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OBJECTIVE: The aim of the present study was to evaluate the impact of previous abdominal surgery on surgical outcomes of single-port access (SPA) total laparoscopic hysterectomy (TLH). METHODS: We reviewed the medical records of 111 women who underwent SPA-TLH at the Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University between January 2010 and December 2010. Women were classified according to their history of previous abdominal surgery. RESULTS: Of 111 women undergoing SPA-TLH, 74 women (66.7%) without history of previous abdominal surgery and 37 women (33.3%) with history of previous abdominal surgery were classified. There was no significant difference in surgical outcomes including operative time, estimated blood loss, change in hemoglobin, uterine weight, perioperative complications, transfusion, and additional port insertion between two groups. CONCLUSION: In our experience, previous abdominal surgery has no significant impact on SPA-TLH.
Subject(s)
Female , Humans , Gynecology , Hemoglobins , Hysterectomy , Laparoscopy , Medical Records , Obstetrics , Operative TimeABSTRACT
OBJECTIVE: The aim of this study was to estimate the feasibility, safety and surgical outcomes of single port access laparoscopic myomectomy (SPA-M). METHODS: We reviewed the medical records of 29 patients with uterine leiomyoma who underwent SPA-M in Gumi CHA hospital between March 2010 and August 2010. We performed SPA-M with conventional rigid straight laparoscopic instruments in all cases. RESULTS: In this study, the mean of leiomyoma weight, operating time, and estimated blood loss were 55.43 gm(+/-54.79, range 5~220 gm), 69.68 min (+/-32.99, range 20~120 min.), 100 mL (+/-104.26 range minimal~300 mL), respectively. Transfusion was done in the one case. CONCLUSION: SPA-M using conventional rigid straight laparoscopic instruments was feasible and could be an alternative to conventional multi-port access laparoscopic myomectomy (MPA-M).
Subject(s)
Humans , Leiomyoma , Medical RecordsABSTRACT
OBJECTIVE: To compare the surgical outcomes between laparoscopy-assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH). METHODS: The data were collected retrospectively from hospital records. Between September 2006 and August 2007, Patients undergone with LAVH (93 cases) and TLH (142 cases) with pathologic reports of leiomyoma or adenomyosis were enrolled. The characteristics and surgical results were compared according to the operation type. The correlations among the variables were analyzed with multiple linear regression. RESULTS: Between two groups, the characteristics of patients were similar such as age, body mass index, surgical history, and pathologic findings. In the univariate analysis, the differences of operation duration and blood loss between LAVH (129.0+/-34.5 min, 385.5+/-296.1 mL) and TLH (123.6+/-40.8 min, 294.7+/-285.4 mL) were significant (P0.050). In multivariate analysis, blood loss was correlated with operation duration and specimen weight (P=0.000) but not with operation type (P=0.213). CONCLUSIONS: LAVH tends to be selected in larger uteri and results in more blood loss and longer operation duration. Operation type (LAVH or TLH) does not affect blood loss which is related with operation duration and uterine weight.
Subject(s)
Female , Humans , Adenomyosis , Body Mass Index , Hospital Records , Hysterectomy , Hysterectomy, Vaginal , Incidence , Laparoscopy , Leiomyoma , Multivariate Analysis , Retrospective Studies , UterusABSTRACT
OBJECTIVE: To estimate the effect of diagnostic cystoscopy in early detection of ureteral injury at the time of total laparoscopic hysterectomy. METHODS: Retrospectively 598 women who received total laparoscopic hysterectomy from August 2004 to August 2006 were included. They were divided into two groups : no cystoscopic examination (n=398) group (Group A) and routine intraoperative diagnostic cystoscopic examination after intravenous indigo-carmine injection (n=200) group (Group B). The rates of ureteral injury after total laparoscopic hysterectomy were compared between both groups. RESULTS: Postoperative ureteral injury was observed in 3 case of Group A (3/398 : 0.75%) and in no case of Group B. In 2 cases of group B (2/200 : 1.00%), Intraoperative ureteral injury was detected by cystoscopy. CONCLUSION: Routine intraoperative diagnostic cystoscopy allows for early recognition and treatment of obstructive ureteral injuries, and reduces the rate of late postoperative ureteral complications during advanced laparoscopic procedures.
