Ovarian follicular and peritoneal fluid prostaglandin E2 and F2a levels according to the clinical symptoms in the women with endometriosis / 대한산부인과학회지

OBJECTIVE: The purpose of the present study was to determine whether a relationship exists between the clinical symptoms (dysmenorrhea and infertility) and prostaglandin (PG) concentrations in follicular and peritoneal fluid in the women with endometriosis during the late follicular phase of the menstrual cycle. METHODS: Thirty patients with pelvic endometriosis diagnosed by pelvic surgery were enrolled. Eight patients were suffering from severe dysmenorrhea and 11 had history of primary or secondary infertility among them. Endometriosis patients were grouped by the presence of each symptom and compared with 33 control patients without endometriosis. Peritoneal fluid was collected in the beginning of peritoneal opening and dominant follicular fluid was aspirated by syringe needle at the time of operation. Then PGE2 and PGF2a concentration were measured at each tube. RESULTS: Follicular fluid PGF2a levels were increased in 30 endometriosis patients (P=0.003), and the levels were significantly higher in 11 patients with infertility compared with the control (P=0.001). Peritoneal fluid PGF2a levels were significantly higher in 8 patients with severe dysmenorrhea compared with the others or the control (P=0.028). Follicular or peritoneal fluid PGE2 levels were not different between any group and the control. There was no significant correlation between size of endometrioma and each PG levels. CONCLUSION: Severe dysmenorrhea in endometriosis patients would be related with the high level of peritoneal fluid PGF2a concentration, and infertility in endometriosis would be related with the high level of follicular fluid PGF2a concentration.

A Study of the Causes and the Predictive Factors in Failed Vaginal Birth After Cesarean Section / 대한주산의학회잡지

OBJECTIVE:The purpose of this study was to determine the factors associated with successful vaginal birth after cesarean section (VBAC), and to analyze the causes of failed VBAC. METHODS:This study was performed based on 193 pregnant women who tried vaginal delivery after cesarean section in Chungbuk National University Hospital from January 1997 to December 2005. Maternal age, gestational age, cervical dilatation at admisson, maternal body mass index (BMI), neonatal bodyweight, history of prior vaginal delivery, and indication of prior cesarean section were retrospectively analyzed between the successful group and the failed group of women who tried labor. The causes of the failed trial were analyzed. RESULTS:Seventy nine percent (153/193) was successful in the trial of VBAC and 21% (40/193) failed. There were no difference in maternal age or gestational age between two groups. The success rate was significantly higher when cervical dilatation at admission was more extended, BMI of pregnant women before pregnancy and birth was lower, and birthweight of newborn was lower. Maternal request was the major cause of failure (47.5%), and others were failure to progress, non-reassuring fetal monitoring and failed induction. CONCLUSION:The factors that had significant differences in this study can be used as predictor of successful VBAC. And failed trial of VBAC due to maternal request can be decreased by adequate explanation regarding the complication of emergency operation, and enough pain control during labor.