Clinical Analysis of Placental Abruption / 대한주산의학회잡지

OBJECTIVE: Placental abruption is one of the obstetric hemorrhage diseases that needs emergent treatment. But there is no predictable tool for placental abruption at present, we clinically analyzed its incidence, etiological factors, signs and symptom and neonatal outcome for reducing complications of this disease. METHODS: The data presented here were based on 80 cases of placental abruption among 20,483 deliveries during 13 years of period from January, 1991 to December, 2003. RESULTS: The incidence of placental abruption was 0.4%. Most of cases (97.5%) occurred over 28 weeks of gestational age. The incidence of unknown etiological factor was 67.5% and pregnancy-induced hypertension was related in 22.5% of cases. The most common signs and symptom was vaginal bleeding (46.3%). Lower abdominal pain (33.8%), fetal distress (10%), premature labor (5%) were also noted. The half of the patients was diagnosed before delivery and the mode of delivery was cesarean section in 93.8%. The survival rate of newborns in severe degree group (14.3%) of placental abruption was lower than that of mild degree group (94.1%) or moderate degree group (84.6%). Additionally, Apgar scores at 1min and 5min of newborns in severe degree group (1.3+/-2.4/1.3+/-3.0) were significantly lower than that of mild degree group (5.9+/-2.5/7.5+/-2.2) or moderate degree group (5.5+/-2.7/7+/-2.8) (p<0.01). There was no maternal death in our study. CONCLUSION: Because the etiological factor of this disease was uncertain in two thirds of cases, comprehension of etiological factor such as pregnancy-induced hypertension and signs and symptom is emphasized. Bleeding and uteroplacental insufficiency caused by placental abruption affect fetal jeopardy in severe cases. Accurate diagnosis and adequate treatment including management of premature baby should be conducted in suspicious case of placental abruption for prevention of progression of this disease.

Clinical Analysis of Uterine Leiomyoma with Increased Mitotic Activity / 대한산부인과학회지

OBJECTIVE: To evaluate clinical-pathological aspects of uterine smooth-muscle tumors with a pathological diagnosis of uncertain malignant potential or leiomyomas with increased mitotic activity. METHODS: We reviewed the charts and pathological records of twenty seven patients with smooth muscle tumors of the uterus, with 5-9 mitotic figures per 10HPF (High power fields) and without cytological atypia or necrosis retrospectively. RESULTS: The patients were 29-60 (mean 41.8+/-6.8) years old and mean parity was 1.7+/-0.9. None of the patients had used any hormones preoperatively. The size of the myomatous tumors ranged from 2 to 23 cm (mean 7.1+/-4.6 cm). On gross examination all tumors appeared as typical leiomyomas. Twenty were intramural and 7 were submucous leiomyomas. The mitotic counts ranged 5-9/10 HPF (mean 6.0+/-1.2/10 HPF). Cytological atypia or necrosis were absent. The histological phase of the endometrium could be evaluated in 18 patients. Of these, ten had secretory-phase endometrium and proliferative endometrium was present in eight patients. Hysterectomy was performed in 20 patients with intramural leiomyoma, and myomectomy was in 7 patients under diagnosis of submucosal type. Postoperative follow-up periods ranged 5-94 months (mean 37.0+/-22.6 months). All patients were alive without evidence of recurrence or metastasis. CONCLUSION: Leiomyomas containing from five to nine mitotic figures per 10 HPF, without cellular atypia or necrosis, should be regarded as benign. Hysterectomy need not autonomically be done, as follow-up is a viable alternative. Myomectomy is an appropriate treatment, particularly in young patients interested in reproduction.

A Case of Leiomyoma of the Ovary / 대한산부인과학회지

Leiomyoma arising primarily in the ovary is a rare tumor, accounting for only 1% of benign ovarian neoplasms. About 50 cases have been reported in the literature to date. Most cases are asymptomatic and this benign neoplasm is usually found incidentally on routine pelvic examination, at surgery, or at autopsy. We present a case of ovarian leiomyoma in 39-year-old woman which has been experienced in our hospital with brief review of literature.

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.

