Nationwide population-based cohort study of adverse obstetric outcomes in pregnancies with myoma or following myomectomy: retrospective cohort study.

BACKGROUND: Our objective was to evaluate risks of adverse obstetric outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy. METHODS: We analyzed the national health insurance database, which covers almost the entire Korean population, between 2004 and 2015. The risks of adverse pregnancy outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy, compared to those in women without a diagnosed myoma, were analyzed in multivariate logistic regression analysis. RESULTS: During the study period, 38,402 women with diagnosed myoma(s), 9890 women with a history of myomectomy, and 740,675 women without a diagnosed myoma gave birth. Women with a history of diagnosed myoma(s) and women with a history of myomectomy had significantly higher risks of cesarean section (aOR 1.13, 95% CI 1.1-1.16 and aOR 7.46, 95% CI 6.97-7.98, respectively) and placenta previa (aOR 1.41, 95% CI 1.29-1.54 and aOR 1.58, 95% CI 1.35-1.83, respectively), compared to women without a diagnosed myoma. And the risk of uterine rupture was significantly higher in women with previous myomectomy (aOR 12.78, 95% CI 6.5-25.13), compared to women without a diagnosed myoma, which was much increased (aOR 41.35, 95% CI 16.18-105.69) in nulliparous women. The incidence of uterine rupture was the highest at delivery within one year after myomectomy and decreased over time after myomectomy. CONCLUSIONS: Women with a history of myomectomy had significantly higher risks of cesarean section and placenta previa compared to women without a diagnosed myoma.

Gender affirmative care of transgender people: a single center's experience in Korea.

OBJECTIVE: To investigate the clinical characteristics and medical management of transgender people in South Korea. METHODS: The electronic medical records of 54 transgender persons who had visited Soonchunhyang University Hospital from January 2016 to December 2017 for medical care were retrospectively reviewed. We identified patient demographics and gender identity-related characteristics. Moreover, we compared our hospital protocol with official guidelines. RESULTS: At the time of the medical record search, the average age of these 52 transgender persons was 27 years, and 46 (88.5%) were Korean. Ten (19.2%) persons had a mental disorder other than gender dysphoria. Gonadotropin-releasing hormone agonist, estrogen, antiandrogen agents, and testosterone were used according to the guidelines issued by the World Professional Association for Transgender Health and the Endocrine Society. Ten (19.2%) transgender persons, including 6 (22.2%) male-to-females (MTFs) and 4 (16.0%) female-to-males (FTMs), had a mental disorder other than gender dysphoria. Among persons who were administered testosterone, 3 had high triglyceride and lipoprotein cholesterol levels. Nine patients, including 6 (66.7%) MTFs and 3 (33.3%) FTMs, underwent both gonadectomy and gender affirmative surgery. Seven (43.8%) persons, including 1 (14.3%) MTF and 6 (85.7%) FTMs, underwent only gonadectomy. There was a significant difference (P=0.040) between MTFs and FTMs. CONCLUSION: Medical providers should have adequate knowledge of and experience in managing transgender persons and be familiar with the relevant guidelines and literature. Long-term follow-up examinations should also be performed.

[Multiple Factors in the Second Trimester of Pregnancy on Preterm Labor Symptoms and Preterm Birth].

PURPOSE: The aim of this study was to determine the influence of various factors on preterm labor symptoms (PLS) and preterm birth (PB). METHODS: This prospective cohort study included 193 women in the second stage of pregnancy. Multiple characteristics including body mass index (BMI), smoking, and pregnancy complications were collected through a self-report questionnaire. Pregnancy stress and PLS were each measured with a related scale. Cervical length and birth outcome were evaluated from medical charts. Multiple regression was used to predict PLS and logistic regression was used to predict PB. RESULTS: Multiple regression showed smoking experience, pregnancy complications and pregnancy specific stress were predictors of PLS and accounted for 19.2% of the total variation. Logistic regression showed predictors of PB to be twins (OR=13.68, CI=3.72~50.33, p<.001), shorter cervix (<25mm) (OR=5.63, CI=1.29~24.54, p<.05), BMI >25 (kg/m²) (OR=3.50, CI=1.35~9.04, p<.01) and a previous PB (OR=4.15, CI=1.07~16.03, p<.05). CONCLUSION: The results of this study show that the multiple factors affect stage II pregnant women can result in PLS or PB. And preterm labor may predict PB. These findings highlight differences in predicting variables for pretrm labor and for PB. Future research is needed to develop a screening tool to predict the risk of preterm birth in pregnant women.

Avoiding unnecessary blood transfusions in women with profound anaemia.

