Positive Effect of Baby-Friendly Hospital Initiatives on Improving Mothers' Intention for Successful Breastfeeding in Korea

BACKGROUND: In Korea, the breastfeeding (BF) rate of infants aged 6 months or more is drastically decreasing, and this phenomenon is particularly worrisome for the future health of the population. The present study aimed to identify an antenatal strategy for initiation and continuation of human BF, and to identify how Baby-Friendly Hospitals (BFHs) may positively influence the intention to breastfeed. METHODS: A total of 414 pregnant Korean antenatal women were surveyed using questionnaires to determine current knowledge of the benefits of human breast milk, whether they planned to breastfeed after delivery, to continue BF after reinstatement in the workforce, are willing to abide by rooming-in care for infants, and plan to give birth at BFHs. RESULTS: We found that planning room-in care, greater awareness of BF benefits for infant and mother, participation in antenatal education programs, and provision of BF facilities in the workplace were positively associated with plans for exclusive breastfeeding (EBF) and longer BF duration. The mothers who planned to give birth at BFHs also desired to breastfeed immediately after birth, implement in-room care, continue BF at their workplace, participate in antenatal BF educational programs, and were more aware of the benefits of BF. CONCLUSION: If the beneficial effects of BFHs were well known to individuals, these would enhance the success rate of BF in Korea. Antenatal education and consequent acquisition of better knowledge of the benefits of BF are important for increasing the rate of BF practices.

Fetal Heart Rate Regresses toward the Mean in the Third Trimester

The purpose of this study was to investigate the feasibility of different fetal heart rate (FHR) ranges in the nonstress test (NST) and to better understand the meaning of mild bradycardia and/or tachycardia without non-reassuring patterns. We employed the heredity to show that mild bradycardia (100-119 beats per minute, bpm) and mild tachycardia (161-180 bpm) regressed to the normal FHR range (120-160 bpm). We used linear regression to analyze FHR data from FHR tracings recorded 10 min before (NST, as the predictor) and 10 min after vibroacoustic stimulation testing (as the dependent variable). Acceleration for 15 bpm-15 seconds (Acc1515) and deceleration for 15 bpm-15 seconds (Dec1515) in the NST were also analyzed for each group. The slope of the best-fit line was the largest in the mild bradycardia group and the smallest in the normal range group. Dec1515 was most prominent in mild tachycardia and both the mild bradycardia and tachycardia groups regressed towards the mean FHR range. Therefore, we propose that both mild bradycardia and tachycardia of FHR in non-acute situations (range between 100 and 180 bpm) are not regarded a pathologic signal for clinical use.

The concepts and necessity of preconception care for men

Several international initiatives have taken place with themes such as "Men as Partners in reproductive health". Furthermore, many articles have recently been published concerning men's preconception care before pregnancy. However, little attention has been paid to this field in Korea. The concept of preconception health and health care for men is very important for pregnancy outcomes, and furthermore, for the health of their future families. Men's contribution to the pregnancy is clear for planned pregnancy and also offers an opportunity for disease prevention and health promotion in men themselves. This paper reviews the important concept of men's health for preparing for pregnancy, and summarizes key component of a comprehensive approach to optimizing the preconception health status of men as expecting fathers. In fact, many clinicians including most obstetricians-gynecologists in Korea are not trained to provide preconception health and care for men. In addition, no consensus has been developed on basic guidelines for preconception care including the pregnancy planning for men and women, laboratory tests before pregnancy, vaccination programs, and much more information on preparing for a successful pregnancy. To improve preconception care for men in Korea, many barriers must be overcome, such as lack of national services, financing, organization, and men's and women's understanding of the importance of preconception health for their pregnancy. Therefore, much more research is needed on men's preconception care in Korea.