Subject(s)
Female , Humans , Cystoscopy , Hysterectomy , Retrospective Studies , UreterABSTRACT
PURPOSE: The purpose of this study was to evaluate the clinical utility of rapid detection of Down syndrome and Edward syndrome by Interphase Fluorescence in Situ Hybridization (FISH) analysis METHODS: A retrospective study in 309 cases of amniotic fluid samples, analysed by interphase FISH with DNA probes specific to chromosome 18 and 21, was performed. All FISH results were compared with conventional cytogenetic karyotypings. RESULTS: The results were considered as informative and they were obtained within 48 hrs. A case of Down syndrome and a case of Edward syndrome were diagnosed by FISH and confirmed by subsequent cytogenetic analysis. In 12 cases with normal FISH results, the cytogenetic analysis showed a case of partial trisomy 22, three cases of sex chromosomal aneuploidy, two cases of mosaicism, two cases of microdeletion, and four cases of structural rearrangement. CONCLUSION: FISH is a rapid and effective diagnostic method, which can be used as an adjunctive test to cytogenetic analysis, for prenatal identification of chromosome aneuploidies. For the more genome- wide screening with variety of probes, the technique of FISH is both expensive and labor-intensive.
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OBJECTIVE: To estimate the effect of maternal age on obstetric outcomes, a retrospective analysis was done. METHODS: Twenty six hundred and forty six women who delivered a singleton baby at our hospital from January 1, to December 31, 2004 were enrolled in this study. Subjects were divided into 3 age groups; 1) less than 35 years, 2) 35-39 years, and 3) 40 years and older. Chi-square test was used to assess the effect of age on obstetrics outcome. Then the odds ratio was calculated to represent clinically meaningful risk. RESULTS: A total of 2646 women with complete data were available; 2245 (84.9%) less than 35 years of age; 350 (13.2%) 35-39 years; and 51 (1.9%) 40 years and older. Increasing age was significantly associated with chromosomal abnormalities (OR 3.9and 8.8 for ages 35-39 years and age 40 years and older, respectively), Preterm premature rupture of membranes (OR 1.3 and 3.2) and cesarean delivery (OR 2.0 and 5.5). Patients aged 35-39 years were at increased risk for placenta previa (OR 1.8) and congenital anomaly (OR 2.8) but these were not statistically significant. The rate of the preterm delivery was increased by age (OR 1.3 and 1.9 for ages 35-39 years and age 40 years and older, respectively) but it was not statistically significant (p=0.121). We did not find advanced maternal age to be associated with a statistically increased risk for preeclampsia, congenital anomaly, gestational diabetes, placenta abruption, low birth weight, macrosomia, neonatal morbidity (NICU admission), and perinatal loss. CONCLUSION: In conclusion, although the likelihood of adverse outcomes increases with maternal age, patients and obstetric care providers can be reassured that overall maternal and fetal outcomes are favorable in this patient population.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Pregnancy , Chromosome Aberrations , Diabetes, Gestational , Infant, Low Birth Weight , Maternal Age , Membranes , Obstetrics , Odds Ratio , Placenta , Placenta Previa , Pre-Eclampsia , Pregnancy Outcome , Retrospective Studies , RuptureABSTRACT
Cervical incompetence is one of the main contributors to repeated pregnancy loss and preterm delivery. Typically it results in progressive cervical dilatation, leading to a painless second or early third trimester abortion. Emergency cerclage can be used in the setting of advanced cervical incompetence, even when fetal membranes bulge through the dilated cervix. To facilitate the procedure, various techniques have been developed to replace the fetal membranes into the uterine cavity. We performed six successful cases of emergency cerclage combined with amnioreduction in advanced incompetent internal os of cervix (IIOC). Interval from emergency cerclage to delivery was 8.1 +/- 2.4 weeks (range 4-10 weeks) and we delivered viable fetuses in all but one. Hereby we report our experiences with a brief review of literature.
