Misplaced IUD / 대한산부인과학회잡지

OBJECTIVE: To study intrauterine or extrauterine misplacement of intrauterine devices in respect to their usage in diagnosis and therapy via retrospective analysis. METHODS: Data from 1993 to 2000 on a total of 32 patients from seven Catholic University branch hospitals who had been admitted to treat IUDs which had misplaced to intrauterine or extrauterine locations were analyzed for usage in a retrospective study. RESULTS: The data for intrauterine and extrauterine misplacement revealed no significant difference between from the statistical average in relation to age, parity and duration of insertion. In terms of removal method, all 15 patients with extrauterine misplacement underwent surgical extraction by open or laparascopic method under general anesthesia, but those patients with intrauterine misplacement had their device removed after cervical dilatation with a laminaria using local anesthesia. Concerning diagnosis, 81.2% of extrauterine misplacement were diagnosed using x-ray while 58% of intrauterine misplacement were diagnosed using vaginal US. The result of the Fisher's exact test showed a significant difference (p=0.043) in the rate of diagnosis for intrauterine and extrauterine misplacement of IUDs. Also, the results of multi-variable analysis performed for logistical regression analysis showed that intrauterine misplacement occurred 1.23 times more frequently than extrauterine misplacement. CONCLUSION: Further studies are required on a broader patient population, on more types of IUDs and with time variables taken into account. Despite more research, prevention of complications such as misplacement remains the most appealing situation, being influenced by such factors as technical skill of the physician inserting the IUD, appropriate duration of insertion and proper patient education.

Expression of Placenta Growth Factor mRNA Transcripts and Protein in Nasal Mucosa and Nasal Polyps

Placenta growth factor (PIGF) was originally described as a placenta produced homodimeric protein that shares substantial structural similarity with vascular endothelial growth factor (VEGF). It is becoming increasingly evident that PIGF may directly or indirectly modulate several key vascular events in various tissues. These include angiogenesis or vasculogenesis, vascular maturation and stabilization, vascular permeability, and endothelial cell survival. Inflammatory reaction in the nasal mucosa increases mucosal vascular permeability, resulting in edematous nasal mucosa with polypoid change. In this respect, PIGF may play a role in the formation of nasal polyp. In the present study we evaluated the expression of PIGF mRNA and protein in human inferior turbinate mucosa and nasal polyp. The expression and localization of PlGF mRNA and protein were investigated in the inferior turbinate mucosa and nasal polyps using reverse transcription-polymerase chain reaction (RT-PCR), Western blotting and immunohistochemistry. These results showed that the mRNA transcripts and protein for PlGF are expressed in human turbinate mucosa and nasal polyps. Semiquantitative RT-PCR revealed that PIGF mRNA in nasal polyps increased in its expression level than that in nasal turbinate mucosa. Likewise, immunoblot analysis demonstrated a higher expression of PIGF protein in nasal polyp tissues, compared with that of the nasal turbinate mucosa. However, immunohistochemical findings revealed that PlGF is localized in the endothelial lining of blood vessels in the inferior turbinate mucosa, whereas it is expressed in the epithelial cells of nasal polyps. These results indicate that PlGF mRNA and protein are expressed in normal turbinate mucosa and nasal polyp. Further, based on the fact showing that the expression site of PIGF is different in both tissues, the action mechanism of PIGF may be different in human nasal mucosa and nasal polyp. That is, the PIGF may play a role in the physiological function of normal nasal mucosa, possibly the maintenance of blood vessel and in the pathogenesis of nasal polyp formation.

