A clinical analysis of uterine myoma / 대한산부인과학회지

From January 1998 to December 2002, 3,259 cases of uterine myoma were treated at the department of Obstetrics and Gynecology, Chunbuk National University Hospital. A clinico-stastical study of uterine myoma was perfomed to analyse the clinical characteristics. The results were as follows. 1. The incidence of uterine myoma was 9.8%. 2. The most frequent age group was 40 to 49 years, and the mean age was 44.6 years. 3. The average parity was 2.29, the infertility was 163 cases (5.0%), while the primary infertility, 2.4%, the secondary, 2.6% respectively. 4. The most frequent chief complaint was pain which was observed in 2,648 cases (81.2%), abnormal bleeding in 1,775 cases (53.8%). dizziness in 270 cases (8.3%). 5. The corporeal myomas were observed in 2,879 cases (95.9%). Intramural type was observed in 1,687 cases (58.2%), subserous in 529 cases (18.2%), submucous in 191 cases (6.5%), mixed type in 483 cases (17.0%). 6. The mean value of preoperative hemoglobin was 11.1 gm/dL, and the anemia (Hb<10.0 gm/dL) was observed in 481 cases (11.7%). Transfusion was necessary in 215 cases (6.5%). 7. The mean weight of the uterine myoma operated was 335.0 gm. 8. The secondary change of myoma was found in 54 cases (1.7%) and hyaline degeneration was the most common (0.7%). 9. The most common associated condition was chronic cervicitis, which was observed in 784 cases (24.1%). 10. The gynecologic surgery were performed in 1,456 cases (44.7%), medical therapy in 25 cases (0.8%), observation in 1,792 cases (55.0%). 11. Total abdominal hysterectomy was performed in 607 cases (41.7%), total abdominal hysterectomy with unilateral adnexectomy in 115 cases (7.9%), total abdominal hysterectomy with both adnexectomy in 164 cases (11.3%), subtotal hysterectomy in 304 cases (20.9%), myomectomy in 153 cases (10.5%), total laparoscopic hysterectomy in 103 cases (7.0%), laparoscopy assisted vaginal hysterectomy in 8 cases (0.5%), diagnostic laparoscopy in 2 cases (0.1%) respectively. 12. The postoperative complication were found in 113 cases (3.5%) and the wound infection was the most common (1.6%). 13. The mean period of hospitalization was 8 days, and the period less than 10 days in 1,177 cases (80.9%).

Determinants of Reproductive Outcome after Abdominal Myomectomy in Infertile Women / 대한산부인과학회잡지

OBJECTIVE: To determine the effect of myomectomy as a treatment for infertility and to define the factors that influence reproductive outcomes MATERIALS AND METHODS: During the period from January 1995 to December 2001, on 39 patients who suffered from infertility and habitual abortion underwent transabdominal myomectomy at the Department of Obstetrics and Gynecology in Chonbuk National University Hospital. RESULTS: Pregnancy occurred in 31 women. The mean age was 32.3 years. The pregnancy rates in women with or without associated factors in addition to myoma were 55.5% and 71.4%, respectively, and those in women with 2 years of infertility were 73.7% and 55%, respectively. In case of women with myoma on lateral side, pregnancy rate was 33.3%. Considering the size, women with a myoma, 30~50 mm in size had higher pregnancy rate (81.2%). The 24-month cumulative probability of conception was 91% in patients 35 years of age. CONCLUSION: Our results suggest a benefit of myomectomy in infertile patients. Factors affecting the pregnancy rate after myomectomy in theses patients are the age of the patient, the duration of infertility, the site of myoma, and the size of myoma <50 mm. However, women should be counseled carefully before surgery because the determinants of outcome appear to be independent of treatment.

Prediction of Preterm Birth by Using Qualitative Fetal Fibronectin Test Combined with C-reactive Protein / 대한산부인과학회잡지

OBJECTIVE: The qualitative test of fibronectin of the cervices and vaginae as well as the C-reactive protein test of pregnant mothers with symptoms of preterm labor were performed in an attempt to examine clinical validity of these factors as predictable elements of preterm delivery. METHODS: This prospective study was conducted on ninety (90) single pregnancies of gestational age from 24 weeks and 1 day to 34 weeks and 6 days admitted to the hospital with symptoms of preterm labor, which occurred in the period from October 1, 1999 through March 31, 2001. Among these pregnant women, those with a uterine contraction rate of 4 per hour or greater and uterine dilatation of less than 3 cm without PROM were used as the subjects. The qualitative test of fetal fibronectin (ROM check, Adeza Biochemical, USA) of the cervices and vaginae as well as the C-reactive protein test by means of latex agglutination method using maternal blood were performed on these subjects. Of the 90 mothers that participated in this study, 15 dropped out and 75 underwent the qualitative test of fetal fibronectin and C-reactive protein test. The results of each test and the combined tests of both at preterm delivery (1) within 1 week, (2) prior to 34 weeks and (3) prior to 37 weeks were compared and analyzed. RESULTS: 1. 22.4% (15/67) resulted in preterm delivery prior to 34 weeks while 48.0% (36/75) ended up with preterm delivery prior to 37 weeks. 2. In predicting preterm delivery within 7 days and prior to 37 weeks after the test, the fetal fibronectin and C-reactive protein qualitative test were statistically insignificant. The combined tests of both fetal fibronectin and C-reactive protein were statistically insignificant in predicting preterm delivery within 7 days (Odds ratio of 4.2; 95% CI 0.7-23.3 p=0.199) and prior to 37 weeks (Odds ratio of 5.3; 95% CI 0.6-48.3 p=0.116). 3. In predicting preterm delivery prior to 34 weeks, fetal fibronectin and C-reactive protein qualitative test were insignificant statistically. Nevertheless, these two tests in combination showed a statistical significance for preterm delivery prior to 34 weeks: It showed a sensitivity of 26.7% (4/15), a specificity of 95.6% (43/45), a positive predictability of 66.7% (4/6), and negative predictability of 79.6% (43/53) [Odds ratio of 7.8; 95% CI 1.3-48.3, p=0.03]. CONCLUSION: Specificity and positive predictive value improved when the combined fetal fibronectin and C-reactive protein tests in pregnancies with symptoms of preterm labor were performed for preterm delivery before 34 weeks. Consequently, this is a clinically valid predictor of preterm delivery before the 34th week.