Angular pregnancy complicated with preterm labor at 25 gestational weeks of pregnancy / 대한산부인과학회지

Angular pregnancy refers to implantation of the embryo just medial to uterotubal junction in the lateral angle of the uterine cavity. This is differentiated from interstitial pregnancy in which the gestational sac is located within intramural portion of the tube. Angular pregnancy is categorized as intrauterine pregnancy and the outcome is known favorable. However, there have been few reports about adverse perinatal complications such as abortion, retained placenta, placenta accreta, placenta percreta and uterine rupture. We report a case of angular pregnancy complicated with preterm labor at 25 gestational weeks, placenta accreta and postpartum endometritis. This case suggests that angular pregnancy should be differentiated from normal intrauterine pregnancy because of its potential risk of adverse outcome.

Postpartum Endometritis in Ulaanbaatar City / Монголын Анагаах Ухаан

Endometritis is a common complication of the postpartum period. It is still a significant cause of maternal morbidity and, rarely, mortality. The term endometritis basically refers to infection of the endometrium or deciduas with extension into the myometrium. Other terms that have been used to define this infection include metritis, myometritis, endomyometritis, and puerperal sepsis. Involvement of the parametrial tissue is termed parametritis. By foreign researchers, the incidence of endometritis varies significantly depending on the population studied and, more importantly, on the method of delivery, i.e., vaginal vs. cesarean section. The risk of developing endometritis following vaginal delivery is estimated to be between 1 and 3%. But the after cesarean section it occurs about 10-20%. By Sebastian Faro (1990), the bacteria most commonly isolated from the inner uterine surface of patients with acute postpartum endometritis are Streptococcus agalactiae, Streptococcus faecalis, Escherichia coli, Bacteroides bivius and less frequently isolated bacteria are Citrobacter, Acinebacter, and pseudomonas. Objective: To indicate the incidence and cause of postpartum endometritis in Ulaanbaatar city. Design: Retrospective and prospective study. Methods. Collection of history data, abdominal and transvaginal ultrasound study using by Mochida ultrasound apparatus; microbiological study on collected materials from cervix of uterus. Settings. Covered 728 cases whose had diagnosed as postpartum endometritis, which treated in 1st Mternity hospital, 2st Mternity Hospital, 3st Mternity Hospital of Ulaanbaatar city and Mternity Hospital of MCMNC last 3 years (2005, 2006, 2007). Results. Last 3 years, incidence of postpartum endometritis was 1.19% in 1st Maternity Hospital 1.05% in 2st Mternity Hospital, 0.95% in 3st Maternity Hospital of Ulaanbaatar city, 1.51% in Maternity Hospital of MCMNC between all delivered mothers. Postpartum entometritis are obtained 43% between all of postpartum pathologyes. Enterobacter and Staphylococcus aureus are causes each by 13.4% of postpartum endometritis in studied biggest Maternity Hospitals of Ulaanbaatar city. Discussion. Average incidence of postpartum endometritis was 1.17% in Maternity Hospitals of Ulaanbaatar city, last 3 years. It is almost similarity by incidence to foreign researchers study, because this is the risk of developing endometritis following vaginal delivery by them is estimated to be between 3-8% [4]. But in our country the postpartum endometritis after cesarean section was higher than foreign researchers study. The commonly causative bacteria of postpartum endometritis is the E.coli, which causes 73.2% for this disease in studied Maternity Hospitals of Ulaanbaatar city. Conclusions: Last 3 years, by our study the incidence of postpartum endometritis after cesarean section was 29.1%. The Escherichia coli is dominantly inducing for postpartum endometritis with vaginal deliveried mothers, and also with mothers, whose had after cesarean section.

Neonatal and maternal infectious morbidity between single and multiple courses of antenatal betamethasone treatment in patients with preterm premature rupture of membranes / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the neonatal and maternal infectious morbidity between single and multiple courses of antenatal betamethasone treatment in patients with preterm premature rupture of membranes. METHODS: One hundred seventy patients who delivered neonates between 28 and 34 weeks' gestation after preterm premature rupture of membranes from January 1992 to July 2000 were reviewed retrospectively. Patients were divided into 3 groups on the basis of the following betamethasone exposures: (1) none (control subjects), (2) betamethasone 4 mg IM, IV simultaneously and then 4 mg IV q 8 hours for 24 hours (single course) and (3) weekly administration after initial single course (multiple courses). All included patients received prophylactic antibiotics for group B streptococci. The statistical analyses were done using x2 test, Fisher's exact test and one way analysis of variance (ANOVA). Multiple logistic regression analysis was performed to determine the confounding effect of the multiple variables those were considered as risk factors for neonatal sepsis. RESULTS: This study included 67 patients in the control group, 60 patients in the single course group, and 43 patients in the multiple courses group. The latency (p=.0001) was significantly longer in the patients exposed to multiple course than the patients in the control group and those in the single course group. No significant difference was demonstrated in the incidence of neonatal sepsis (p=.881) and postpartum endometritis (p=.619) among the three groups. Neonatal sepsis was significantly associated with clinical chorioamnionitis (p=.022). CONCLUSION: According to our data, multiple courses of antenatal betamethasone treatment in patients with preterm premature rupture of membranes was not associated with the increased incidence of neonatal sepsis and postpartum endometritis.