Effect of Childbirth Age on Bone Mineral Density in Postmenopausal Women

BACKGROUND: In postmenopausal women, there is rapid bone loss due to estrogen depletion. In women, reproductive factors such as age at menarche, breastfeeding, and parity are considered risk factors of osteoporosis. Many reports suggest that obesity is associated with a reduced risk of osteoporosis. This nationwide, population-based study aims to identify the association between maternal age and osteoporosis risk in postmenopausal women of different obesity classifications. METHODS: We assessed data from the Korean National Health and Nutrition Examination Survey 2010–2012. The study included 1,328 postmenopausal women, after excluding women with missing data for reproductive history among 4,546 postmenopausal women in the survey. Multivariate regression was used to identify the association between childbirth age and postmenopausal bone mineral density after adjustments for confounding factors. RESULTS: The prevalence of postmenopausal osteoporosis was 35.24% (n = 468). After dividing the subjects into obese and non-obese groups based on body mass index (BMI) and waist circumference, there were significant differences between non-osteoporosis and osteoporosis groups with regard to age at first childbirth, age at last childbirth, and parity in the BMI-based general obesity group. The prevalence of osteoporosis was highest in women older than 35 years old at last childbirth. The prevalence of osteoporosis was also greater in women with parity ≥ 4 compared to those with lower parity levels. CONCLUSION: Postmenopausal women of older age at last childbirth and higher parity were at increased risk of osteoporosis in the BMI-based non-general obesity group.

Significance of multidisciplinary counseling on prospective parents with fetus of congenital disease / 대한산부인과학회지

OBJECTIVE: This exploratory study was undertaken to analyze the anxiety of parents of prenatally diagnosed fetal congenital disease and satisfaction after the multidisciplinary counseling. METHODS: The study included 32 prospective parents of antenatally diagnosed congenital disease fetus who received multidisciplinary counseling at The Catholic Congenital Disease Center (CCDC) for the period from May, 2009 through March, 2010. The Korean version of the Spielberger State-Trait Anxiety Inventory (STAI) was utilized to assess parental anxiety. Categories of satisfaction survey were classified into accessibility, professionalism, empathy, recoverability, satisfaction, and expectation after counseling. RESULTS: The mean time and number of medical professionals for each counseling were 58.0+/-36.9 min and 3.5+/-1.1 persons. Most common congenital diseases were cardiovascular (36.1%) and urogenital diseases (25.0%). STAI scores were significantly decreased after than before counseling (43.5+/-5.9 vs 36.9+/-6.0, P=0.0007). STAI scores after counseling showed significant decrease in prospective mothers who were nulliparous (P=0.0005), less than 35 years old (P=0.0014), had religion (P=0.0014) and counseled more than 40 minutes (P=0.0027). The mean rate of positive satisfactory response about multidisciplinary counseling was 85.6% in satisfaction survey. CONCLUSION: This study provides evidence of the positive impact on the prospective parental anxiety of a multidisciplinary counseling in prenatal management of fetal congenital diseases.

Congenital lymphangiomatosis of the right lower limb / 대한산부인과학회지

Lymphangiomatosis is a condition of lymphatic tissue malformation with multiple or diffuse involvement of soft tissues, visceral organs. Congenital abnormalities of the lymphatic system are very rare, and reports of congenital lymphangiomatosis are even fewer. We experienced a case of congenital lymphangiomatosis detected as edema of the right limb by prenatal ultrasonography and then diagnosed by magnetic resonance imaging. We describe this case with a brief review of the literature.

Perinatal Outcomes according to the Types of Fetal Acidosis in Term Newborns with Umbilical Artery Acidosis / 대한주산의학회잡지

PURPOSE:To investigate the significance of umbilical artery acidosis and compare perinatal outcomes according to the types of acidosis for a tertiary hospital population delivered at term. METHODS:We reviewed maternal and neonatal medical records of all term liveborn infants with an umbilical artery pH or =20 mEq/L) and high pCO2 (> or =20 mmHg) were significantly associated with low pH value, the perinatal outcomes were not significantly different according to the level of base deficit or pCO2. CONCLUSION:The mixed acidemia was more associated with pathologic fetal acidemia than pure respiratory or metabolic acidosis. The ability to predict not only metabolic but also respiratory component of fetal acidemia may help in safe management of delivery leading to reduce the fetal acidemia.

Prenatal diagnosis of thrombocytopenia-absent radius syndrome using three-dimensional ultrasound / 대한산부인과학회지

We describe a case of thrombocytopenia-absent radius syndrome suspected by ultrasonography, later confirmed by fetal blood analysis. From this case we confirmed the usefulness of three-dimensional ultrasonography in diagnosing abnormalities in the fetal skeletal system and genetic counseling.

