A case of acute pancreatitis induced by hypertriglyceridemia in gestational diabetes / 대한산부인과학회지

Hypertriglyceridemia is a rare cause of pancreatitis in pregnancy. Pregnancy is related with hypertriglyceridemia especially in the 3rd trimester due to increase of estrogen. Diabetes is known as a common cause of secondary lipid metabolism disorder and is often associated with hypertriglyceridemia. Shock and sepsis related to pancreatitis in pregnancy result in a relatively high morbidity and mortality rate for both the mother and the fetus. Hypertriglyceridemic pancreatitis complicated in gestational diabetes has not previously been reported. We report a case of 26(+4) weeks gestational aged primigravida with acute pancreatitis induced by hypertriglyceridemia in gestational diabetes. We reviewed the clinical courses and treatments of acute pancreatitis in pregnancy with the literatures.

Effectiveness of preemptive Gabapentin on postoperative pain after vaginal hysterectomy / 대한산부인과학회지

OBJECTIVE: Gabapentin is a new generation anticonvulsant drug. Preemptive gabapentin may produce analgesic effect in postoperative patient and have antiemetic effect. The aim of the present study was to investigate the opioid-sparing and analgesic effect of preemptive gabapentin on postoperative pain in patient undergoing vaginal hysterectomy. METHODS: In a randomized, double-blind, controlled study, 40 patients scheduled for an elective vaginal total hysterectomy were investigated/-. The patients were randomized to receive either oral gabapentin 1200mg (GABA group 2, n=17) or 900mg (GABA group 1, n=13) with premedication the night before and again 2hours before surgery. The other group (control group, n=10) had only routine premedication without gabapentin. All patients received patient-controlled analgesia (PCA). Postoperatively, pain was assessed using a visual analogue scale (VAS, 0-10) at time 1, 2, 4, 8, and 20 hours. Cumulative PCA consumption and opioid-related adverse events (nausea, vomiting, dizziness) was recorded. RESULTS: There was significant decrease of fentanly consumption in gabapentin group (GABA 2 group : 57.51+/-8.95 mg, GABA 1 group : 52.21+/-5.78 mg) compared to control group (50.63+/-2.55 mg)(p<0.05). There was no significant difference in side-effect (nausea, vomiting, dizziness) were observed between case and control group. CONCLUSIONS: Preemptive gabapentin has a good analgesic effect and reduce postoperative fentanyl consumption on postoperative pain after vaginal hysterectomy. Gabapentin effectively rescue analgesic requirement in post-operative patients with vaginal total hysterectomy.

A case of acute pulmonary edema with peripartum cardiomyopathy in severe preeclampsia / 대한산부인과학회지

Women with severe preeclampsia or eclampsia who develop pulmonary edema most often do so postpartum and some of these women have cardiac failure. Peripartum cardiomyopathy is defined as a cardiac failure occurring in the latter part of pregnancy or in the peripartum, without obvious cause and prior evidence of heart disease. It is very rare but the mortality rate is as high as 10~50%. Here, we describe a case of a woman who has undergone emergency Cesarean section due to complicated severe preeclampsia with acute pulmonary edema and peripartum cardiomyopathy at 33+1 weeks of gestation.

A case of angiography and transarterial embolization in arteriovenous malformation of uterus after a cesarean section episode / 대한산부인과학회지

Uterine arteriovenous malformation are very rare but life-threatening disease with massive uterine bleeding. These lesions may be congenital or acquired, the diagnosis is made by Doppler ultrasound, CT, MRI, pelvic angiography. We have experienced a patient, 33-year-old woman with vaginal bleeding after a cesarean section episode. The diagnosis was established by angiography, and the treatment was done successfully by uterine artery embolization. We report a case of uterine arteriovenous malformation, which is presented with a brief review of the literatures.