Is Selective Iron Supplementation Needed During Gestation? / 대한산부인과학회잡지

OBJECTIVE: It is controversial whether routine or selective iron supplementation during gestation is needed. The aim of this study is to evaluate whether screening with serum ferritin during the first trimester of pregnancy could be identify women who need prophylactic iron supplementation. METHODS: According to the serum ferritin level of cut-off point of 30 microgram/L during the first trimester of pregnancy and the presence of iron supplementation during gestation, the subject was divided into 4 group that were as follows: serum ferritin level of 30 microgram/L and iron- supplemented group (n=40), serum ferritin level of >30 microgram/L and non iron-supplemented group (n=15). Maternal serum ferritin, TIBC, iron, hemoglobin, hematocrit, red cell indices (MCV, MCH, MCHC, RDW) were measured before 14 weeks of gestation and after 34 weeks of gestation. RESULTS: All hematologic and biochemical markers indicated more severe anemic status in the late pregnancy than during the first trimester of pregnancy. The effect of iron supplementation was profounder on the pregnant woman whose ferritin levels were below 30 microgram/L during the first trimester of pregnancy. Regardless of iron supplementation, the group (ferritin >30 microgram/L during the first trimester of pregnancy) showed relatively higher ferritin level in late pregnancy. CONCLUSION: The screening with serum ferritin level of cut-off point of 30 microgram/L during the first trimester of pregnancy may be useful to identify women who need prophylactic iron supplementation.

Cytogenetic Analysis in 3,503 Cases of Midtrimester Amniocentesis: CUMC Experience (II) / 대한산부인과학회잡지

OBJECTIVE: To analyze chromosomal abnormalities according to patient's age and indications of patients in midtrimester amniocentesis for prenatal genetic diagnosis. METHODS: We retrospectively analyzed 3,503 cases of midtrimester prenatal genetic amniocentesis cases which were done in the cytogenetic laboratory at Kangnam St. Mary's Hospital, Catholic University Medical College. RESULTS: In 3,503 cases, the most common maternal and gestational age distributions were 35 to 39 years old and 17 to 17 week 6 days (32.2% and 21.5%, respectively). Abnormal maternal serum markers was the most common indication for amniocentesis (46.4%), and followed by advanced maternal age (40.3%) and abnormal ultrasonographic findings (3.2%). The overall incidence of chromosomal abnormalities was 180 cases (5.1%), of which numerical abnormalities and structural abnormalities were 78 cases (2.2%) and 102 cases (2.9%), respectively. Among the autosomal abnormalities, Down syndrome was most common (33 cases, 0.9%), and followed by Edward syndrome (17 cases, 0.5%). Among the sex chromosomal abnormalities, 45,X was the most common (6 cases, 0.2%). Chromosomal abnormalities were most frequently noted in the maternal age 18-19 years old (14.3%), 40 to 44 years old (7.0%), 25 to 29 years old (6.1%), 30 to 34 years old (5.2%), and followed by 20 to 24 years old (4.1%). On the other hand, chromosomal abnormalities were most frequently noted in abnormal ultrasonographic findings (12.4%), previous history of aneuploidy (8.3%), and followed by family history of aneuploidy (7.0%). CONCLUSION: This study suggested that although advanced maternal age is still important indication in midtrimester amniocentesis for prenatal diagnosis, abnormal maternal serum markers and ultrasonographic findings might be also important as indications. Therefore, they should be considered in prenatal genetic counseling.

Two Cases of Pregnancy-associated Breast Cancer / 대한산부인과학회잡지

Pregnancy-associated breast cancer is defined as that occurring during pregnancy or within 1 year after delivery. The incidence of pregnancy-associated breast cancer is 0.2% to 3.8%. Tenderness, engorgement, increased size and increased prominence of the glandular tissue during pregnancy and lactation make mammography and clinical breast examination uncomfortable for the patient and less accurate for the detection of an abnormal breast mass. Pregnancy-associated breast cancer tends to be diagnosed at a more advanced stage, with an attendant adverse prognosis, than in women who are not pregnant or lactating. So physicians should perform a thorough breast examination at the first prenatal visit and maintain a high index of suspicion for cancer. We experienced 2 cases of pregnancy-associated breast cancer patients and reported these cases with a brief review of literature.

Retroperitoneal Ectopic Pregnancy: A Case Report / 대한산부인과학회잡지

Of the various types of ectopic pregnancies that have been reported, the retroperitoneal implantation probably represents the rarest. A search of the literature reveals only three other cases that appear to be true retroperitoneal pregnancies. We have experienced a case of the true retroperitoneal ectopic pregnancy, which was seen to be adherent to the anteromedial aspect of the left kidney. We report the case with a brief review of literatures.