Congenital depression of the neonatal skull unassociated with birth trauma / 대한주산의학회잡지

In spite of the fact that there is general consensus that neonatal depressed skull fractures are caused largely by instrumental extraction, there are a few reports regarding congenital depression of the skull unrelated to external trauma. In the case herein, the mother did not have any history of abdominal trauma during pregnancy and the neonate was delivered vaginally without the use of instruments, yet a round depression was noted in the left parietal bone of the neonate at the time of delivery. Computed tomography with three dimensional reconstruction images was performed and a congenital depression of the neonatal skull without fracture was diagnosed. We describe this case with a brief review of the literature.

Clinical analysis of ovarian pregnancy / 대한주산의학회잡지

OBJECTIVE: To evaluate the early diagnostic key of ovarian pregnancy. METHODS: A Retrospective case study of 31 cases of ovarian pregnancies treated between 1990 and 2007 at Kangnam St. Mary's hospital Catholic University of Korea was performed. The maternal age, obstetric history, clinical symptoms, sonographic findings, preceding factors, diagnostic modalities, and surgical treatment methods were investigated. RESULT: 31 ovarian pregnancies, diagnosed between 1990 and 2007, comprised (31/1176) 2.6% of all ectopic pregnancies. The most common sonographic finding was fluid collection surrounding the ovary and an ipsilateral enlarged ovary (83.9%). Presenting symptoms were similar to those of tubal pregnancies. Before 1997, wedge resection was done mostly by laparotomy (15/16 cases, 93.8 %) and from then on by laparoscopy (8/14 cases, 57.1%). CONCLUSION: Ovarian pregnancy should be suspected in young woman with symptom of lower abdominal pain, history of pelvic adhesion and sonographic finding of fluid collection around ovary or enlarged ovary for an early diagnosis. Early diagnosis and management can preserve fertility and ovarian function.

Significance of prenatal radiologic diagnosis of the central nervous system anomalies / 대한주산의학회잡지

OBJECTIVE: The present study compared the findings of ultrasonography and MRI in the prenatal diagnosis of congenital central nervous system anomalies and identified the merits of MRI. METHODS: We retrospectively analyzed the medical records of neonates diagnosed with congenital central nervous system anomaly after birth born at the Department of Obstetrics and Gynecology in Kangnam St. Marys Hospital during the period from January 1997 to April 2008, and compared the findings of prenatal ultrasonography and MRI with the results of postnatal diagnosis. RESULTS: There were a total of 13 neonates postnatally diagnosed with congenital central nervous system anomaly, and 6 of them had prenatal MRI. Among them, ventriculomegaly and hydrocephalus were observed in 3 cases, arachnoid cyst in 2 cases, and megacisterna magna in 1 case. Supplementary information was available for all the 6 cases, and diagnosis based on the supplementary information was closer to postnatal diagnosis. CONCLUSION: In fetuses in which congenital central nervous system anomaly is observed in ultrasonography, prenatal MRI can provide supplementary information and enable more accurate diagnosis. This can be helpful in counseling the guardians and deciding treatment modality.

Comparative study between pregnancies with and without hypertensive disorders in placental abruption / 대한주산의학회잡지

OBJECTIVE: The aim of this study was to compare the clinical characteristics of placental abruption according to the presence or absence of hypertensive disorders in pregnancy. METHODS: The retrospective analysis was performed in total 363 cases of placental abruption among 25,895 deliveries during 5 years from January, 2003 to December, 2007 in 8 hospitals of Catholic university in Korea. Maternal characteristics and neonatal outcomes were compared with parametric test. RESULTS: The incidence of placental abruption was 1.40% during the study period. The proportion of patients complicated with hypertensive disorders was 33.1%. There was no difference in maternal age and the number of previous pregnancy between two groups with or without hypertensive disorders. As expected, mean gestational age at delivery was lower in placental abruption with hypertensive disorders compared to those without the diseases (237.1 days vs 239.1 days). The incidence of abnormal fetal presentation, multiple gestation, PPROM, and polyhydramnios were more common in patients with placental abruption without hypertensive disorders. On the other hand, the incidence of maternal thrombophilia was significantly higher in patients with placental abruption with hypertensive disorders. The patients with placental abruption with hypertensive disorders had higher incidence of abdominal pain, fetal distress, uterine contraction, and uterine hypertonus (p<0.05). In terms of maternal complication, the patients with placental abruption with hypertensive disorders had more severe complications including shock, coagulopathy and renal failure (p<0.05) and had worse perinatal outcome including FDIU (fetal death in uterus) and neonatal death (10.8% vs 10.3%). CONCLUSION: In patients with placental abruption with hypertensive disorders in pregnancy, maternal complications were more common and prenatal outcome was worse compared to patients with placental abruption without hypertensive disorders.