A Case of Cornual Curettage Under the High-resolution Ultrasound Guidance / 대한주산의학회잡지

Cornual or interstitial pregnancy is a rare form of ectopic pregnancy. In previous reports it accounted for 2~6% of all ectopic pregnancies. Because this unique anatomic location of the implantation site is a highly vascular area, potentially catastrophic hemorrhage from uterine rupture may occur in 15~20% of the cases, and early diagnosis is very important. As sensitive serum beta-hCGmeasurement and imaging techniques have evolved, it is possible to diagnose cornual pregnancies earlier than in the past. Traditional management is cornual wedge resection or hysterectomy by laparotomy. But this invasive treatment method may increase the morbidity and the risk of uterine rupture in subsequent pregnancies, medical treatment with methotrexate has been applied to treat cornual pregnancies, offering an alternative to surgery. Also there have been case reports of laparoscopic treatment of cornual pregnancy. We report a case of viable cornual pregnancy, which was treated successfully by curettage of the uterine cornus under the guidance of high-resolution ultrasound.

Delayed Interval Delivery after Emergency Cerclage of Cervical Incompetency in Twin Pregnancy by in vitro Fertilization / 대한주산의학회잡지

Twin pregnancies are at substantially higher risks for premature delivery than singleton pregnancies. This further increases their risk of perinatal and infant mortality. Recently there has been a marked increase in multiple pregnancies as a direct result of assisted reproductive technology. Cervical incompetency is a condition in which a pregnant woman's cervix begins to dilate and efface before her pregnancy has reached term. And multiple pregnancies and pregnancies by in vitro fertilization (IVF) have been increasing the risk of cervical incompetency. In twin pregnancy during preterm delivery, successful delayed-interval deliveries may improve the neonatal outcomes of the second fetus. We report a case of a delayed interval delivery in twin pregnancy of incompetent of cervix with an interval of 28 days after 3rd emergency cerclage.

Delayed Interval Delivery after Emergency Cerclage of Cervical Incompetency in Twin Pregnancy by in vitro Fertilization / 대한주산의학회잡지

Twin pregnancies are at substantially higher risks for premature delivery than singleton pregnancies. This further increases their risk of perinatal and infant mortality. Recently there has been a marked increase in multiple pregnancies as a direct result of assisted reproductive technology. Cervical incompetency is a condition in which a pregnant woman's cervix begins to dilate and efface before her pregnancy has reached term. And multiple pregnancies and pregnancies by in vitro fertilization (IVF) have been increasing the risk of cervical incompetency. In twin pregnancy during preterm delivery, successful delayed-interval deliveries may improve the neonatal outcomes of the second fetus. We report a case of a delayed interval delivery in twin pregnancy of incompetent of cervix with an interval of 28 days after 3rd emergency cerclage.

The influence of body mass index on the prevalence of complications after hysterectomy: A comparison of prognosis of hysterectomy related to body mass index / 대한산부인과학회지

OBJECTIVE: To investigate the association between obesity and peri- or postoperative outcome after abdominal or vaginal hysterectomies for benign gynecologic disorder. METHODS: We retrospectively reviewed the charts of all women who underwent abdominal or vaginal hysterectomy for benign gynecologic disorders in Kangnam Sacred Heart Hospital between Jan and Dec, 2006. We analyzed the rate of operative and postoperative complications, length of hospital stay, operative time, and perioperative hemoglobin change for abdominal or vaginal hysterectomy. RESULTS: The study group consisted of 915 women, of who 643 underwent vaginal, and 272 abdominal hysterectomy. Obesity was related to longer operation time for vaginal hysterectomy only. No association was found between BMI and serious complications such as postoperative bleeding, transfusion, urinary tract injury, febrile morbidity, bowel injury, wound complication, ileus, infection. CONCLUSION: Obesity is not a contraindication of vaginal or abdominal hysterectomy. Obese patients did not experience an increased risk of serious morbidity compared to normal weight women. Hysterectomy can be successfully performed, with acceptable morbidity, in obese women.