A Case of Vesicoallantoic Cyst Diagnosed by Prenatal Ultrasonogram Imaging / 대한주산의학회잡지

Fetal vesicoallantoic cyst is extremely rare anomaly of umbilical cord. This disorder is thought to be a remnant of the extraembryonic portion of the allantois and incomplete obliteration of the vesico-allantoic lumen results in a wide spectrum of urachal anomalies. A 23-years-old primigravida was referred to our hospital at 18 weeks of gestation age because of fetal abdominal cystic mass in basal part of umbilicus. On the ultrasonographic examination, the cystic mass appeared to be in direct communication with the urinary bladder markedly distended. The cytogenetic study by amniocentesis showed normal 46, XY. The fetus was dead at 21 weeks of gestation age. The results of autopsy showed multiple anomalies. We report this rare case with review on similar anomalies of the allantois.

Association of the polymorphisms in CYP1A1 and CYP1A2 genes with preterm premature rupture of membranes / 대한산부인과학회잡지

OBJECTIVE: Preterm delivery (PTD) is the leading cause of perinatal mortality and morbidity. However, its etiology and pathogenesis remain unknown in most cases. Recently, some research put forth the hypothesis that PTD results, at least in part, from a genetic predisposition. This study was undertaken to elucidate whether polymorphisms of cytochrome 450 (CYP) 1A1 and 1A2 are associated with PTD caused by preterm premature rupture of membrane (PPROM) in Korean pregnant women. METHODS: From August 2002 to October 2003, in the affiliated hospitals in the Catholic University of Korea, we have collected the samples from the 264 women who delivered after 37 weeks and from 26 women who delivered following spontaneously ruptured membranes before 37 weeks. RESULTS: There was no significant difference in the genotype frequency as well as in the allelic frequency of CYP1A1*m2 in PPROM group compared with the control group (54% vs. 66%, P=0.224; 0.29 vs. 0.40, P=0.111, respectively). The genotype frequency of CYP1A2*C was significantly higher in PPROM group than in the control group (69% vs. 49%, P=0.047). However, the allelic frequency of CYP1A2*C was not significantly higher in PPROM group than in the control group (0.4 vs. 0.275, P=0.45). CONCLUSION: These results suggest that CYP1A2*C may be, at least in part, associated with PPROM.

Association of polymorphism in the tumor necrotic factor-alpha (TNF-alpha) gene and interleukin-1beta (IL-1beta) gene with preterm delivery / 대한산부인과학회잡지

OBJECTIVE: To elucidate whether polymorphisms of tumor necrotic factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) are associated with preterm delivery caused by preterm labor and preterm premature rupture of membrane (PPROM) in korean pregnant women. METHODS: From August 2002 to October 2003, we recruited 93 pregnant women who delivered before 37 weeks in gestation. In 93 cases, there were 66 cases with preterm labor and 27 cases with PPROM. 288 pregnant women who delivered after 37 weeks in gestation served as controls. Maternal blood was collected and Genomic DNA was extracted from peripheral blood and the relevant genomic region was amplified using polymerase chain reaction (PCR). PCR products were digested with the restriction enzymes, Nco I for TNF-alpha and Ava I for IL-1beta. Data was analyzed by 2-tailed unpaired t test, x2 test, odds ratio with 95% confidence interval using SPSS 10.0. RESULTS: In normal pregnant group, the proportions of TNF-alpha*1/ TNF-alpha*1, TNF-alpha*1/ TNF-alpha*2, and TNF-alpha*2/ TNF-alpha*2 were 91%, 8%, and 1%, respectively. In normal pregnant group, the proportions of IL-1beta*A/IL-1beta*A, IL-1beta*A/IL-1beta*a, and IL-1beta*a/IL-1beta*a were 29%, 40%, and 31%,respectively. The carrier rate of TNF-alpha*2 was significantly different in PPROM group compared with control group (22% vs. 9%, P=0.03), while not in preterm labor group (15% vs. 9%, P=0.138). The allelic frequency of TNF-alpha*2 was significantly different neither in preterm labor group nor in PPROM group compared with control group (0.08 vs. 0.05, P=0.248; 0.11 vs. 0.5, P=0.062, respectively). The carrier rate of IL-1beta*a was significantly different neither in preterm labor group nor in PPROM group compared with control group (68% vs. 71%, P=0.671; 67% vs. 71%, P=0.65, respectively). The allelic frequency of IL-1beta*a was significantly different neither in preterm labor group nor in PPROM group compared with control group (0.44 vs 0.52, P=0.151; 0.52 vs. 0.52, P=0.512, respectively). CONCLUSION: These results suggest that TNF-alpha polymorphism may be, at least in part, associated with PPROM.