The comparison of beta-hCG levels according to treatment modalities in tubal pregnancy / 대한주산의학회잡지

OBJECTIVE: The aims of this study were to evaluate the effect of the methotrexate (MTX) method by comparing the change of the serum beta-hCG level between the MTX method and salpingectomy for treating tubal pregnancy, furthermore by analyzing differences between the MTX success group and the failure group, and to provide helps in establishing criteria for choosing the MTX method. METHODS: Medical records of the 118 patients who were diagnosed with tubal pregnancy were reviewed retrospectively for the period of January 2006 to December 2007 at Kangnam St. Marys Hospital. RESULTS: Between the MTX success group and the failure group, no difference was observed in pregnancy duration, but statistically significant differences were observed in the size of hematoma and the quantity of hemoperitoneum at the site of tubal pregnancy in ultrasonography and in the serum beta-hCG level (p<0.05). Compared with salpingectomy, the MTX method showed the patterns of a low decrease rate of serum beta-hCG level after treatment and even its increase during the early period of treatment, but the serum beta-hCG level decreased rapidly from Day 7 after treatment and became equal to that of salpingectomy on Day 28 after treatment. CONCLUSION: The size of hematoma and the quantity of hemoperitoneum at the site of tubal pregnancy and the serum beta-hCG level before treatment are important factors for success in the MTX method. The MTX method may be safe and effective relatively in hemodynamically stable tubal pregnancy patients, who need preserve the salpinx particularly.

Ovarian malignancy in pregnancy: Experience for 17 years / 대한주산의학회잡지

OBJECTIVE: The aim of this study was to evaluate the clinical course and pregnancy outcome in patients who had ovarian cancer diagnosed during pregnancy. METHODS: Review of medical records of 10 cases of patients who have ovarian cancer diagnosed during pregnancy at three affiliated hospitals in the Catholic Medical Center from January 1991 to December 2007 was done. RESULTS: Among 10 cases diagnosed as ovarian cancer during pregnancy, six cases were in the first trimester, one case in the second trimester, and 3 cases in the third trimester. Six cases did not show any specific symptoms at diagnosis and seven cases showed malignant characteristics on ultrasonography. Pathologic evaluation showed 2 clear cell tumors in stage IIIb and Ia, 1 germ cell tumor in Ic, 1 immature teratoma in Ic, and 2 serous adenocarcinoma in Ic and Ic, 2 borderline serous adenocarcinoma, and 2 borderline mucinous adenocarcinoma. Three cases with epithelial ovarian cancer in stage I did not receive chemotherapy. Two cases in non-epithelial ovarian malignancy and 1 stage IIIb epithelial ovarian cancer received chemotherapy. In one case, chemotherapy was performed during pregnancy and a healthy child was delivered. Five in 10 cases were lost in long term follow-up and 5 cases including stage IIIb case, remain without evidence of recurrent disease. CONCLUSION: If early diagnosis and treatment are performed, ovarian cancer diagnosed during pregnancy has favorable prognosis. So, delay the treatment of ovarian cancer due to pregnancy should not be permitted and proper chemotherapy during pregnancy should be considered if necessary.

Mullerian inhibiting substance as a predictive marker of menopausal transition / 대한산부인과학회지

OBJECTIVE: To identified whether serum Mullerian inhibiting substance (MIS) level may be used as a predictive marker of menopausal transition. METHODS: Serum MIS level was measured in reproductive women (n=87), in menopausal transition women (n=58), and in menopausal women (n=5) by ELISA. And we examined the immunohistochemical staining of the MIS in the ovarian tissues of 15 reproductive, 15 menopausal transition, and 5 menopausal women. RESULTS: 1. In the reproductive women, mean serum MIS level was 1.73+/-1.07 ng/ml. In the menopausal transition women, mean serum MIS level was 0.18+/-0.11 ng/ml. Serum MIS level did not show any significant fluctuation patterns according to follicular development. In menopausal transition women, serum MIS level was significantly lower than that of reproductive women (P<0.001). The cutoff value of serum MIS level for menopausal transition was 0.5 ng/mg. In the menopausal women, serum MIS level was not detected. 2. Serum MIS level was significantly decreased as patient age was increased. 3. In the reproductive group, the immunohistochemical staining demonstrated strong expression of MIS in the granulosa cells of the primary follicles and the growing follicles, but not in corpus luteum, preovulatory mature follicle, atretic follicle, and corpus luteum. In the menopausal transition women, immunohistochemical staining for MIS was observed in the nearly same pattern as that of thereproductive women, but with weaker expression. In the menopausal women, immunohistochemical staining of the MIS was not observed. CONCLUSION: MIS is a good candidate for predictive marker for ovarian aging and perimenopausal transition.

