagnosed by operation or imaging studies. Symmetric congenital uterine malformations, consisting of bicornuate uterus (45.6%), septate uterus (19.0%), and uterus didelphys (31.6%), were the most common, constituting 96.2% of the malformations. Two patients (2.5%) had unicornuate uterus and one patient (1.3%) had arcuate uterus. No cases of the agenesis type and T-shaped uteri were found. 196 pregnancies occurred in the 74 patients. Only 43.4% of the pregnancies reached term, while 8.2% resulted in preterm delivery, and 48.4% terminated as miscarriages. CONCLUSION: Obstetric complications occur more frequently among women with congenital uterine malformations than among women in general. Knowledge concerning of congenital uterine malformations is important in recognizing and managing the obstetric complications that may result.

A case of Vascular Anastomoses in Dichorionic Diamniotic-Fused Placentas Resulting in "Pseudo" Twin-to-Twin Transfusion Syndrome / 대한산부인과학회지

Virtually all monochorionic twin placentas contain vascular connections between the circulatory domains of each twin. In contrast, vascular anastomoses are generally thought not to occur in fused, dichorionic placentation. In the twin-to-twin transfusion syndrome (TTTS) one twin is preferentially perfused by blood from the cotwin via unbalanced placental vascular anastomoses. This vascular shunting results in twins born with discrepant weights, colors and hemoglobins. When one of the TTTS criteria was not present, the pregnancy was defined as "pseudo" TTTS. In pregnancies complicated by "pseudo" TTTS indicate that small twins have abnormal cord insertion more frequently than large twins. We present a case of vascular anastomoses in dichorionic diamniotic-fused placentas resulting in "pseudo" TTTS with a brief review of the literatures concerned.