Umbilical Nucleated Red Blood Cell Counts and Perinatal Outcome According to Doppler End-Diastolic Velocity in Severe Preeclampsia / 대한산부인과학회잡지

OBJECTIVE: To assess the umbilical nucleated red blood cell counts and perinatal outcomes according to umbilical artery Doppler end diastolic velocity in severe preeclampsia. MATERIALS AND METHODS: A prospective case-control study comparing 42 severe preeclampsia patients who had present umbilical artery end diastolic velocity with 7 severe preeclampsia patients who absent end diastolic velocity for umbilical nucleated red blood cell counts and perinatal outcomes. RESULTS: Those with absent end diastolic velocity did not have significantly greater nucleated red blood cell counts, but they had increased hemoglobin, hematocrit. These newborn had significantly lower birth weight, increased Cesarean section rate for fetal distress and been more frequently admitted to the neonatal intensive care unit. These newborn also had significantly increased intracranial hemorrhage,assisted ventilation and longer hospital days. CONCLUSION: No correlation with nucleated red blood cell counts and chronic fetal hypoxia were presented. However further study with more expanded cases for the role of nucleated red blood cell counts as a marker of fetal hypoxia will be needed.

A case of de novo ring (13) chromosome with deletion 13q32.2-->qter / 대한산부인과학회잡지

We report a case of ring chromosome 13 with a distal deletion of 13q32.2-->qter observed in a fetus who was referred to our institution at term due to severe growth restriction and multiple congenital malformations on ultrasonographic examination.This boy was born by vaginal delivery at 39 weeks in gestation. His weight, head circumference and height were less than the 3 percentile of gestational age. Apgar score was 7 at 1 minute and 9 at 5 minutes. He showed microcephaly, large forehead, low set ears, hypertelorism, flat nasal bridge, and micrognathia. The genitalia was ambiguous, showing severe hypoplasia of the penis. The anus was ectopic, displaced anteriorly from its normal position but with a normal opening and function. Neurologic examination was normal. Echocardiogram done at 2 weeks of life showed a persistent foramen ovale and a ventriculoseptal defect (type II) with increased pulmonary hypertension. MRI examination of the brain showed poorly demarcating corpus callosum suspecting agenesis of corpus callosum. Also, cerebellar vermis was small and hypoplastic, mimicking a variant form of Dandy-Walker malformation. MRI of the pelvis showed a tubular structure in pelvic cavity, suspicious of uterine remnant, between urinary bladder and rectum, and a inguinal hernia was noted in the left side. In the abdominal cavity enlarged adrenal glands were noted, and hormonal study showed elevated 17-alpha-OH-progesterone (168.9 ng/ml) with normal 17-KS and 17-OHCS levels. Gastrointestinal and urogenital system were otherwise normal. Cytogenetic analysis of the parents were both normal but the newborn showed 46, XY, r (13), de novo, with deletion points q32.2-->qter. Our findings are in line with previous reports about chromosome 13 deletions, in which loss of the "critical point" leads to major malformations like brain anomalies and ambiguous genitalia.

A case of gastrointestinal stromal tumor of ileum preoperatively diagnosed as extrauterine myoma / 대한산부인과학회잡지

Gastrointestinal stromal tumor (GIST) of ileum is a rare tumor of gastrointestial tract that arise from primitive mesenchymal cells. GIST occur predominantly in persons over 40 years of age with an equal sex incidence. GIST expresses a heterogenous clinical course and the most important prognostic factors are tumor size, site, degree of mitotic activity, tumor necrosis. We report a case of GIST of ileum, which was misdiagnosed as extrauterine leiomyoma preoperatively.

Clinical manifestations and perinatal outcomes of pregnancies complicated with gestational impaired glucose tolerance and gestational diabetes mellitus / 대한산부인과학회잡지