Subject(s)
Female , Humans , Pregnancy , Cervix Uteri , Emergencies , Extraembryonic Membranes , Fetus , Labor Stage, First , Pregnancy Trimester, ThirdABSTRACT
Extrapelvic endometriosis is a fairly rare phenomenon. The majority of extrapelvic endometriosis involves scar tissue following obstetric or gynecologic procedures. Abdominal wall endometriosis secondary to cesarean section is a very rare condition, being reported in less than 0.5% of patients undergoing cesarean section. It has a distinct presentation and treatment. An abdominal mass with noncyclical symptoms is a common presentation. Imaging techniques are nonspecific and needle biopsy may confirm the diagnosis. Wide excision is the treatment of choice for abdominal wall endometriosis as well as for recurrent lesions. A patient with a history of cesarean section presented with a painful, enlarging mass. The pain was cyclic and aggravated just prior to menstruation. The patient was treated with surgical scar excision pathologically confirmed as endometriosis. We present this case with a brief review of literature.
Subject(s)
Female , Humans , Pregnancy , Abdominal Wall , Biopsy, Needle , Cesarean Section , Cicatrix , Diagnosis , Endometriosis , MenstruationABSTRACT
Although tubal pregnancy is increasing, primary ovarian ectopic pregnancy has remained a rare event. However, recent reports suggest an increasing incidence to both tubal and term pregnancies. Ovarian pregnancy occurs within the ovary and on the corpus luteum. Earlier diagnosis is now possible, owing to the availability of highly specific radioimmunoassay for human chorionic gonadotrophin and the development of transvaginal ultrasonography. Clinical and even intraoperative diagnosis is difficult and confirmation may be made only by microscopic examination of the tissue specimen. Current understanding of the etiological factors, classification, possible pathogenesis, clinical presentation, diagnostic steps, reevaluation of diagnostic criteria, preferred management and future fertility are detailed. The therapy is surgical and currently more conservative than in the past, because of improvement in operative laparoscopy. We report a case of primary ovarian pregnancy treated conservatively under laparoscopic surgery with a brief review of literature.
Subject(s)
Female , Humans , Pregnancy , Chorion , Classification , Corpus Luteum , Diagnosis , Fertility , Incidence , Laparoscopy , Ovary , Pregnancy, Ectopic , Pregnancy, Tubal , Radioimmunoassay , UltrasonographyABSTRACT
Sirenomelia, characterised by a complete or incomplete fusion of the lower extremities, is a severe form of caudal defect affecting 1 in 60,000 births. Most cases of sirenomelia die within 5days after birth and are associated with abnormalities such as renal agenesis, urinary tract agenesis, single umbilical artery, etc. Thirdtrimester ultrasonographic diagnosis is usually impaired by severe oligohydramnios whereas the amount of amniotic fluid may be efficient to allow diagnosis in the late first trimester. We report of a case of sirenomelia at 14 weeks of gestation using prenatal transvaginal and transabdominal ultrasonography.