Preconception infection and genetic counseling

Congenital malformations are a common cause of illness, handicapping conditions, and death. Errors of morphogenesis leading to congenital anomalies have many recognized causes, including specific single-gene mutations, chromosome imbalances, and the action of teratogenic agents. Most congenital anomalies, however, are of multifactorial origin, occurring by complex interactions between not yet well understood genetic and environmental factors. Two to six percent of the newborn babies worldwide, i.e., 3 to 9 million infants a year, suffer from major congenital anomalies and genetic diseases. However, a great deal of this misery could be avoided. In particular, preconception care is more important than prenatal care for prevention of congenital anomalies since as many as 30 percent of pregnant women begin traditional prenatal care in the second trimester (>13 weeks of gestation), which is after the period of maximal organogenesis. Women and their partners whose ethnic background, race, or personal or family history places them at increased risk of having a fetus with a genetic disease should receive appropriate counseling. Furthermore, certain laboratory tests of the infection status of couples may be helpful in assessing the risk for and preventing some complications during pregnancy. Preconception evaluation and appropriate counseling permits parents to make informed reproductive decisions and provides reassurance.

Small bowel hernia through 5 mm trocar site with drainage tube in situ and its reduction by laparoscopy: A case report / 대한산부인과학회지

The incisional hernia through trocar site is an uncommon complication of gynecologic laparoscopy. Its incidence is less than 1% and most of them are occurring through 10 mm trocar site. Small bowel herniation through 5 mm trocar site is very rare. Furthermore, 5 mm trocar site bowel herniation with drain tube in situ has not yet been reported. We present a case of small bowel herniation through 5 mm trocar site with drain tube in situ and its reduction by laparoscopy with a brief review of literature.

Laparoscopic systemic retroperitoneal lymphadenectomy for women with low-risk early endometrial cancer

<p><b>INTRODUCTION</b>There is no consensus on the extent of lymphadenectomy and the appropriate patients for lymphadenectomy in low-risk patients with endometrial cancer. This study aimed to evaluate the feasibility and effectiveness of laparoscopic lymphadenectomy for low-risk patients with endometrial cancer.</p><p><b>MATERIALS AND METHODS</b>From January 2004 to May 2008, we reviewed the medical records of 28 patients with low-risk, endometrial cancer; endometrioid type, grade 1 or 2, and with a depth of myometrial invasion of less than one-half of the myometrium. All patients underwent laparoscopically-assisted staging surgery.</p><p><b>RESULTS</b>The median age and body mass index were 56 years (range, 28 to 75) and 25.5 kg/m(2) (range, 21.3 to 37.2). The median operating time, estimated blood loss, and length of hospital stay were 142 minutes (range, 110 to 410), 215 mL (range, 100 to 700), and 7 days (range, 3 to 19), respectively. No conversion to laparotomy was noted. The median number of harvested lymph nodes was 21 (range, 10 to 48) pelvic nodes and 12 (range, 4 to 21) para-aortic nodes. One (3.6%) patient presented pelvic lymph node metastasis and 2 (7.1%) presented isolated para-aortic lymph node metastasis. The complication rate was 14.3%. No recurrence in the vaginal vault, distant metastasis, port site metastasis was noted up to the last follow-up.</p><p><b>CONCLUSION</b>Systemic pelvic and para-aortic lymphadenectomy should be considered in all low-risk patients with endometrial cancer until it is concluded to be clinically insignificant through large-scale prospective research in the future. However, it will be difficult to explain statistical differences in survival rates according to lymphadenectomy, because the increase of the survival rate resulting from lymphadenectomy will fall within the margin of statistical error.</p>

Ovarian Thecoma with Virilizing Manifestations

A 29-year-old woman presented with secondary amenorrhea, primary infertility, and virilization, which had developed over the past 2 years was suspected to have a virilizing tumor at her left ovary. Her serum testosterone level was markedly elevated (380 ng/dL). Left salpingooophorectomy was performed, and histopathological examination revealed a thecoma of the left ovary. The postoperative serum testosterone level returned to 65 ng/dL. The patient did not have regression of virilism soon. However, the patient had a normal menstruation 29 days after surgery and gave birth to a baby 13 months after surgery.

A Case of Placenta Increta Complicating a First Trimester Abortion / 대한주산의학회잡지

Placenta increta is a life threatening complication of pregnancy, causing severe post-curettage bleeding. It is usually presented in the postpartum period with hemorrhage during difficult placental removal. It is especially rare in the 1st and 2nd trimesters, which is not easy to find and diagnose. We have confirmed a case of placenta increta after emergency hysterectomy due to severe vaginal bleeding following the dilatation and curettage during the 1st trimester of her pregnancy. So we report it with a brief case history and review of the concerned literatures.

