Clinical Review on 93 Cases of Laparoscopic Myomectomy / 대한산부인과학회잡지

OBJECTIVE: The study was undertaken to evaluate clinical safety and usefulness of laparoscopic myomectomy with analyzing clinical course and postoperative complications of 93 patients underwent laparoscopic myomectomy at Yosu Chon-nam Hospital and to introduce operative methods executed in this hospital. METHODS: Total number of patients underwent laparoscopic myomectomy at Yosu Chon-nam Hospital from May 2001 to December 2002 was 93. With ward chart and admission recordings, Age, parity, symtom, size of myoma, number of myoma, location operation time and hemoglobin change were recorded. Data were analyzed with Microsoft Excel. RESULTS: The mean age of patients was 42.68 ( +/- 6.05) years. The mean parity was 2.02 ( +/- 0.96). The mean number of myoma was 1.70 ( +/- 1.27). The mean weight of myoma was 71.7 ( +/- 56.4) gm. The most common symtom was hypermenorrhea. The location of myoma was submucosal, intramural, subserosal in large order. The mean operation time was 101.1 ( +/- 30.2) minutes. The mean hemoglobin change after operation was 1.40 ( +/- 0.81) g/dL. Mean hospital stay was 3.90 ( +/- 1.20) days. The operative complication was trocar site bleeding (2 cases), surgical emphysema (2 cases). In 2 cases, Laparoscopic procedure was converted to laparotomic method. CONCLUSION: Indication of operation was extended in almost all age (including reproductive age) and 93 Laparoscopic myomectomy was done safely and effectively without severe complications. However, to obtain more safety and usefulness of laparoscopic myomectomy, adequate laparoscopic instrument and expertized operative technic should be demanded. In near future, laparoscopic myomectomy will be more popular and effective by variable technical development and ordered discipline.

Hydrogen Peroxide-producing Lactobacillus in Vaginal Flora of Pregnant Women with Preterm Labor and Intact Membranes / 대한산부인과학회잡지

OBJECTIVE: To investigate the possible role of vaginal infection in preterm delivery, we studied characteristics of vaginal discharge related to hydrogen peroxide producing Lactobacillus. METHODS: Vaginal specimens were obtained from 66 women with normal pregnancy and 30 women with preterm labor and intact membranes. Vaginal pH, leukocyte counts on wet smear, and scores by Nugent criteria on Gram stain were measured. Lactobacillus were tested for production of hydrogen peroxide using a qualitative assay on a tetramethylbenzidine agar plate after incubated for 30 minutes and 1 hour. One hundred eighty-seven hydrogen peroxide-producing Lactobacillus colonies isolated from vaginal fluid of normal pregnant women, and 77 hydrogen peroxide-producing Lactobacillus colonies isolated from it of women with preterm labor and intact membrane. RESULTS: 1. There were no significant differences in vaginal pH between normal pregnant women and women with preterm labor and intact membranes (4.06 +/- 0.31 vs. 4.04 +/- 0.57, p

The Influence on Birth Canal Laceration of New Head Delivery Method by Rapid Breathing / 대한산부인과학회잡지

OBJECTIVE: This study was conducted to evaluate the effect of new delivery method of fetal head on the vaginal and perineal laceration at vaginal delivery. METHODS: In this prospective clinical trial of 291 parturients with singleton pregnancy at or more than 37 weeks' gestation, pregnant women were radomely assigned to classical delivery method (control group) or new delivery method (study group) of the fetal head from September 1999 to August 2000 at Chonnam National University Hospital. The frequency and degree of vaginal and perineal lacerations at vaginal delivery were compared between two groups. RESULTS: Perineal lacerations of the 3rd or 4th degree was developed in 20 women (13.8%) among 145 cases of control group and 6 women (4.1%) among 146 cases of study group (P<0.01). Vaginal wall laceration was developed in 55 women (37.9%) of the control group and 37 women (25.3%) of the study group (P<0.01). The incidence of the laceration of perineum and vaginal wall was significantly lower in the study group than that of control group. CONCLUSION: The new delivery method of fetal head was effective for reducing the laceration of perineum and vaginal wall at full-term vaginal delivery.

Three cases of cervical pregnancy treated by intra-amniotic methotrexate injection after systemic methotrexate treatment / 대한산부인과학회잡지

Cervical pregnancy is a rare condition representing less than 1% of ectopic gestations in which the blastocyst implant within the cervical canal below the internal os of uterine cervix. Most cervical pregnancy result in early spontaneous abortion, complicated by severe hemorrhage from the eroded blood vessels within the cervix. Because of the fear of profuse hemorrhage, hysterectomy has been historically considered the standard therapy. However, a number of new therapies have been aimed at uterine preservation, conservative treatment is highly desirable for young women who want to preserve her fertility. Methotrexate has been utilized recently in the management of tubal, interstitial, and cervical pregnancies. We experienced three cases of successful treatment of cervical pregnancy by local injection of methotrexate into gestational sac under the guidance of vaginal sonogram after systemic methotrexate treatment, so we report the cases with a brief review of the literatures.