A Case of Caudal Regression Syndrome in the Newborn of the Diabetic Mother / 대한산부인과학회잡지

The Caudal regression syndrome is characterized by sacrococcygeal or lumbosacrococcygeal agenesis, of variable extent, most often accompanied by multiple musculoskeletal abnormalities of the pelvis and legs. It is rare fetal complication of diabetic pregnancy. Although the exact teratogenic mechanism is not known, hyperglycemia appears to play a crucial role as a teratogen. Strict control of diabetes preconceptually and in early pregnancy is presumed to reduce the risk of occurrence. We report a case of caudal regression syndrome detected by pelvic radiography and MRI in the newborn of the diabetic mother.

A Clinical Analysis of Laparoscopically Assisted Vaginal Hysterectomy (LAVH) / 대한산부인과학회잡지

OBJECTIVE: To report our experience with laparoscopically assisted vaginal hysterectomy (LAVH) and evaluate the advantages of LAVH. This is a retrospective study. METHODS: From Jan. 2001 to Aug. 2002, 204 LAVHs were performed at the Department of Obstetrics and Gynecology, Our Lady of Mercy Hospital, The Catholic University of Korea. We studied the results with regard to the age, parity, previous abdominal surgery, surgical indications, operation time, weight of uterus, change of hemoglobin, hospital stay, concomitant procedures, and complications. RESULTS: The mean age was 43.9+/-6.4 years. The mean parity was 2.1+/-1.3. Tubal ligation was most common previous abdominal surgery. As a surgical indication, leiomyoma (52.9%) and adenomyosis (33.3%) were more common indications than any other gynecological problem. The mean operation time was 85.7+/-22.4 minutes. The mean uterine weight was 206.2+/-103.7 g. The mean hemoglobin change was 1.2+/-0.7 g/dl. The mean hospital stay was 3.3+/-0.8 days. Unilateral salpingoophorectomy was most common operation as concomitant procedure. Surgical complication rate was 3.4%. CONCLUSION: LAVH is a safe and effective alternative to abdominal hysterectomy with advanced technologic development in laparoscopic instruments and skills.

A Case of Glassy Cell Carcinoma of the Uterine Cervix with Photodynamic Therapy prior to Radical Surgery / 대한산부인과학회잡지

It has been known that glassy cell carcinoma (GCC) of uterine cervix is rare and rapidly progressive, and has a poor prognosis. Here we describe a case of GCC in which photodynamic therapy (PDT) was performed prior to radical hysterectomy. The patient, a 42 year-old woman at the stage of FIGO Ib2 underwent interstitial PDT (Photogem, 2 mg/kg; light, p=100 mV, W=100 J/cm2, 15 min/each 4 direction). The cervical lesion displayed inflammation and necrosis at 48 h following PDT. At 2 weeks post PDT, inflammatory reaction was disappeared and the tumor volume was decreased. No side effects of PDT were also observed. Subsequently, the patient underwent radical hysterectomy and pelvic lymph node resection. This case suggests that PDT prior to radical surgery might be an effective way to reduce tumor size without any side effects. More cycles of PDT might be beneficial for treating GCC of the uterine cervix.