BACKGROUND: Blood transfusions may be associated with risks and the risk: benefit ratio is not always clear, even in the setting of haemorrhage. AIMS: To describe the management practices and outcomes in women with profound anaemia who refused blood transfusion. MATERIALS AND METHODS: Retrospective analysis over a 10-year time frame of severely anaemic women (Hb <50 g/L) with benign conditions who had requested not to receive a blood transfusion. Demographic data, clinical presentation, anaemia management practice and serious adverse events were collected from the medical record charts. Women were analysed in two groups: a gynaecologic (Gyn) and an obstetric (Ob) population. RESULTS: A total of 19 women (12 Gyn and 7 Ob) met the inclusion criteria with a mean age of 35.8 ± 10.2 years. The lowest mean Hb concentration was 41.3 ± 9.7 g/L (Gyn Group) and 36.0 ± 8.9 g/L (Ob Group) which increased, to 67.3 ± 14.3 g/L and 73.1 ± 6.9 g/L, respectively, by the time of hospital discharge. Anaemia management initially addressed the underlying etiology and was followed by intravenous iron (all cases) plus erythropoiesis stimulating agents, haemocoagulase and/or fluids. The mean length of hospital stay was 10.5 ± 4.4 and 13.7 ± 4.1 days for the Gyn and Ob groups, respectively. No deaths or other serious complications occurred. CONCLUSION: These findings suggest that young and otherwise healthy women can tolerate profound anaemia (Hb <50 g/L) permitting corrective strategies to be successfully implemented without the need for blood transfusion.

Voiding characteristics and related hormonal changes in peri-menopausal and post-menopausal women: a preliminary study.

OBJECTIVES: To characterize voiding symptoms during the peri- and post-menopausal periods and to investigate related hormonal changes. METHODS: We enrolled a total of 55 patients between February 10, 2013, and August 15, 2013, to participate in this cross-sectional study. To characterize patients' voiding symptoms, we administered voiding questionnaires, including the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Sandvik Severity Index. Measured hormones included E2, FSH, TSH, prolactin, progesterone, and testosterone. RESULTS: In the univariate analysis, there were significant intergroup differences for all of the hormones except progesterone. Among the voiding symptoms, straining (IPSS question 1), frequency (IPSS question 2), and SUI were significantly different between the two groups (p=0.039. 0.010, and 0.017, respectively). In the multivariate analysis, frequency (IPSS question 2) and SUI were significantly different between the two groups (p=0.020 and 0.011, respectively). Among the hormones, only testosterone was marginally different between the two groups (p=0.059). CONCLUSIONS: During the transition to menopause, voiding symptoms, such as frequency, can potentially worsen in the peri-menopausal period, and SUI is more prevalent in the post-menopausal period. Additionally, testosterone may have a role in voiding changes that occur during the menopausal transition.

Comparison of adverse event profile of intravenous iron sucrose and iron sucrose similar in postpartum and gynecologic operative patients.

OBJECTIVE: Severe iron deficiency resulting in anemia is a common problem during pregnancy and in menstruating women. Several choices for IV iron replacement therapies exist and increased pressures on budgets may require cheaper 'iron sucrose similar' (ISS) to be used. In our practice, an iron sucrose similar (Ferex; ISS(FRX)) was introduced to reduce costs in the treatment of pregnant women or those planned for surgery. Post several months of use we observed increased rates of adverse events from patients and hence performed this analysis to confirm these findings. METHODS: Data on adverse events was retrospectively collected from 658 patients treated between September 2004 and December 2011. Patients were analyzed in three cohorts, iron sucrose originator (IS(ORIG)), ISS(FRX) diluted in 100 mL saline and ISS(FRX) diluted in 200 mL saline. RESULTS: The mean age was 38.5 years and included patients having normal delivery, Cesarean section, myomectomy, hysterectomy, cystectomy and adnexectomy. There were 169 patients in the IS(ORG) group and 210 and 279 in the ISS(FRX)-100 and ISS(FRX)-200 groups respectively. Adverse drug reactions were more frequent in the ISS(FRX) groups vs. IS(ORIG) (11.0 vs. 14.3 vs. 1.8%; p < 0.02). Events were mild-to-moderate in nature and were predominately injection site reactions and phlebitis. RESULTS: may be impacted by imbalance in baseline characteristics and cumulative iron dose received, however events were mostly acute and all patients received 200 mg iron as single administration. CONCLUSION: This is the first large analysis suggesting increased adverse events due to an ISS. For our practice, the use of ISS(FRX) was discontinued owing to safety concerns outweighing the theoretical cost benefit. This study raises the question on the appropriate approval process for complex drugs and if these can be substituted without appropriate clinical testing, both for efficacy and most importantly safety, in routine clinical practice.