A clinical study on macrosomia / 대한산부인과학회지

OBJECTIVE: Macrosomia is one of the important problems in obstetrics and perinatology. This study was to investigate the changing trend in incidence, area distribution, and other relavant factors of macrosomia. METHODS: We studied 2,206 cases of large babies weighing 4,000 g or more among 72,084 deliveries at Catholic Medical College Hospital from Jan. 1, 1993 to Dec. 31, 2003. The cases were divided into two group, one group from 1993 to 1998 (group I), the other group from 1998 to 2003 (group II). RESULTS: The incidence of large babies weighing 4,000 g or more was 3.06%. The incidence of macrosomia in group I was 3.02%, and that from group II was 3.14% (P=0.149). The incidence of macrosomia throughout the country was 2.5-3.3%. The average body weight of macrosomia was raised by 30 g from 4,218 +/- 224 g in group I to 4,248 +/- 246 g. in group II (P=0.003). The average of maternal body weight was raised by 246 g from 73.12 +/- 9.08 kg in group I to 75.56 +/- 9.64 kg in group II (P<0.001). According to gestational age, the percentage of macrosomia less than 38 weeks was 5.0%, that during 38 weeks and 40 weeks was 39.4%, that during 40 weeks and 42 weeks was 53.4%, more than 42 weeks was 2.2% in group I, and that in group II was 6.2%, 46.1%, 44.1%, and 3.6%, respectively. Male fetuses were 927 cases (64.69%), and female fetuses were 506 cases (35.31) in group I, and those in group II were 520 cases (67.27%), and 253 cases (32.73%), respectively. CONCLUSION: There is no change in the incidence of macrosomia past 11 years. There is no significant difference in the incidence of macrosomia throughout the country. Maternal body weight may associated with fetal body weight. Gestational weeks in group II were earlier, that in group II. Sex ratio was similar in the two groups, and male was predominant.

Effectiveness of sacrospinous colpopexy in vault prolapse patients / 대한산부인과학회지

OBJECTIVE: To evaluate the effectiveness of sacrospinous colpopexy in vault prolapse patients. METHODS: It is the retrospective study including 10 vault prolapse patients who received sacrospinous colpopexy at St. Paul Hospital, the Catholic University from July 1999 to April 2004. RESULTS: The 10 patients receiving sacrospinous colpopexy had the average age of 58.9 years, and the parity of 3.4. They were moderately overweighted with average BMI of 24.5. The average period from hysterectomy to diagnosis of vault prolapse was 11.1 years. Hypertension was noted on most of patients (70.0%). The average operation time was 68.5 minutes and postoperative hemoglobin decrement was 2.4 on average. During 2-month period of postoperative follow-up, there were no significant complications noted except one case of wound infection associated with diabetes and one case of transfusion due to anemia. After sacrospinous colpopexy, protruding mass out of vagina was resolved on 100% and urologic and other complications were improved over 50% of cases. CONCLUSION: Considering that several underlying medical conditions such as hypertension, obesity are associated with vault prolapse patients, sacrospinous colpopexy in case of vault prolapse is an excellent operative approach with low complication and recurrence rates.

A Case of Primary Peritoneal Serous Papillary Carcinoma / 대한산부인과학회잡지

Primary peritoneal serous papillary carcinoma (PPSPC) is a rare tumor that originates from a single or multicentric foci of peritoneum. Histologically the disease resembles primary serous papillary carcinoma of the ovary, but either involves the ovarian surface microscopically only or spares the ovaries entirely. Currently PPSPC is evaluated, staged and treated in the same way as epithelial ovarian cancer. We experienced one case of primary peritoneal serous papillary carcinoma which achieved a complete remission with carboplatin and paclitaxel, and report this with brief review of the literatures.

Prenatal Diagnosis of Yq Deletion by Cytogenetic and Fluorescence in Situ Hybridization / 대한주산의학회잡지

OBJECTIVE: The accurate evaluation of a marker chromosome has been limited during prenatal karyotyping. We proposed a method of step-by-step approach to evaluate the origin of a marker chromosome. METHODS: A patient with 19 weeks of gestation was transferred to our hospital for karyotyping due to abnormal Triple test. Karyotyping of amniotic fluid was performed. NOR (nucleolar organizer region) banding and FISH (fluorescence in situ hybridization) using two types of sex chromosome probes: chromosome X alpha satellite probe (DXZI) & chromosome Y alpha satellite probe (DYZ3)(Cytocell, Bambury, UK) and CEP X/Y (Xp11.1-q11.1 CEP X alpha satellite & Yq12 CEP Y satellite III)(Vysis, IL, USA) were done. RESULTS: The routine chromosomal analysis showed 46,X,+mar. As the result of NOR banding, we supposed that the marker chromosome was less likely originated from acrocentric chromosomes. FISH analysis revealed Y centromere signal on marker chromosome, but Yq12 signal was not detected. Therefore the marker chromosome was identified as Y chromosome formed by deletion at Yq11.2. CONCLUSION: This study demonstrated that FISH and NOR banding technique is more effective method for a marker chromosome evaluation during prenatal karyotyping.

A Case of Vaginal Prolapse after McIndoe Operation Managed by Transvaginal Sacrospinous Colpopexy / 대한산부인과학회잡지

McIndoe procedure using the colonic segment has been used in treatment of patients with Mullerian agenesis. Prolapse of a colonic neovagina is rare condition and its treatment is not yet standardized. We experienced a case of neovaginal prolapse following McIndoe procedure using colonic segment. A 51-year-old woman developed prolapse of a neovagina 17 years after the McIndoe operation. She had been diagnosed to have Mullerian agenesis and was managed by McIndoe operation using colonic segment. The prolapse was successfully managed with transvaginal sacrospinous colpopexy. She has no sign of recurrent prolapse and is satisfied with sexual intercourse. Patients with neovaginal prolapse following McIndoe procedure can be treated successfully with transvaginal sacrospinous colpopexy.

A case of Necrotizing Fascitis after Cesarean Section / 대한산부인과학회잡지

The necrotizing fascitis, that develops after a Cesarean section, is acknowledged as a rare complication due to the development of antibiotics. Having a very high mortality rate, the only way to prevent the septic shock and the impairment of the cardiopulomary function is the use of adequate antibiotics, the infusion of IV fluids, a radical section of the necrotized fascia and a through cleansing. We have an experience in treating a primipara who had a necrotic fascitis after Cesarean section, and therefore, report this case with the review of articles enclosed.