Subject(s)
Female , Humans , Pregnancy , Amniotic Fluid , Diagnosis , Ectromelia , Lower Extremity , Oligohydramnios , Parturition , Pregnancy Trimester, First , Single Umbilical Artery , Ultrasonography , Urinary TractABSTRACT
BACKGROUND: Osteoporosis after menopause is known as a disease that needs preventive measures before medical treatment. Many patients, however, do not undergo hormone therapy to prevent it. This paper investigates some obstacles to hormone replacement therapy (HRT). METHOD: A total of 85 menopausal women who under went bone-mineralodensitometry (BMD) examination at Chuncheon Sungshim Hospital Health Care Clinic from May, 1995 to April, 1997 were the subjects of our study. We interviewed them by telephone, examined their medical records including their BMD results. We also examined what the obstacles were for them to receive HRT for osteoporosis. RESULTS: The average age of the subjects was 55.8years. Only 40 women (47%) replied that they knew beforehand the purpose of the BMD examination. The rest of the subjects replied that they simply went through the examination because it was inclusive to health items. Those who had heard of HRT for osteoporosis were only 43 people because(50.1%), and those who did not currently receive HRT amounted to 32 (74.4%). The reasons why they do not undergo the therapy were fear of cancer, no symptoms related to osteoporosis, financial difficulty, and weight gain. Among the 32 subjects, only 1 person replied that she would not receive the HRT even if the above obstacles were removed. Therefore, it seems that most of our subjects would receive HRT if such obstacles removed. Those who were currently receiving HRT were 11 people(12.9%). According to the open questionnaire, many of them replied that they do not feel any inconvenience while receiving the HRT, but some of them complained of epigastric pain, dysmenorrhea, or mastalgia. They replied that after the HRT they felt no arthralgia and felt far better in body and mind than before treatment. All the 11 people replied that they will continue to receive the HRT. CONCLUSION: The main reason why so few people received HRT for osteoporosis proved to be the lack of knowledge of the therapy. Even those who had heard of HRT complained about the negative aspects, which in fact can be overcome, and as a result a considerable number of them do not receive HRT. Therefore we conclude that in order to increase the number of patients who will undergo HRT for osteoporosis after menopause we need to strengthen education about the merits of this therapy rather than just performing BMD examination.
Subject(s)
Female , Humans , Arthralgia , Delivery of Health Care , Dysmenorrhea , Education , Hormone Replacement Therapy , Mastodynia , Medical Records , Menopause , Osteoporosis , Osteoporosis, Postmenopausal , Telephone , Weight Gain , Surveys and QuestionnairesABSTRACT
Intentional delay of aftercoming siblings in multiple gestation is an infrequent occurrence in obstetrics. After delivery of an immature twin, conventional treatment calls for induction and delivery of the aftercoming sibling. However, several case reports have documented the feasibility of an expectant management. And also, as in our case, an aggressive treatment consisting of cerclage, tocolysis, and broad-spectrum antibiotics has been shown to prolong pregnancy. We experienced an unavoidable delivery of a nonviable first twin after premature rupture of membranes at 16 weeks' of gestation. The placenta was left undisturbed. Twin B was confirmed to be alive within the intact second sac. Tocolysis was started and cervical cerclage was done directly after delivery of twin A. Pregnancy was successfully prolonged, which enabled the second fetus to remain in utero and grow for another 145 days. To our knowledge, this was the longest interval between deliveries in a twin pregnancy reported in the literature. A healthy 3,050 gm male was delivered by cesarean section at 37 weeks' of gestation. Below we present this case in detail and discussed with respect to the aggressive approach undertaken to prolong gestation.
Subject(s)
Female , Humans , Male , Pregnancy , Anti-Bacterial Agents , Cerclage, Cervical , Cesarean Section , Fetus , Membranes , Obstetrics , Placenta , Pregnancy, Twin , Rupture , Siblings , Tocolysis , TwinsABSTRACT
Uterine prolapse with pregnancy is rare condition. The overall incidence is 1/10000- 15000 deliveries. The complications from uterine prolapse range from minor cervical ulceration and infection to fetal death or uterine rupture. The fetal mortality was as high as 22% mainly due to prematurity, respiratory infection. The management of this condition is focused on preventing late occurrence of prolapse during pregnancy and continued reduction. We present a case of uterine prolapse in pregnancy with a brief review of the literature.
