Successful Vaginal Delivery Following Immunologic Thrombocytopenic Purpuric Woman: Case Report With Prior History / 대한산부인과학회잡지

Thrombocytopenia is hematologic disorder commonly occurs during pregnancy (5%) with different severity. It doesn't cause severe problem during pregnancy and after the delivery if it is not below certain level which will cause spontaneous bleeding. But in this case, patient was previous cesarean section status and platelet number didn't arise more than 20,000/microliter even after transfusion which will cause spontaneous bleeding. Vaginal delivery was done because transverse cesarean section was considered relatively safe although there was the risk of rupture of uterus, and was successful-both mother and baby is in good health condition. Here now we report this case because vaginal delivery of Immunologic thrombocytopenic purpuric woman with prior history of cesarean section has not reported.

Relation of placental size to large-for-gestational-age infants in women with gestational diabetes mellitus controlled with insulin / 대한산부인과학회잡지

OBJECTIVE: To determine if the placental size is disproportionately increased in the large-for-gestational age infants in pregnancies complicated by impaired glucose tolerance controlled with insulin. PATIENS AND METHODS: A retrospective study was performed on 104 singleton pregnancies complicated by gestational impaired glucose tolerance controlled with insulin. The cases were categorized by the infant birthweight percentile into three groups, i.e. small-for-gestational age (90th percentile). Maternal and infant anthropometric data, glycemic status, and placental weight-to-birthweight ratio were compared among three groups. RESULTS: The maternal glucose level just after delivery, infant body mass index and placental weight showed a significant increment from the small-for-gestational age to the large-for-gestational age groups (p<0.05). The placental weight-to-birthweight ratio was significantly higher in the small-for-gestational group. On the other hand, there was no significant difference in the values of the oral glucose test, hemoglobin A1c and maternal body mass index among three groups. Maternal body mass index showed a increasing trend from the small-for gestational age to the large-for-gestational age groups. Placental weight-to-birthweight ratio was not significantly correlate with maternal glucose level. CONCLUSIONS: The results indicate that the placenta is disproportionately bigger, and rigid control of maternal blood glucose does not prevent the development of placental overgrowth. Maternal obesity in well- controlled gestational diabetes mellitus may be more significant than glucose control in the development of large-for-gestational-age infants. Different management strategies for women with gestational diabetes mellitus with different pregravid weights are warranted.

The prenatal care and delivery in a pregnant woman complicated by hereditary sideroblastic anemia / 대한산부인과학회잡지

Anemia is the one of the most common complications among pregnant women, but sideroblastic anemia is very rare condition. The sideroblastic anemias have diverse etiologies but have in common an impaired biosynthesis of heme in the erythroid cells of the marrow. The ringed sideroblasts in the bone marrow aspirate is diagnostic hallmark of sideroblastic anemia. We report here a prenatal care and delivery in a pregnant woman complicated by hereditary sideroblastic anemia. This patient was treated with 200mg of pyridoxine per day during entire pregnancy period and further more, 4mg of oral folate per day was supplemented because concomitant folate deficiency is frequent in case of erythroid hyperplasia. Intermittently, the transfusions of packed red blood cells were required to maintain the hemoglobin level in the 9 to 10gm/dl range. We have experienced healthy maternal and perinatal outcome.

A Case of Mucinous Cystadenocarcinoma Arising from a Mature Cystic Teratoma in the Right Ovary / 대한부인종양콜포스코피학회잡지

A case of mucinous cystadenocarcinoma arising from a mature cystic teratoma in the right ovary of a 37-year-old woman is reported. Malignant transformation of a mature teratoma is a rare event and the commonest malignant neoplasm to develop is squamous cell carcinoma.(83%) Adenocarcinoma occurs with less frequency.(6.8%) The patient was treated by staging operation followed by adjuvant chemotherapy. After six courses of combination chemotherapy, oncological investigations, including chest X-ray, abdominopelvic CT scan and tumor markers, all revealed no evidence of recurrence.

Analysis of Serum Triple-Marker Screening in In Vitro Fertilization and Naturally Conceived Pregnancy / 대한산부인과학회잡지

OBJECTIVE: To compare and analysis the result of second trimester maternal serum triple marker screening test for Down syndrome and open neural tube defects in singleton pregnancies conceived by conventional in vitro fertilization- embryo transfer (IVF-ET) with that of the naturally conceived pregnancies. METHODS: Maternal serum screening tests during the second trimester in 49 singleton pregnancies conceived by IVF-ET and 813 singleton pregnancies conceived naturally of whom delivery outcome was normal in each other were analyzed from April 1997 to June 2000. RESULTS: 4 (8.2%) out of 49 cases of IVF-ET singleton pregnancies compared with 62 (7.6%) out of 813 cases of naturally conceived pregnancies had a positive RESULTS: for Down syndrome or open neural tube defects. The median level of the triple markers were 1.03 0.47 multiples of the median (MoM) in IVF-ET pregnancies vs 1.05+/-0.39 MoM in natural pregnancies for alpha-fetoprotein (AFP), 1.11+/-0.64 vs 1.19+/-1.13 MoM for unconjugated estriol (uE3) and 1.21+/-0.56 vs 1.11+/-0.59 MoM for human chorionic gonadotropin (hCG). CONCLUSION: The positive rate of triple test and the median values of triple markers for Down syndrome and open neural tube defect between two groups were not different in terms of statistical significance. To provide an objective assessment of an individual patient's risk of fetal abnormality, the impact of IVF-ET on triple marker biochemistry should be studied further in larger samples and adjustments made if appropriate.