Validity of Indications and Clinical Outcome of Transabdominal Cervicoisthmic Cerclage for Cervical Incompetence / 대한주산의학회잡지

OBJECTIVES: The purpose of this study was to review the indications of transabdominal cervicoisthmic cerclage and clinical outcome to determine whether it is a valid alternative to transvaginal cerclage. METHODS: A retrospective review was carried out of transabdominal cerclage patients at our hospital from Jan. 1999 to Dec. 2004. Analysis of the indications for the transabdominal rather than the vaginal approach and evaluation of fetal outcomes was performed. RESULTS: 48 patients underwent transabdominal cerclage. The primary indication for transabdominal cervicoisthmic cerclage was failed transvaginal cerclage in 23 patients, the secondary indication was short cervix for transvaginal cerclage in 19 patients and cervical laceration in 6 patients. In 48 pregnancies, 8 twins were included. Therefore, total number of fetus was 56. One fetus of twin died in uterus at 27 weeks of gestation with unknown cause. 48 patients successfully delivered 55 live babies by Cesarean section. However, three babies died due to Tetralogy of Fallot, gastroschisis and preterm delivery. Complication including blood loss requiring transfusion did not occur. All patients had histories compatible with incompetent cervix requiring cerclage, and none were suitable candidates for vaginal cerclage. Live birth rate was 92% (52/56), compared with 28% salvage of pregnancies beyond the first trimester before the transabdominal cervicoisthmic cerclage procedure. CONCLUSIONS: Our results and review of literature confirm that with strict indications transabdominal cervicoisthmic cerclage offers a high rate of fetal salvage with minimum of complications in patients with extremely poor obstetric histories because of cervical incompetence.

Thyroid Disease in Pregnancy / 대한주산의학회잡지

No abstract available.

A case of trapped placenta in uterine sacculation after normal delivery / 대한산부인과학회지

Uterine sacculation is a very rare functional malformation associated with pregnancy in which a part of the uterine wall balloons. It is a transitory pouch or sacculation and resolves once the uterine contents are delivered. The uterine sacculation frequently contains the placenta. If the aperture of the sacculation is small, manual delivery of the placenta is impossible. It explains why many patients with uterine sacculation ends up with having a laparotomy with or without a hysterectomy. We report a case of a trapped placenta in uterine sacculation after normal delivery which is removed by laparotomy.

Morbidity of Vaginal Hysterectomy for Uterine Myoma as Function of Uterine Weight / 대한산부인과학회지

OBJECTIVE: To evaluate the relationship between uterine weight and morbidity in women undergoing vaginal total hysterectomy. METHODS: A retrospective chart review of 549 cases of patients with vaginal totoal hysterectomy was performed. Patients included in this study underwent vaginal total hysterectomy as benign uterine tumors at Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea from June 2003 through June 2004. These patients were stratified into four groups; Group I patients with uterine weight of 380 gm (n=79). The groups were compared as regard age, paturity, previous pelvic operations, postoperative discharge day, postoperation hemoglobin change, operation time, postoperative complications. RESULTS: There was no significant difference between the four groups with repect to postoperative discharge day (Mean=9.08 day), concurrent surgical procedure, age (M=45.96 years old), parturity (M=1.88). The overall complication rate was not significantly different (postoperation hemoglobin change (M=1.25), Complication). But the morcellation rate increased 8.33% in group I, 34.18% in group II, 55% in group III, 83.5% in group IV, respectively. The operation time prolonged as uterus weight increased.; 73 minutes in group I, 79 minutes in group II, 85 minutes in group III, 91 minutes in group IV. CONCLUSION: The vaginal total hysterectomy can be performed successfully in case of greatly enlarged uterus. Uterus enlargement is not an absolute contraindication.

Morbidity of Vaginal Hysterectomy for Uterine Myoma as Function of Uterine Weight / 대한산부인과학회지

OBJECTIVE: To evaluate the relationship between uterine weight and morbidity in women undergoing vaginal total hysterectomy. METHODS: A retrospective chart review of 549 cases of patients with vaginal totoal hysterectomy was performed. Patients included in this study underwent vaginal total hysterectomy as benign uterine tumors at Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea from June 2003 through June 2004. These patients were stratified into four groups; Group I patients with uterine weight of 380 gm (n=79). The groups were compared as regard age, paturity, previous pelvic operations, postoperative discharge day, postoperation hemoglobin change, operation time, postoperative complications. RESULTS: There was no significant difference between the four groups with repect to postoperative discharge day (Mean=9.08 day), concurrent surgical procedure, age (M=45.96 years old), parturity (M=1.88). The overall complication rate was not significantly different (postoperation hemoglobin change (M=1.25), Complication). But the morcellation rate increased 8.33% in group I, 34.18% in group II, 55% in group III, 83.5% in group IV, respectively. The operation time prolonged as uterus weight increased.; 73 minutes in group I, 79 minutes in group II, 85 minutes in group III, 91 minutes in group IV. CONCLUSION: The vaginal total hysterectomy can be performed successfully in case of greatly enlarged uterus. Uterus enlargement is not an absolute contraindication.