Methotrexate for Treatment of Tubal Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate value of methotretrexate (MTX) in the treatment of tubal pregnancy. METHODS: 28 patients with unruptured tubal pregnancy were treated alternately with four doses of intramuscular MTX (1.0 mg/kg) and four doses of intramuscular citrovorum factor (0.1 mg/kg). Patients considered eligible for MTX treatment of tubal pregnancy were those with unruptured tubal pregnancy

PCR Application in Female Lower Genital Infection / 대한산부인과학회잡지

OBJECTIVE: This study was performed to evaluate the diagnostic value of polymerase chain reaction (PCR) for multiple microorganisms in female lower genital infection, because infections of the vaginal are caused by multiple microorganisms. METHODS: A total of 222 patients (161 cases of gynecologic patients and 61 cases of obstetric patients) who complained of profuse vaginal discharge or had excessive vaginal discharge were evaluated for detection of Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, and Trichomonas vaginalis infections using PCR. RESULTS: Infecting microorganisms by PCR were found in 61 out of 161 gynecologic patients (37.6%). Among the 61 patients, single infection was present in 45 patients (78.3%), and infection by multiple microorganisms (26.6%) in the remaining 16. In these same patients, 72 showed an abundance of WBCs with the Gram stain. Among these 72 patients, 26 (74.3%) were infected with a single microorganism, and 9 (25.7%) were infected with multiple microorganisms. In 61 pregnant women, 26 patients (42.6%) were positive for infection. Single infection was found in 25 patients (96.2%) and infection by multiple microorganisms was present in one patient (3.8%). Many WBCs were observed in 19 out of the 61 pregnant women with the detection of single infection in 9 patients and none of the mixed forms. CONCLUSION: The majority of female lower genital infections are due to multiple organisms. Individual tests, cultures, and Gram staining must be done in order to detect all involved organisms which may potentially double cost and time loss. However, with the use of PCR, this can be achieved all at once. We therefore suggest that PCR may be precise and economically beneficial in the detection of female lower genital infection.

Autologous blood transfusion in the third trimester of pregnancy / 대한산부인과학회잡지

OBJECTIVE: Preoperative autologous blood donation aims at avoiding the risks associated with exposure to allogenic blood and transfusion related diseases such as AIDS and hepatitis. While its use is frequent in adult patients with elective surgery, it is still uncommon in pregnant women because its safety has not been established for mother and fetus. The aim of this study is to determine the safety and utility of autologous blood donation in the third trimester of pregnancy. METHODS: In this study, sixteen pregnant women with placenta previa, Rh negative or huge myoma underwent 24 phlebotomies according to an autologous transfusion program. Phlebotomies were performed at an average gestational age of 36+4 weeks (range 34-41 weeks). Maternal vital sign and fetal heart rate were monitored before, during and after phlebotomy. Hematocrit was statistically evaluated by paired t-test. RESULTS: During the phlebotomy, there was no remarkable change in fetal heart rate except one case with temporary fetal tachycardia. Furthermore, changes in mean maternal diastolic blood pressure and pulse rate were not noted except one case with mild dizziness and diaphoresis. Change in mean maternal hematocrit between the initial donation and admission day for delivery was not statistically significant (P>0.05). The average interval from last donation to delivery was 9.8 day (2-20 day). Fetal outcomes were good in all cases. CONCLUSION: We concluded that preoperative autologous blood donation in pregnant woman in third trimester is safe for mother and fetus. So, if pregnant woman do not want to receive allogeneic transfusion, autologous blood transfusion might be the alternative method.

A Case of Squamous Cell Carcinoma of Bartholin's Gland / 대한산부인과학회잡지

Carcinomas of Bartholin's gland are rare tumors that account for less than 1% of all gynecological malignancies. Two major histological types, squamous cell carcinoma and adenocarcinoma, account for 80% to 90% of primary cases. The remainders are adenosquamous carcinoma, adenoid cystic carcinoma and so on. We experienced a case of squamous cell carcinoma of the Bartholin's gland managed by wide local excision and chemotherapy with cisplatin and 5-fluorouracil (5-FU). We present this case with a brief review of the literatures.

A Case of Heterotopic Pregnancy Following IVF-ET / 대한산부인과학회잡지

The simultaneous existence of intrauterine and extrauterine pregnancies is known as a heterotopic pregnancy. Spontaneous heterotopic pregnancy is a rare event although its incidence has increased since the recent development of treatment of infertile women with ovulation induction or in-vitro fertilization and embryo transfer(IVF-ET).The theoretical rate of this condition was estimated to be approximately 1 in 30,000 pregnancies. The early diagnosis of heterotopic pregnancy is very difficult . So there is a high maternal morbidity and fetal loss. We reported a IVP - ET patient resulting in the successful delivery of live infant at 35weeks of gestational age from intrauterine pregnancy following surgical removal of ruptured concurrent extrauterine pregnancy.