Subject(s)
Pregnancy , Fetal Death , Fetal Mortality , Incidence , Prolapse , Ulcer , Uterine Prolapse , Uterine RuptureABSTRACT
OBJECTIVES: Estimation of the anterior lower uterine segment (LUS) thickness difference who underwent prior cesarean delivery measured with transvaginal sonography at or after 36 gestational weeks (sonographic thickness) and a ruler during elective cesarean section (operation thickness) Methods: One hundred sixty women who underwent prior cesarean delivery had the thickness of their LUS measured with transvaginal sonography at or after 36 gestational weeks. The LUS thickness was measured with a ruler during elective cesarean section. We compared group I whose LUS was fairly well visualized 4 cm or more from the uterine cervix to group II which had less than 4 cm. RESULTS: The mean sonographic thickness of LUS was 1.7 0.8 mm and that of operation thickness was 1.9 0.5 mm. The mean difference of the two (thickness difference) was 0.5 0.5 mm. In 31.3% the sonographic thickness was same as the operation thickness and in 70.7% of the total with 0.5 mm or less difference, the sonographic thickness could be regarded as accurate. The thickness difference with the sonographic thickness with 2 mm or more was smaller than those with 1 mm or less (0.4 0.5; 0.6 0.6) and that of group I was smaller than that of group II (0.4 0.4; 0.9 0.6) (p< .05). CONCLUSION: The thickness difference was 0.5 0.5 mm and it was smaller when the LUS thickness is 2 mm or over, clearly visible 4 cm or over from the cervix.
Subject(s)
Female , Humans , Pregnancy , Cervix Uteri , Cesarean Section , Cicatrix , UltrasonographyABSTRACT
OBJECTIVE: The purpose of this study is to evaluate the efficacy of ferritin-folate-cyanocobalamin supplementation for prevention of anemia during pregnancy. METHODS: The authors conducted a clinical investigation on 50 pregnant women from 20th to 36th gestational weeks. The cobination of cyanocobalamin coenzyme 500mg, folic coenzyme 800mcg, and ferritin 20mg constituted the supplementation. The parameters examined in first trimester as baseline, before treatment(at 20th weeks), and after treatment(at 36th weeks) were : hemoglobin, hematocrit, ferritin, mean corpuscular hemoglobin(MCH), mean corpuscular hemoglobin concentration(MCHC), mean corpuscular volume(MCV), red blood cell count(RDW), folic acid, and vit. BPaired sample t-test was used for comparison. RESULTS: The results indicated a significant increase in the value of hemoglobin(p<0.05) and hematocrit(p<0.01) in comparison to before and after the treatment. The values of serum ferritin, folic acid, vitamin Bwere increased after the treatment compared to those of before the treatment, though there was no statistical significance. The results of MCV, MCH, MCHC, and RDW showed no statistically significant in comparison to before and after the treatment. CONCLUSIONS: These data indicate that supplementing ferritin 20mg-folate 800mcg-cyanocobalamine 500mcg per day from 20th to 36th weeks' gestation can increase values of hemoglobin, hematocrit, and ferritin concentration and can be cosidered as an appropriate method to prevent iron deficient anemia. It also might increase the value of folic acid and vitamin B12, concentration, but further study is stiU needed to determine whether the supplementation of folate and cyanocobalamine in combination with iron can have better eflicacy than iron alone in prevention of iron deficiency anemia.
Subject(s)
Female , Humans , Pregnancy , Anemia , Anemia, Iron-Deficiency , Erythrocyte Indices , Erythrocytes , Ferritins , Folic Acid , Hematocrit , Iron , Pregnancy Trimester, First , Pregnant Women , Vitamin B 12 , VitaminsABSTRACT
Mullerian agenesis or dysgenesis, rare developmental anomaly presenting as primary amenorrhea, is characterized by absence of vagina and absence or rudimentary development of the uterus. Anatomic anomalies of the axial skeleton and kindney often accompany this psychologically devatating condition. There are various methods of surgical treatment for congenital absence of the vagina. The six cases reviewed in this paper were all treated with McIndoe technique. All of 6 women experienced satisfactory sexual activity and were satisfied with vaginal depth following vaginal creation using a split thickness skin graft technique. Despite the existence of several alternative methods, the McIndoe technique is a relatively simple and highly successful procedure and hence is still prefered by many surgeons.