Chorioamnionitis and Fetal Death with Intact Membranes Involving Staphylococcus aureus at term / 대한산부인과학회잡지

It has been believed that the intact placental membranes are a good barrier to ascending infection, but this may be only partly true.` Neonatal infection without premature rupture of the amniotic membranes occurs in 1-2% of births. The prevalence of membranes inflammation among births at term is approximately 10%.2-4 Chorioamnionitis is a frequent cause of fetal death mostly as a silent chorioamnionitis without maternal signs of infection.4 Below we present a case of subclinical acute chorioamnionitis in a woman admitted because of labor pain at 39weeks with intact membranes and subsequent sudden intrauterine fetal death. Culture specimens from the endometrium and uterine cervix showed growth of Staphylococcus aureus.

Effects of Th1 type cytokines on secretion of vascular endothelial growth factor by human first trimester trophoblast cell line / 대한산부인과학회잡지

Embryo implantation and development are critically dependent upon the regulation of angiogenesis and adequate immunologic acceptance. These local angiogenesis and vascular permeability are regulated by the interaction between fetal trophoblast, uterine decidua, and endothelial cells through the key mediator, vascular endothelial growth factor (VEGF). PROBLEM: The mechanism through which VEGF regulation occurs at the feto-maternal interface is poorly understood. The Th1 type cytokines are known to be harmful to the successful maintenance of early pregnancy at the feto-maternal interface. OBJECTIVE: To clarify whether the Th1 type cytokines could be involved in the regulation of VEGF secretion at the feto-maternal interface. Method of Study : we investigated the effects of Th1 type cytokines on VEGF secretion in human first trimester trophoblast cell-line by using reverse transcription polymerase chain reaction(RT-PCR)and enzyme-linked immunosorbent assay (ELISA). RESULTS: The trophoblast cells expressed VEGF constitutively and the main isoforms were VEGF121 and VEGF165. When cultured in the presence of IFN-gamma or IL-2, VEGF secretion was most significantly increased by IFN-gamma treatment but not affected by IL-2 treatment. The level of intracellular VEGF was also increased by IFN-gamma treatment. CONCLUSION: These results suggest that IFN-gamma, despite of harmful Th1 type cytokine to the maint enance of early pregnancy, may regulate the production of VEGF in early gestational trophoblasts.

The Relationship between Placental Ratio and Neonatal Morbidity in Intrauterine Growth Restricted Infants / 대한산부인과학회잡지

An increased placental ratio has known to be associated with the occurrence of cardiovascular complications in adulthood among the intrauterine fetal growth restriction. A retrospective study on 202 singleton growth-restricted infants without major congenital anomalies born from Jan. 1995 to Feb. 2001 was performed to determine the relationship between placental ratio and neonatal morbidity. The cases were categorized into three groups according to the placental ratio (1SD above the mean). There were no differences in the maternal characteristics and antenatal complications except pregnancy induced hypertension between high placental ratio group and the other groups. It presented the trend that was toward the increase of placental weight and the decrease of birth weight in high placental ratio group. The infants with a high placental ratio had increasing tendencies of meconium stained amnionic fluid, hypocalcemia, phototherapy, asphyxia.

The Relationship between Placental Ratio and Neonatal Morbidity in Intrauterine Growth Restricted Infants / 대한산부인과학회잡지

An increased placental ratio has known to be associated with the occurrence of cardiovascular complications in adulthood among the intrauterine fetal growth restriction. A retrospective study on 202 singleton growth-restricted infants without major congenital anomalies born from Jan. 1995 to Feb. 2001 was performed to determine the relationship between placental ratio and neonatal morbidity. The cases were categorized into three groups according to the placental ratio (1SD above the mean). There were no differences in the maternal characteristics and antenatal complications except pregnancy induced hypertension between high placental ratio group and the other groups. It presented the trend that was toward the increase of placental weight and the decrease of birth weight in high placental ratio group. The infants with a high placental ratio had increasing tendencies of meconium stained amnionic fluid, hypocalcemia, phototherapy, asphyxia.

Clinical Response of Uterine Embolization for the management of Leiomyomas / 대한산부인과학회잡지

OBJECTIVE: To determine of the effectiveness of uterine arterial embolization as a primary therapy in the management of symptomatic leiomyomas. MATERIALS AND METHODS: Uterine arterial embolization was performed in 23 patients (age range, 27-50 years) who complaint menorrhagia, bulk-related symptoms(frequency of urination, sensation of pressure, sensation of mass), or both, with leiomyomas. The effectiveness of the therapy was evaluated in the view of symptomatic relief and the patients' acceptance with ultrasonography, 3 months later. RESULTS: Sixteen (89%) of 18 patients reported marked improvement in their abnormal bleeding. Ten (90%) of 11 patients with bulk-related symptoms reported marked improvement in these symptoms. Follow-up ultrasonographic examination showed a mean 21% reduction in uterine size and mean 39% reduction in leiomyoma size. CONCLUSION: Utrine arterial embolization is an effective therapy in the management of symptomatic leiomyomas and may prove to be a valuable alternative to myomectomy, hysterectomy, or other surgical procedures.

A Case of Delivery of Normal Term Baby after Treatment of Gonadoblastoma with Dysgerminoma and Choriocarcinoma in the Ovary in a Woman with 46XX Karyotype / 대한부인종양콜포스코피학회잡지

A case of gonadoblastoma with dysgerminoma and choriocarcinoma in the right ovary of a 23-year-old woman is reported. A case of gonadoblastoma without a Y chromosome is very rare. She had a 46XX chromosomes, normal genitalia, no history of menstrual irregularities, thereby differing from the other reproted case. The patient had a normal term pregnancy 2 years after surgery and chemotherapy. It is suggested that gonadoblastoma may occur in functionally and morphologically normal gonads. There have been no signs of recurrence or metastasis for 3 years after the first operation.

A case of Lipoleiomyoma of the Uterus / 대한산부인과학회잡지

No abstract available.