A case of ectopic pregnancy in the previous Cesarean section scar treated by laparoscopic surgery / 대한산부인과학회지

Pregnancy in the previous Cesarean section scar is a very rare form of ectopic pregnancy. This ectopic pregnancy may cause grave complications such as severe vaginal bleeding or spontaneous uterine rupture. Suction curettage, exploratory laparotomy, or systemic or local injection of methotrexate is the treatment method currently performed. In this report, we treat a case of this patient by laparoscopic surgery. By this surgery, we could successfully remove gestational sac from the implantation site and repair the defect by primary suture and preserve uterus.

Endometrial stromal sarcoma of the uterus: A study of 8 cases / 부인종양

OBJECTIVE: The purpose of this study was to investigate the clinicopathologic findings, treatment, and outcome of patients with endometrial stromal sarcoma (ESS) of the uterus. METHODS: This study retrospectively reviewed 8 patients with histologically proven stage I low-grade ESS of the uterus, at the Department of Obstetrics and Gynecology of Korea University Kuro Hospital, between May 1994 and July 2005, for clinical profiles and survival. The median follow-up was 79 months and ranged from 7 months to 131 months. RESULTS: The median age at the time of diagnosis was 43 years (range: 29-49 years). The common presenting symptoms were vaginal bleeding, lower abdominal pain and vaginal discharge. Four patients were treated with surgery followed by postoperative adjuvant chemotherapy, and four patients were treated with surgery alone. Recurrence was in one patient, and the site was the lung. The overall five-year survival rate of stage I low-grade ESS was 100%. Bilateral salpingo-oophorectomy and adjuvant chemotherapy did not significantly affect the survival of patients (p>0.05). CONCLUSION: The patients with stage I low-grade ESS have a very excellent prognosis. The role of bilateral salpingo-oophorectomy and adjuvant chemotherapy have not get been clearly defined and further studies, including prospective studies with larger numbers of patients, are needed.

Usefulness of an Unconjugated Estriol for prediction of Gestational Diabetes Mellitus / 대한산부인과학회지

OBJECTIVE: Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders complicating pregnancy. It is associated with adverse outcomes of pregnancy including obstetrical complications such as increased rate of cesarean section, preeclampsia, and birth trauma, and perinatal morbidities, such as macrosomia, hypoglycemia, hypocalcemia, and hyperbilirubinemia. Therefore, screening for gestational diabetes mellitus and early diagnosis of this condition allows intervention to be carried out, thereby, the reduction of the untoward effects mentioned above can be minimized. But selective screening based on clinical or historic risk factors has been reported ineffective to identify the women with GDM. BACKGROUND: Circulating sex hormones have a role in the development of insulin resistance associated with certain physiological states including hyperandrogenism and polycystic ovary syndrome. Throughout pregnancy, normal human pregnancy is a hyperestrogenic state of major proportions. To evaluate the clinical correlation between Gestational diabetes mellitus and unconjugated estriol, we used it to screening protocol using three biochemical markers for unconjugated estriol levels. METHODS: In our retrospective between January 2002 and December 2003 at Korea university medical center, 137 women were screened for three biochemical tests and 50 gm Glucose challenge test at second trimester of pregnancy. The 50 gm GCT positive (n=56) women were performed 100 gm oral glucose tolerance test and by NDDG diagnosic criteria, women were diagnosed as Gestational diabetes mellitus (n=42). RESULTS: With logistic regression analysis, the significant risk factors were family history of DM (odd ration 16.59 95% CI 2.66-103.52), previous macrosomia birth (odd ratio 9.02 95% CI 1.98-41.6), maternal BMI (odd ratio 1.29 95% CI 1.09-1.49), parity (odd ratio 0.31 95% CI 0.11-0.83), glucosuria (odd ratio 0.68 95% CI 0.26-1.76) and among three biochemical test, estriol (odd ratio 1.60 95% CI 0.49-5.27), AFP (odd ratio 1.35 95% CI 0.35-5.28), hCG (odd ratio 0.59 95% CI 0.27-1.28). CONCLUSION: The screening test of GDM would be preferable and intensified management approach needed for patients with obesity, previous macrosomia birth. In three biochemical test, estriol and AFP levels were elevated in GDM but these odd ratio were not statistically significant.

Agenesis of corpus callosum prenatally diagnosed with fetal MRI: case report / 대한산부인과학회지

Agenesis of corpus callosum is the cerebral malformations whose prognosis is uncertain. But the complete agenesis shows more poor prognosis than partial agenesis. So, the type of agenesis can affect significantly the antepartum management. Recently, there has been a development in diagnostic tools like MRI to overcome these limitations of antenatal ultrasonography. We report a case of agenesis of corpus callosum which was diagnosed by prenatal MRI. This case was confused with Dandy-Walker complex in prenatal ultrasonography and supported in diagnosis by prental MRI.