Emergency Cervical Cerclage: A Retrospective Study of 5 Years' Practice in 71 Cases / 대한산부인과학회잡지

OBJECTIVE: We investigated the outcome of emergency cervical cerclage in women with cervical incompetence. Cervical incompetence was diagnosed when cervical dilatation exceeded 2 cm with intact but bulging membranes. METHODS: Retrospective chart review of 71 cases of patients who underwent emergency cervical cerclage using Mcdonald suture after amnioreduction performed for cervical incompetence with cervical dilatation and membrane bulging from March 1998 through August 2003 at Kang-Nam Sacred Heart Hospital, Hallym University. Clinical variables evaluated included gestational age at cerclage, cervical dilatationa at cerclage, prolongation of pregnancy, and neonatal outcome. RESULTS: Emergency cerclage was performed successfully in 67 cases (94%). Gestational age at cerclage ranged from 16 weeks to 29 weeks, with the mean being 23.6 +/- 3.3 weeks. Cervical dilatation at cerclage was between 2 cm and 9 cm (mean 3.8 +/- 1.6 cm). Gestational age at delivery ranged from 16 to 40 weeks (mean 28.2 +/- 6.0 weeks). Prolongation of pregnancy following cerclage varied from between 1 to 134 days (mean 31.5 +/- 33.1 days). The median birth weight was 1370.29 +/- 72.6 g (range 140-3640 g). Thirty-seven babies were born live, and 30 of them survived (survival rate 49%). CONCLUSION: The possibility of a 49% survival rate is considered a good result for emergency cerclage. Emergency cervical cerclage can prolong pregnancy and influence the outcome of pregnancy favorably, and may be considered one potential method of treatment in such cases.

Evaluation and Management of Overweight Fetus / 대한주산의학회잡지

No abstract available.

A Case of Primary Malignant Melanoma of Posterior Vaginal Fornix / 대한산부인과학회잡지

Primary malignant melanoma of the vagina is a very rare disease with incidence of 0.026 per 100,000 women. The opinion of several types of treatment is suggested but the prognosis is extremely poor. Although malignant melanoma is generally regarded as a radioresistant tumor, recent reports show that definitive irradiation with high-dose fractionation regimen demonstrates high response rates in primary and metastatic lesions. A case of primary malignant melanoma of the vagina which was treated with intensity-modulated radiation therapy is presented with a brief review of concerned literature.

Comparision of Vaginal Hysterectomy and Abdominal Hysterectomy for a Nonprolapsed, Benign Uterine Disease in Women Without Vaginal Delivery / 대한산부인과학회잡지

OBJECTIVE: This study was designed to compare the vaginal hysterectomy and abdominal hysterectomy for a non-prolapsed, benign uterus in women without vaginal delivery. METHODS: A retrospective study in Hallym-university hospital analysed 182 total hysterectomies in women without vaginal delivery performed from January 2000 to December 2001. Vaginal route was used for 98 (53.8%) patients and 84 (46.2%) had laparotomies. RESULTS: The mean uterine weight was 217 g in vaginal route, 270 g in abdominal route. Mean operation time was 70 minutes in vaginal route, 125 minutes in abdominal route. There was one serious re-operation due to hemorrhge in each group and other complication was not much different at each gruops. The hospital stay was 6.2 days in vaginal route and 8.4 days in abdominal route. CONCLUSION: Vaginal hysterectomy for a non-prolapsed uterus is indicated for women without vaginal delivery and is feasible to performance. Vaginal hyterectomy is less morbidity, shorter hospitalization and faster convalescence. So training in vaginal surgury should allow safe performance of the procedure at most center.