OBJECTIVES: To evaluate the clinical manifestations and perinatal outcomes of pregnancies complicated with gestational impaired glucose tolerance (GIGT) and gestational diabetes mellitus (GDM). METHODS: We performed 50gm oral glucose tolerance test (OGTT) for GIGT and GDM screening in 4,367 pregnant women at 24-28 weeks of gestation. In 1,010 women with plasma glucose level over 130mg/dl, 753 women underwent 100gm OGTTs at 28-32 weeks of gestation. According to the NDDG criteria, 113 cases with GIGT (single positive level of OGTT ; group 2), 125 cases with GDM (group 3), and 515 cases with control (group 1) were identified among the 753 cases. Retrospective review of outcome of these patients was performed. ANOVA and chi-square test were used to determine the statistical significance. RESULTS: The incidence of GIGT and GDM was 2.7%, 3.0%. The prepregnant body mass index (21.4+/- 3.0kg/m2, 21.3+/-2.8kg/m2, 23.2+/-4.1kg/m2), overweight of BMI over 26 (7.4%, 4.4%, 14.4%) and obesity of BMI over 30 (1.2%, 0.0%, 8.0%) was significantly higher in group 3 than group 1 (p<0.05). We defined poor maternal outcome as those suffering from any one of birth canal injury, hydramnios or oligohydramnios, preeclampsia, cesarean delivery due to cephalopelvic disproportion, dystocia, fetal distress. Group 3 showed most highest poor maternal outcome (22.3%, 28.3%, 39.2%, p<0.05). And we defined poor neonatal outcome as those suffering from any one of hyperbilirubinemia, hypoglycemia, congenital anomaly, admission to neonatal intensive care unit due to respiratory distress syndrome. Group 2 and group 3 showed poor neonatal outcome than group 1 (6.2%, 13.3%, 21.6%, p<0.05). CONCLUSION: Pregnancies complicated with GDM showed poor maternal and neonatal outcome, and GIGT experienced no adverse maternal outcomes but showed poor neonatal outcomes compared to normal pregnancy, and showed less correlation with obesity than GDM. Further study of pathophysiology and proper management of GIGT will be mandatory.

The Expression of LH/CG receptor, alpha and Beta-hCG mRNA in the trophoblast of spontaneous abortion / 대한산부인과학회잡지

OBJECTIVE: To investigate the mechanisms involved in the mRNA expressions of hCG, LH/CG receptor and in hormone secretion in the trophoblast of normal and abnormal early pregnancy. METHODS: hCG, free Beta-hCG, and progesterone concentrations were measured in serum and the mRNA expressions of alpha,Beta-hCG and LH/CG receptor were measured in the placental trophoblast of 22 spontaneous abortion patients (spontaneous abortion group), 20 normal pregnancy women (normal pregnancy group) and 6 hydatidiform mole patients (hydatidiform mole group). RESULTS: 1. Mean values of serum hCG and free Beta-hCG concentrations were the lowest in spontaneous abortion group (46343.63+/-40404.18 mIU/ml, p<0.001; 31.34+/-61.57 mIU/ml, p<0.01 respectively) among the three groups. Mean progesterone concentration was the lowest in spontaneous abortion group (11.84+/-7.60 ng/ml, p<0.01), too.2. The expression levels of alpha,Beta-hCG were the highest in spontaneous abortion group (4.64+/-5.47, p=0.015; 4.57+/-4.42 p=0.002 respectively). The expression levels of LH/CG receptor were not different statistically among the three groups and they were high at the 5th week of gestation, reaching nadir at the 10th week of gestation when the concentrations of serum hCG showed peak values in normal pregnancy group.3. The correlations between serum hCG and progesterone concentrations were positive in both spontaneous abortion (r=0.827, p<0.001) and normal pregnancy (r=0.438, p=0.054) group. Though they were not significant statistically, the correlations between progesterone concentrations and the levels of alpha,Beta-hCG expressions were negative in both spontaneous abortion (r=-0.237, p=0.289; r=-0.211, p=0.347) and normal pregnancy (r=-0.270, p=0.250; r=-0.235, p=0.318) group. In hydatidiform mole group, the correlation between progesterone concentrations and the levels of Beta-hCG expression was positive (r=0.968, p=0.002). CONCLUSION: Our results suggest that the mechanisms involved in the secretion of hCG, progesterone and the expression of alpha,Beta-hCG, LH/CG receptor be normal in spontaneous abortion as in normal pregnancy and in the both groups, hCG stimulate the secretion of progesterone by autocrine function and control the secretion of itself, through the suppression of the expressions of alpha,Beta-hCG and LH/CG receptors. So the cause of spontaneous abortion in early pregnancy may be not placental dysfunction but the defect of embryo itself with poor placental growth.

