The Value of Laparoscopic Assistance in Total Vaginal Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate value of laparoscopic assistance during total vaginal hysterectomy, and its implications for hysterectomy method. METHODS: Between January 2001 and December 2001, 236 patients underwent transvaginal hysterectomy (TVH) or Laparoscopic assisted vaginal hysterectomies (LAVH) for benign disease. We compared the results of the two methods, taking account of age, parity, past history of abdominal surgery, surgical indication, operation time, blood loss, presence of pelvic adhesion, weight of uterus, and intra- and post- operative complications and hospital stays. RESULTS: There was no difference in patients' mean age, parity, or menopausal status. Previous operation history was similar between the two groups, except previous cesarean section history. Indications for surgery were similar between the two group. There was no statistical difference on preoperative hemoglobin, postoperative hemoglobin, and 1st day hemoglobin drop. However, mean blood loss checked in operation room was greater for the LAVH group (TVH:113.7+/-83.9 cc, LAVH:146.1+/-113.3 (p<0.05). Uterine weight was heavier in the laparoscopic (249.6 gm) than the vaginal group (214.8 gm) (p<0.05). Mean operating time was shorter in the vaginal (46.5 min) than the laparoscopic group (84.9 min). In laparoscopic group, 15 patients had pelvic adhesions. Four of the 15 patients had adhesions between the posterior surface of the uterus and the bowel, and successful laparoscopic adhesiolysis was achieved in all four cases. CONCLUSION: LAVH have longer operation times and hopital stays than vaginal hysterectomies, but can be safer procedures in patients with possible pelvic adhesions.

Large cell Neuroendocrine Carcinoma Associated with Invasive Mucinous Adenocarcinoma of the Uterine Cervix / 대한산부인과학회잡지

Cervical large cell neuroendocrine carcinoma is rare. We experienced one case of cervical large cell neuroendocrine carcinoma with invasive mucinous adenocarcinoma in 49 years old woman. So we report the case and brief review of literature.

The Clinical Usefulness of Cervicovaginal Fetal Fibronectin as a Prediction of the Time of Induction / 대한산부인과학회잡지

OBJECTIVES: Fibronectin is a high-molecular-weight glycoprotein found in the plasma and extracellular matrix. The presence of fetal fibronectin in cervicovaginal secretion of pregnant women during the second and the third trimester has been suggested as a means of identifying women in preterm labor who be delivered prematurely. Therefore, our purpose was to determine the clinical efficacy of the presence of fetal fibronectin in cervicovaginal secretion of patient in full term as biochemical predictor of Time of Induction. METHODS: Fetal fibronectin was obtained at external os and posterior vaginal fornix in 30 women in full term who had no uterine contraction with intact membrane. The cervix was assessed by digital vaginal examination and scored with a modified Bishop score. RESULTS: There was a good correlation in delivery time after induction between the fetal fibronectin and the modified Bishop score (r=0.695,P<0.005) CONCLUSION: The presence of fetal fibronectin is better than Bishop score that is dependent on clinical experience as biochemical predictor of Time of Induction.

Antenatal Screening for Gestational Diabetes by 50-g, 1-hour Glucose Screening Test / 대한산부인과학회잡지

OBJECTIVE: Gestational diabetes mellitus is defined as carbohydrate intolerance of variable severity first diagnosed during pregnancy. It is associated with adverse outcomes of pregnancy including obstetrical complications such as increased rate of cesarean sections, 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. METHODS: Screening for abnormal glucose metabolism was carried out in 489 pregnant women. A 50-g oral glucose load without regard to time of day or last meal, and a 1-hour plasma glucose determination with a threshold of 140mg/dl were used as a glucose screening test(GST). Patients with an abnormal GST underwent an oral glucose tolerance test(GTT). RESULTS: The overall incidence of gestational diabetes was 2.7%. The occurrence of this disorder was significantly related to the age of pregnant women, parity, or the presence of risk factors for gestational diabetes and obesity(Body Mass Index> or =26kg/m2). CONCLUSION: This study suggests that Korean pregnant women should be screened for gestational diabetes.

A Clinical Survey of Cesarean Hysterectomy / 대한주산의학회잡지

Cesarean hysterectomy remains a necessary procedure for life saving during intractable obstetric hemorrhage. The procedure itself is usually associated with considerable perioperative morbidity, especially when performed under emergency conditions. In this study, the outcomes of 15 cases of cesarean hysterectomy performed at Catholic university of Taegu-Hyosung hospital for 5 years from January, 1993 to December, 1997 were reviewed. There were 22,251 deliveries during this period, cesarean hysterectomy was performed in 13 of 5,753 cesarean section(0.22%) and in 2 of 16,698 vaginal deliveries(0.12%), so more frequently after cesarean section than vaginal deliveries. The age of patients varied from 23 to 39 years old. The higher the age of patients, the higher incidence of cesarean hysterectomy was noted. The most common indication of emergency cesarean hysterectomy was in uterine atony(53.3%), followed by placental disorders(33.3%), uterine rupture(6.7%), and uterine myoma with pregnancy (6.7%). All patients who had cesarean hysterectomy received transfusion from 3 pints to 13 pints. In aspect of fetal outcomes, live birth were 12 cases(80%), one case was fetal death in utero(6.6%), 2 infants were dead during the early neonatal period(13.3%) due to prematurity and RDS (respiratory distress syndrome), so the perinatal mortality rate was 20.0%. The postoperative complications were wound disruption, hematoma, febrile morbidity and disseminated intravascular coagulopathy.