A case of retroperitoneal leiomyosarcoma presenting as a pelvic mass / 부인종양

The authors report a rare case of retroperitoneal leiomyosarcoma in a 49 year-old woman, with a palpable mass in the left lower abdomen. There is a large neoplasm which was soft and movable, looking a pelvic mass. Abdominal and pelvic CT scan showed a 11.0x9.2x7.5 cm-sized lobulated heterogenous enhancing mass with multifocal necrotic portion near the left ovary. Laparotomy and resection of the mass was performed. Microscopic examination revealed 15 mitoses per 10 high power fields. She was diagnosed as primary leiomyosarcoma originated from the left common iliac vein, stage I (IB). The best treatment of these neoplasms is complete surgical excision, and no therapeutic benefit has been derived from chemotherapy or radiotherapy. Though metastases are occasional, local recurrences can be taken into consideration and, after a careful tumoral re-staging, they can be resected once more. Therefore, careful follow-up is necessary on the basis of neoplastic grading, extension and involvement of the adjacent structures.

The Effect of Vitamin-C Vaginal Tablets (Vagi-C(R)) in Patients with Each Vaginitis in Pregnancy and in Normal Pregnant Women / 대한주산의학회잡지

OBJECTIVE: The purpose of this study is to evaluate the effect of Vitamin-C vaginal tablets on vaginal pH and vaginitis symptoms of pregnant women. METHODS: Ninety pregnant women who visited the antenatal clinic were included in this study after giving their informed consent. The treatment regimen of the vitamin-C vaginal tablets (250 mg, Vagi-C(R), Taurus Pharma GmbH, Germany) was one tablet given once a day for 6 consecutive days. Vaginal pH was measured the day before and the day after the Vit-C vaginal treatment. Ninety women of initial, ten failed to follow-up (participate). After routine screening using microscopic analysis of the vaginal smears, 31 of the 80 participating women fell into one of 3 pathologic groups (15 monilial infection, 10 bacterial vaginosis, 6 trichomonial infection) and leaving 49 pathogen-free pregnant women. 10 of the pathogen-free pregnant women were excluded during the study because they did not complete the treatment period due to vaginal irritation such as itching or burning sensations. The diagnosis of each vaginal infection was made by specific pathologic findings. RESULT: Mean vaginal pH values for the pathology group decreased significantly from 4.9 to 4.2. Pathologic findings of each infection were also improved without specific treatment. Bacterial vaginosis disappeared in 80.0% (8/10) of patients. The specific pathogens of the remained two vaginitis types were not detected in 33.3% (5/15) of monilial infection and 33.3% (2/6) trichomonial infection 1 week after discontinuation of Vitamin-C vaginal tablets. Although it is not significant, mean vaginal pH values decreased from 4.4 to 4.2 in the pathogen-free pregnant women. CONCLUSION: Vitamin-C, when vaginally applied, is effective in lowering vaginal pH and in the treatment of vaginitis in pregnant women.

A Case of bladder stone after intravesical migration of Lippes IUD / 대한산부인과학회지

Migration of an intrauterine device into the bladder, together with secondary stone formation is an extremely rare complication. We have recently encountered the migration of a Lippes loop into the urinary bladder and an associated secondary stone formation. We report our findings together with a review of the literature.