A Case of Acute Fatty Liver of Pregnancy / 대한주산의학회잡지

Acute fatty liver of pregnancy(AFLP) is rare, potentially fatal disorder developing in the third trimester of pregnancy. It is characterized by nausea, vomiting, jaundice and malaise. Initially the disease is often mistaken for preeclampsia, HELLP(hemolysis, elevated liver enzymes, low blood platelet count)syndrome, fulminant hepatitis and cholestasis of pregnancy. But acute fatty liver of pregnancy has clinical manifestations, biochemical findings and complications clearly distinguished of HELLP syndrome, fulminant hepatitis and cholestasis of pregnancy. We report a case of pregnancy complicated with fatty liver with brief review of the common causes of acute hepatic failure associated with pregnancy.

Ultrasound Detection of Vault Hematoma Following Vaginal Hysterectomy and Their Relation to Morbidity / 대한산부인과학회잡지

OBJECTIVE: To assess whether ultrasound detection of vault hematoma can be used as a predictor of post-operative morbidity following vaginal hysterectomy. METHODS: Prospective observational study of 418 consecutive cases of vaginal hysterectomy was performed between December 2000 and May 2001. The transvaginal sonographic examination of vaginal vault in the first postoperative week (3rd or 4th day) after vaginal hysterectomy was done. Routine observation and clinical assessments were made by established management protocol: febrile morbidity, hemoglobin drop, need for transfusion, length of stay in hospital. RESULTS: Of the 418 scaned patients, 103 (24.6%) had a vault hematoma. This group was compared with the 315 patients without hematoma. Significant increases in febrile morbidity (22.3% vs 7.6%), postoperative hemoglobin drop (2.39 g/dL vs 1.58 g/dL), need for blood transfusion (10.7% vs 1.3%) and length of hospital stay (8.6 days vs 6.2 days) were seen in the hematoma group. CONCLUSION: Ultrasound detection of vault hematoma following vaginal hysterectomy is a common finding associated with increased febrile morbidity, hemoglobin drop, need for blood transfusion and longer hospital stay. Transvaginal sonography may facilitate the diagnosis of posthysterectomy vault hematoma, which are not readily detected by pelvic examination.

Prediction of Residual Lesion based on Histopathology and Margin Status of Conization Specimens Related to Post-cone Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: The objective of this study is to evaluate predictive factors for residual lesion after conization in patients with cervical neoplasia. METHODS: we performed retrospective study (between January 1996 and June 2002) and reviewed 146 patients who had undergone cervical conization followed by subsequent hysterectomy. The age and the parity of patients, the histopathology and the status of resection margins of cone specimens were analysed as predictive values of residual lesions. RESULTS: The prevalence rate of positive cone margins were 0%, 15%, 43.4%, and 85.7% respectively in patients with low-grade squamous intraepithelial lesion (LSIL) (n=3), high-grade squamous intraepithelial lesion (HSIL) (n=60), Cervical cancer stage I a1 (CC-I a1) (n=76) and Cervical cancer stage I a2 (CC- I a2) (n=7). The prevalence rates of positive residual lesions in post-cone hysterectomy specimens were 0%, 23.3%, 35.5%, and 100% respectively in those with LSIL, HSIL, CC- I a1, and CC- I a2. Residual lesions were significantly more frequently found in patients with positive cone margin (56.3%) than in those with negative margin (21.4%) (P value=0.000026). Positive predictive values of margin status for the presence of residual lesions were 0% (LSIL), 22.2% (HSIL), 57.6% (CC- I a1) and 100% (CC- I a2). Negative predictive values of margin status for the absence of residual lesions were 100% (LSIL), 76.5% (HSIL), 81.4% (CC- I a1) and 0% (CC- I a2). Only 8.3% (4/48) of patients with positive cone margin had more advanced residual lesions. 9.2% (9/98) of patients with negative margins had invasive residual lesion. CONCLUSION: The prevalence rate of positive cone margin and residual lesion increased with high severity of cervical neoplasia. Patients with positive cone margin had significantly higher chances of having residual lesion than those with negative margin. Free cone margin does not ensure the absence of residual lesion in the remaining cervix. Positive cone margin does not invariably indicate the presence and persistence of more severe residual lesion. Subsequent hysterectomy may be reserved for the patients with invasive cone pathology, concomitant morbid uterine condition, or not reliable for continuous follow-up.