A Clinical Review of the HELLP Syndrome / 대한주산의학회잡지

No abstract available.

Clinical Manifestations and Perinatal Outcomes in Pregnancies with Fetal Dysplastic Kidney Disease / 대한산부인과학회잡지

OBJECTIVE: To obtain clinically useful data regarding prenatal diagnosis, proper antepartum counseling and obstetric management in pregnancies with fetal dysplastic kidney disease. METHODS: We retrospectively reviewed 13 cases of MCDK(Multicystic dysplastic kidney) and PCDK(Polycystic dysplastic kidney), diagnosed by antenatal ultrasound and delivered from June 1994 through July 1999 at Ajou University School of Medicine, Department of Obstetrics and Gynecology, with regard to prenatal ultrasonographic findings, perinatal outcomes, maternal complications and associated fetal anomalies. RESULTS: The incidence of MCDK and PCDK was one in 1,066 and one in 2,398 births, respectively. Of the 9 cases of MCDK, one case was terminated due to severely associated anomaly, and 6 cases were delivered by spontaneous labor or pitocin induction at term, of which 1 case was delivered by pitocin induction at 36 weeks gestation due to intrauterine fetal death. Two cases were delivered by cesarean section. There were no neonatal deaths in 7 cases of MCDK and they have been followed up to date, and alive. Of the 4 cases of PCDK, 3 cases were terminated by induced abortion or induced vaginal delivery, and 1 case was delivered by cesarean section, which was combined with hypertrophic cardiomyopathy, and the baby died within 24 hours after birth. Perinatal complications consisted of small for gestational age, urinary tract infection, hydronephrosis, acute respiratory failure, acute renal failure, periventricular hemorrhage and laryngomalacia in the neonatal period. CONCLUSION: It is suggested that antenatal ultrasonography and genetic analysis to evaluate accurate diagnosis and associated anomalies should be performed to manage and councel properly the pregnancies with fetal dysplastic kidney disease.

Expression of cyclooxygenase-1, -2 in human uterine cervix during gestational period / 대한산부인과학회잡지

OBJECTIVE: To determine whether cyclooxygenase (COX)-1 and COX-2 are expressed differentially during the whole gestational period in the pregnant human uterine cervix and if they are involved in the process of labor. METHODS: Nine patients were matched for obstetrical history and maternal age were divided into an abortion group who aborted between 13 and 16 weeks(n=3), a preterm group who delivered between 20 and 37 weeks(n=3), and a term group who delivered between 37 and 42 weeks of gestation(n=3). Immediately after vaginal delivery cervical biopsy samples were obtained and immunohistochemically stained for COX-1 and COX-2 and the degree of staining was evaluated by H-scoring system. RESULTS: Expression of COX-1 and COX-2 was found in epithelial and stromal cells of uterine cervical tissues of preterm and term group. The immunohistochemical expression of COX-1 and COX-2 was strongest in the term group compared to the preterm group in stromal cells(HSCORE : 2.0 vs. 4.0 ; 2.0 vs. 3.0), and in epithelial cells(HSCORE : 1.0 vs. 3.0 ; 1.0 vs. 3.0). CONCLUSION: Although small amount of the groups were investigated, in the pregnant human uterine cervix, COX-1 and COX-2 are found to be expressed, and both shows the strongest expression in term cervical tissue. It is suggested that the uterine cervix, under the control of prostaglandins, is actively involved in the process of labor, and it is thought that the role of COX-1 and COX-2 is more important in parturition process with advancing gestational age.