Identification of marker chromosomes by reverse painting fluorescence in situ hybridization and comparative genomic hybridization / 대한산부인과학회지

OBJECTIVE: Although marker chromosome is defined as an abnormal chromosome in which no part can be identified, derivative chromosomes with structural abnormalities of unknown origin are also called as marker chromosomes conventionally. The clinical significance of a marker chromosome is determined according to the origin of marker chromosome. In this study reverse painting fluorescence in situ hybridization (FISH), and comparative genomic hybridization (CGH) methods were employed to elucidate the origin of marker chromosomes in 5 clinical cases. METHODS: Reverse painting probes were generated from five copies of each marker chromosomes microdissected with micromanipulator, amplified with DOP-PCR, and labeled with fluorochromes. The probes were hybridized to normal metaphases. For CGH, normal control and patients' DNA were directly labeled with spectrum-red-dUTP and spectrum-green-dUTP by CGH nick translation kit, and hybridized to normal reference metaphases. The CGH images were captured with a computer controlled fluorescence microscope equipped with a CCD camera and analyzed by Cytovision workstation. RESULTS: Five marker chromosomes were identified as follows (1) derivative chromosome 15 inducing partial trisomy of 15pter->q21, (2) isochromosome of 18p causing 18p tetrasomy, (3) short arm of chromosome 5 causing 5p trisomy (4) small accessory chromosome originated from centromeric region of chromosome Xq11->q12 (5) der(17) with inverted duplication of the short arm of chromosome 17. In all cases the origin of each marker chromosomes were identified successfully with reverse painting FISH, and these results were concordant with the CGH profiles. CONCLUSION: Our results indicate that combined reverse painting FISH and CGH is a rapid, convinient and powerful tool to identify the origin of marker chromosomes and derivative chromosomes caused by various chromosome abnormalities such as translocation, duplication, deletion.

Biological significance of progesterone receptor isoforms A and B in the normal ovary, and in benign, borderline, and malignant ovarian tumors / 대한산부인과학회지

OBJECTIVE: The differential expression patterns of the two progesterone receptor (PR) isoforms, PRA and PRB were examined using immunohistochemistry and real time quantitative RT-PCR in normal and neoplastic ovarian tissues, and in cell lines derived from epithelial ovarian cancer and breast cancer as a positive control in order to further elucidate the possible involvement of progesterone in the development of ovarian neoplasia. METHODS: Breast cancer cell line MCF-7 and ovarian cancer cell line SNU-8 were seeded to 24-well plate with 5 X 10(5) cell/well and incubated overnight. Those cell lines were treated with 17-beta-estradiol and incubated for another 24 hrs. RNA were purified for RT-PCR and whole cell prepared total proteins were subject to immunoblot with DAB-staining. DNA ladder pattern and flowcytometry were studied to evaluate progestins induced apoptosis in the ovarian epithelium. RESULTS: The median H-scores for PR isoforms in normal (n=8), benign (n=10), borderline (n=8) and malignant (n=24) ovarian tissues were as follows; PRA: 194.0, 171.0, 49.5, 0.0 (P<0.05), and PRB: 175.0, 180.5, 251.5, 168.5, respectively. In ovarian cancer cell line (SNU-8), PRB/PRAB mRNA ratio was not increased by 17-beta-estradiol, but that ratio was increased by 17-beta-estradiol in breast cancer cell line (MCF 7). Immunoblotting analysis demonstrated that PRB protein expression was markedly up- regulated in SNU-8, whereas the PRA and PRB isoforms both appeared to be increased in MCF-7. DNA ladder pattern was increased in dose and time related exposure of progestins and apoptotic cells were markedly increased during exposure progestins in ovarian cancer cell line were found by flowcytometry. CONCLUSION: These results suggest that down-regulation of PRA is associated with the development of ovarian epithelial carcinoma. Progestins can activate the apoptotic pathway in the ovarian epithelium for protection of normal tissues from neoplatic transformation suggests that progestins deserve further evaluation as potential ovarian cancer preventive agents.

A case of pelvic splenosis after splenectomy: A cause of pelvic pain / 대한산부인과학회지

Splenosis represents the autotransplantation of splenic tissue, after splenic trauma or surgery. These splenic implants may be located anywhere in the abdominal cavity. These implants may misinterpreted as endometriosis or malignancy. We present a case of multiple pelvic splenic implants after a splenectomy.

