Clinical Efficacy of Cervicovaginal Fetal Fibronectin in Induction of Labor / 대한산부인과학회잡지

OBJECTIVE: To determine whether the presence of fetal fibronectin in the cervicovaginal secretion could be used as a clinical marker to predict the outcome of labor induction. METHODS: The study group comprised 58 term pregnant women with intact amnionic membranes, 44 without labor and 14 with irregular labor. All patients had been admitted for induction of labor during Sept. 1, 1999 to Dec. 31, 1999 at the Department of Obstetrics and Gynecology of Yeungnam University Hospital. Fetal fibronectin was assayed with the cervicovaginal secretion. We analyzed the variables of labor outcome by the presence (positove) or absence (negative) of fetal fibronectin and the modified Bishop score. RESULTS: Cervicovaginal fetal fibronectin was detected in 75.0% (33/44) of the women without labor and 85.7% (12/14) with irregular labor, and 76.3% (29/38) with Bishop score 4 or less and 80.0% (16/20) with score 5 or above. There was no statistical differences in the positive rate of fetal fibronectin between the women without labor and those with irregular labor, and the women with Bishop score 4 or less and those with Bishop score 5 or above, respectively. The mean oral PGE2 tablets used for cervical ripening, the mean time interval from the beginning of labor induction to delivery, and the mean cesarean delivery rate were 1.97+/-2.56 tabs and 3.12+/-2.42, 10.12+/- 6.56 hours and 13.88+/-6.14, and 20.0% and 38.4%, in the women with positive fetal fibronectin and those with negative respectively, and 1.83+/-2.50 and 2.42+/-2.60, 10.11+/-7.17 hours and 11.28+/-6.26 hours, and 10.0% and 31.6% in the women with Bishop score 5 or above and those with Bishop score 4 or less, respectively. There were no statistical differences in the mean values between the women with positive and negative fetal fibronectin, and between Bishop score 5 or above and Bishop score 4 or less, respectively. There were no statistical differences in the mean oral PGE2 tablets used for cervical ripening (2.00+/- 2.65 vs. 4.40+/-1.82) and the mean time interval from the beginning of labor induction to delivery (10.11+/- 7.53 vs. 16.17+/-5.38), between the women with positive fetal fibronectin and Bishop score 5 or above and those with negative fetal fibronectin and Bishop score 4 or less, respectively. However, the cesarean delivery rate was significantly lower in the women with positive fetal fibronectin and Bishop score 5 or above than those with negative fetal fibronectin and Bishop score 4 or less (6.3% vs 44.4%, p=0.040). CONCLUSION: The assesment of cervicovaginal fetal fibronectin and Bishop score could be useful in predicting the success or failure of labor induction. But it was not helpful to predict the easiness of labor induction by the presence or absence of fetal fibronectin in the cervicovaginal secretion and/or modified Bishop score.

A Case of Pulmonary Embolism and Deep Vein Thrombosis in Leg after Total Abdominal Hystrectomy of Huge Uterine Myoma complicated with Abscess / 대한산부인과학회잡지

Pulmonary thromboembolism (PTE) is a serious postoperative complication. Prompt diagnosis of PTE is important but it is difficult because clinical manifestations of PTE are not obvious in most cases. If a patient had tachypnea, cold sweating and hypoxemia in postoperative period, PTE must be thought to be one of possible causes of tachypnea. We have experienced one case of PTE after operation. A 40 year-old woman underwent total hystrectomy and partial omentectomy due to huge, bizarre shaped and inflammatory myoma presenting as an abdominal mass with abscess pocket accompanied by severe and adhesion. At the 5 th postoperative day tachypnea and hypoxemia were developed suddenly. PTE was confirmed with lung perfusion scan and leg edema with deep vein thrombosis occurred later. Proper cardiopulmonary support and anticoagulant therapy were done and the patient was recovered and discharged in improved condition.

A Case of Pulmonary Embolism and Deep Vein Thrombosis in Leg after Total Abdominal Hystrectomy of Huge Uterine Myoma complicated with Abscess / 대한산부인과학회잡지

Pulmonary thromboembolism (PTE) is a serious postoperative complication. Prompt diagnosis of PTE is important but it is difficult because clinical manifestations of PTE are not obvious in most cases. If a patient had tachypnea, cold sweating and hypoxemia in postoperative period, PTE must be thought to be one of possible causes of tachypnea. We have experienced one case of PTE after operation. A 40 year-old woman underwent total hystrectomy and partial omentectomy due to huge, bizarre shaped and inflammatory myoma presenting as an abdominal mass with abscess pocket accompanied by severe and adhesion. At the 5 th postoperative day tachypnea and hypoxemia were developed suddenly. PTE was confirmed with lung perfusion scan and leg edema with deep vein thrombosis occurred later. Proper cardiopulmonary support and anticoagulant therapy were done and the patient was recovered and discharged in improved condition.