A case of cystolithiasis after intravesical migration of Copper T intrauterine device / 대한산부인과학회지

An intrauterine device (IUD) is one of the most commonly used contraceptive method in the world. One of the major complications of intrauterine contraception is the perforation through the uterine wall into the pelvic or abdominal cavity. The incidence is 0.9 people per 1000. However, bladder perforation is even more rare. It happens mostly at the time when it was inserted. The symptom varies from no symptom at all to low abdominal pain, massive bleeding, et cetera. We report a case with displaced intrauterine device in bladder, producing the bladder stone which was managed with cystoscopic lithotripsy and intrauterine device removal, followed by a review of the literature.

Magnetic resonance imaging in the evaluation of uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis: a case report / 대한산부인과학회지

Uterus didelphys with unilateral obstructed hemivagina is indeed a very rare congenital anomaly. Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis usually presents after menarche with progressive abdominal pain during menses secondary to hematocolpos. The method of choice for diagnosis is magnetic resonance imaging (MRI). MRI can do much for the early diagnosis and the prevention against further complications of this condition because it can demonstrate the mullerian duct anomaly complicated with obstructed hemivagina in detail and even ipsilateral renal agenesis. A greater awareness of the syndrome of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis should lead to its prompt diagnosis, allowing for early and appropriate surgical intervention as well as decreased long-term morbidity. Early accurate diagnosis after menarche followed by excision and marsupialization of the blind hemivagina offers complete relief of symptoms and preserves reproductive potential. We report a case of uterine didelphys with obstructed hemivagina and ipsilateral renal agensis with a brief review of the literature.

The effect of colpoperineoplasty on female sexual function / 대한산부인과학회지

OBJECTIVE: To evaluate female sexual function after colpoperineoplasty. METHODS: Women who visited regional clinic for colpoperineoplasty from June. 2004-Aug. 2004. filled in FSFI (The Female Sexual Function Index) questionnarie before and 4 months after surgery. Six weeks after surgery, they start pelvic muscle training with HMT 2000 (Korea, electric stimulator). RESULTS: Frequency of coitus, sexual desire, arousal, lubrication and orgasm was increased after colpoperineoplasty. Percentage of patients who had coitus more than once a week increased from 18% to 63%. In sexual desire, about 18% felt sexual arousal more than or about half the time before surgery, but increased to 45% after surgery. In sexual arousal, percentage of who felt sexually aroused during more than half of sexual activity increased from 34% before surgery to 69% after surgery. In Lubrication, percentage of who became lubricated during more than half of sexual activity increased from 44% before surgery to 82% after surgery. Who reached orgasm more than half of sexual activity increased from 29% before surgery to 70%. CONCLUSION: Colpoperineoplasty increased female sexual activity.

The Safety of Incidental Appendectomy during Total Abdominal Hysterectomy / 대한산부인과학회지

OBJECTIVE: To evaluate the safety of the incidental appendectomies in women who undergo total abdominal hysterectomies for benign diseases. METHODS: This was a retrospective case-controlled study of patients who did (n=54) or did not (n=70) undergo incidental appendectomies at the time of an total abdominal hysterectomy between January 2002 and December 2003. Data were obtained about operation time, the number of days with nothing by mouth, the length of hospital stay (LOS), postoperative complications and pathology of appendix. Data were analyzed using student t-test. RESULTS: 1) There was no significant difference between two groups in operation time. The mean time was 120.0+/-23.8 in incidental appendectomy group and 112.5+/-23.9 minutes in control group. 2) There was no significant difference between two groups in the days with nothing by mouth. The mean was 1.06+/-0.23 in incidental appendectomy group and 1.03+/-0.17 days in control group. 3) There was no significant difference between two groups in the length of hospital stays. The mean was 7.34+/-0.68 in incidental appendectomy group and 7.14+/-1.15 days in control group. 4) There were no significant differences between two groups with respect to the post operative complications; fever, wound infection, stump disruption, and postoperative bleeding. 5) Seventy-six percent of the histologic specimens were abnormal, with fecalith being most common, and there were three cases of acute appendicitis. CONCLUSION: An incidental appendectomy at the time of hysterectomy does not increase operation time, the days with nothing by mouth, LOS, and postoperative complication rates. The incidental appendectomies during total abdominal hysterectomy may be safe procedures.