A Case of Fetal Anesthesia with Fentanyl for Thoracentesis of Fetal Pleural Effusion / 대한산부인과학회지

Fentanyl is an opiate-like, pain-killing drug. It was found in the 1950s and prescribed from the 1960s. Fentanyl shows its effect by acting on opiate-like receptors. This case was a case of a 24-year-old primiparous woman who was referred from local clinic due to fetal pleural effusion in the left lung on antenatal ultrasonographic examination at 32 weeks of gestational age. The amount of pleural effusion increased and fetal heart deviated to the right side. We injected fentanyl 2 microgram intramuscularly into the fetal left thigh under ultrasound-guide for fetal anesthesia at 34 weeks of gestational age. After 5 minutes, we inserted 22 gage spinal needle to the left pleural cavity and aspirated 50 mL pleural fluid under ultrasound-guided. After aspiration, follow-up was performed oat one week interval and there was no more pleural fluid until delivery. At gestational age 41 weeks, the fetus was delivered vaginally as a 3.2 kg, healthy male baby. This is a case of fentanyl injection to fetus as a fetal anesthesia during thoracentesis for fetal pleural effusion at gestational age 34 weeks, we think that fentanyl is useful drug for fetal anesthesia.

Hysteroscopic Findings in Abnormal Uterine Bleeding / 대한산부인과학회잡지

OBJECTIVE: Abnormal uterine bleeding is the most common disorder of gynecologic department. Organic causes of abnormal uterine bleednig are chronic cervicitis, submucosal myoma, endometrial polyp, endometrial malignancy. To find the exact cause of uterine bleeding, hysteroscopic endometrial biopsy was used. METHODS: 214 patients were included in the study, who received hysteroscopic endometrial biopsy from Feb. 2000 to Dec. 2002 with abnormal uterine bleeding, negative in urine pregnancy test, normal in cervix cytology, and without organic lesion causing uterine bleeding in pelvic examination and ultrasonography. Age, parity, hysteroscopic biopsy result were analyzed retrospectively. RESULTS: Mean age of study group was 42 and mean parity was 2.75. When final hysteroscopic biopsy histology were analysed, proliferative phase was most common (28.9%). Next followed secretory phase (18.2%), simple hyperplasia (13.5%), endometrial polyp (9.8%), chronic endocervicitis (5.1%). Submucosal myoma (4.2%), endometrial cancer (4.2%). Complex hyperplasia were detected in 3.2%. Of 214 patients, who complained uterine bleeding, only 99 (47.1%) patients were proved true non- organic uterine bleeding on hysteroscopic biopsy. Remainder had organic disorder (39.8%). CONCLUSION: When a patient visits the hospital with abnormal uterine bleeding, doctor should be suspicious of endometrial organic disease and treat the patient under exact diagnosis. In these patients, hysteroscopic examination and biopsy were very useful and safe method to determine exact diagnosis and treatment plan.

A Clinical Study in Pregnant Women Over the Age of 35 / 대한산부인과학회잡지

OBJECTIVES: Although pregnancy in women who are 35 years old or more is considered a high risk pregnancy, it has occurred more frequently in recent years. The aim of our study was to evaluate the course of delivery and perinatal outcomes in women who are 35 years old or more. METHOD: We have compared 765 cases of the elderly gravida over the age of 35 at the department of Obstetrics and Gynecology, Mokpo, Catholic Hospital, from January 1, 1997 to December 31, 1999, with 800 cases of randomly chosen young pregnant women during the same period. RESULTS: There were 765 cases of the elderly gravida among total 8285 deliveries and the incidence of the elderly gravida for 3 years was 9.2%. The rate of elderly gravida was increased from 8.2% in 1997 to 10.0% in 1999. 46.9% were in the age group of 35 to 36 years. The incidence of primigravida was 13.9%. 93.6% of total cases was vertex presentation breech presentation was 5.2%, and transverse lie was 1.2%. The percentage of preterm pregnancy was 9.5% in elderly gravida, and 4.0% in control group. post-term pregnancy was 2.0% in elderly gravida, and 1.0% in control group.The rate of cesarean section was 48.8%, compared with 26.7% in the control group. Among the indications of cesarean section, the highest incidence was previous cesarean section (40.0%) and elderly primigravida (18.0%), fetal distress (10.7%), cephalopelvic disproportion (7.5%), and abnormal presentation (6.7%). Concerning the prenatal complications, the incidence of hypertensive disorder was 4.3%, and 2.6% in control group. The incidence of low birth weight and macrosomia were 8.9%, 8.8% in elderly gravida, and 5.5%, and 9.3% in control group. The incidence of IUFD was 3.1% in elderly gravida, and 0.63% in control group. Male-to-female sex ratios were 1.12:1 in elderly gravida, 1:1.16 in elderly primigravida, 1.17:1 in elderly multi gravida, and 1.20:1 in control group. CONCLUSION: The rate of elderly gravida increased in recent years, and the cesarean rate was higher compared with the control group. But there was no difference in perinatal mortality. The reasons for increasing rate of cesarean delivery may be due to physician and patient concern over pregnancy outcome in older women. Therefore it is necessary to exert more attention to pregnancies in those over the age of 35.

A case of Full Term Delivery of a Edward Syndrome Associated with Dandy-Walker Syndrome subsequent to Prenatal Diagnosis / 대한산부인과학회잡지

Dandy-Walker syndrome indicates the association of cystic dilatation of fourth ventricle, dysgenesis of the cerebellar vermis and a high position of the tentorium. Dandy-Walker syndrome has an estimated prevalence of about 1 in 30,000 births and is found in 4% to 12% of all cases of infantile hydrocephalus. And trisomy 18 was present in 4.8% of the Dandy-Walker syndrome. Trisomy 18 is a chromosomal aneuploid, which results in multiple severe structural abnormalities that mostly involve the heart, extremities, face, and brain. We experienced a case of Edward syndrome associated with Dandy-Walker syndrome. She did not want to terminate her pregnancy. So, we reviewed a Edward syndrome with Dandy-Walker syndrome and presented the final result in full term delivery.

A Case of Large Placental Chorioangioma Combined with Polyhydramnios / 대한산부인과학회잡지

No abstract available.