The Relationship of Maternal Physical Characteristic Change and Neonatal Weights: the Comparison between 1989 and 1999 / 대한산부인과학회잡지

OBJECTIVE: This study was organized to find out whether there are differences between pregravid weight, body mass index, weight gain during pregnancy and birth weight in 1989 and 1999. Also it was designed to find out the factors which influenced the birth weight changes. METHODS: A total of 725 (313 in 1989, 412 in 1999) pregnant women who had term delivery in the department of Obstetrics and Gynecology, Hanyang University Hospital were recruited for the study. Pregravid weight, body mass index, weight gain during pregnancy, body weight at the time of delivery and birth weight were examined through medical records retrospectively. RESULTS: Pregnant women in 1999 were older (29.7 +/- 3.7 yr vs 28.3 +/- 3.2 yr, p=0.0001), pregravid weight (54.0 +/- 7.5 kg vs 50.7 +/- 5.5 kg, p=0.0001), height (159.6 +/- 4.8 cm vs 158.5 +/- 4.7 cm, p=0.002), body mass index (21.2 +/- 2.8 kg/m2 vs 20.2 +/- 2.1 kg/m2, p=0.0001), weight gain during pregnancy (13.6 +/- 4.8 kg vs 12.8 +/- 4.6 kg, p=0.016) and birth weight (3103 +/- 652 gm vs 2993 +/- 843 gm, p=0.025) compared with those in 1989. The frequency of overweight (BMI>26) in pregravid was significantly higher in 1999 (9.4%) than in 1989 (1.9%) (p=0.0001). Weight gain during pregnancy were lower in over-weight pregravid than in normal or under-weight pregravid in both year, but birth weight was not different according to pregravid weight in both years. Compared to the weight gain during pregnancy less than 16 kg, women who gained weight more than 16 kg during pregnancy were significantly taller and weighed more at the time of delivery, and showed increased birth weight than those who gained weight during pregnancy less than 16 kg in both years. Weight gain during pregnancy was higher in over-weight pregravid than normal or under-weight pregravid in 1999 (p=0.012). The gain of body weight at the time of delivery in 1999 compared to those in 1989 is the most important factor for the birth weight change between two years. The increased pregravid weight, greater weight gain during pregnancy, and increased BMI also had an impact on the increasing birth weight in 1999. CONCLUSION: It is considered that physical characteristics of pregnant women in 1999 have been changed compared to those in 1989, and this change might be responsible for a birth weight increase.

A Clinical Significance of Second-look Laparotomy in Patients with Epithelial Ovarian Cancer / 대한산부인과학회잡지

OBJECTIVE: To evaluate pathological complete remission rate (pCR), survival rate, recurrence rate, 91 patients who had clinical complete remission with epithelial ovarian cancer were studied. METHODS: From 1983 to 2002, 91 consecutive patients with epithelial ovarian cancer underwent surgical cytoreduction followed by platinum-based chemotherapy at the Department of Obstetrics and Gynecology, Hanyang University Hospital. At the conclusion of chemotherapy, all patients who were clinically disease free and whose CA 125 was 2 cm with advanced stage at primary surgery and negative second-look findings should be the focus of future protocols for consolidation chemotherapy.

A case of malaria infection in pregnancy / 대한산부인과학회잡지

In Korea, malaria is known to have been eradicated for several years due to our persistent national health programs. But recently imported malarias through increased traveling to abroad are becoming a problem and occasional malarial infections are being reported. No malarial infection of pregnant woman has been reported until now, but recently, we have experienced one case of malaria infected pregnant woman who has no history of traveling and blood transfusion. This patient has been treated with hydroxychlorquine. We present this case with a brief review of literatures.

Two Cases of Accessory Fallopian Tube / 대한산부인과학회잡지

Accessory tubes are a congenital and developmental Mullerian duct abnormality of fallopian tubes. Due to their morphological abnormality, the accessory tubes predispose to the occurrence of ectopic pregnancy, infertility and tubal torsion among others and can lead to life-threatening conditions. We are reporting two recent cases of tubal pregnancies with accessory tubes together with literature reviews.

Correlation Analysis of Each Variable of Fetal Heart Rate in Normal and Abnormal Pregnancies / 대한주산의학회잡지

No abstract available.

Correlation Analysis of Each Variable of Fetal Heart Rate After Maternal Hearing of Alpha-Brain Wave Induced Sound and Natural Sounds / 대한주산의학회잡지

No abstract available.