Clinical use of a Sengstaken-Blakemore tube in the management of postpartum hemorrhage / 대한산부인과학회지

OBJECTIVE: To evaluate the efficacy of clinical use of a intrauterine Sengstaken-Blakemore tube (S-B tube) in postpartum hemorrhage not controlled with medication and conservative treatment. METHODS: Retrospective review was done in 18 women with insertion of S-B tube into intrauterine cavity who did not controlled with medication and conservative treatment for postpartum hemorrhage. After third stage of labor, women were treated with prophylactic intramuscular Methylergonovine 0.2 mg and intravenous infusions of oxytocin routinely. If the postpartum bleeding continued, Misoprostol 800 microgram (per rectal) and intravenous infusions of Dinoprost 2 mg mixed with 5% D/S 500 cc were employed. And then women were examined for retained placenta and laceration of birth canal. Where necessary, retained placenta was removed and lacerations were sutured. If the postpartum bleeding did not controlled despite all of procedures, we decided use of intrauterine S-B tube. RESULTS: The mean age of the patients was 30.9+/-4.4 (27-39) years, their mean body weights and parities were 67.8+/-8.2 (56.2-85.7) kg, 1.8+/-0.8 (1-4) and mean gestational age was 38.5+/-2.9 (37-42) weeks respectively. The mean time from delivery to insertion of S-B tube was 107.6+/-94.0 (24-360) minutes. The mean filled normal saline amount was 190.5+/-35.2 (120-230) cc. Of 18 who was inserted of S B tube, 15 cases needed not additional surgical therapy. So success rate was 83.3%. CONCLUSION: Insertion of intrauterine S-B tube appears as a simple and effective means of treating postpartum hemorrhage not controlled with medication and conservative treatment.

Effects of Metformin in Patients with Polycystic Ovary Syndrome (PCOS) undergoing In Vitro Fertilization and Embryo Transfer / 대한산부인과학회지

OBJECTIVE: This study was performed to investigate the effects of metformin in PCOS patients undergoing IVF-ET. METHODS: From January 2002 to December 2004, 87 cycles in 32 PCOS patients undergoing IVF-ET at the Infertility clinic of Grace Women's Hospital were randomly divided into two groups and enrolled in this study. The diagnosis of PCOS was made by the criteria from 2003 Rotterdam Consensus. Metformin group (19 patients, 45 cycles) received metformin (Daewoong Pharma Co., Korea; 500 mg three times or two times a day from one or two months before and during IVF cycle) and control group (13 patients, 42 cycles) did not receive metformin. All patients received controlled ovarian hyperstimulation (COH) using gonadotropins (Fostimon, IBSA, Switzerland) with GnRH antagonist (Cetrotide, Serono, Germany). When leading follilces reached 18 mm in diameter, recombinant hCG 250 ?g (OVIDREL, Serono, Italy) was injected. Oocytes were retrieved transvaginally 35 hours later. The luteal phase was supported everyday by progesterone 50 mg IM (Progest, Samil, Korea) with micronized progesterone 200 mg vaginal insertion (Utrogestan, Besins, France). RESULTS: There was no statistical difference in the patients age (34.1+/-3.0 vs 33.5+/-2.9 years), the duration of infertility (4.3+/-1.3 vs 4.5.+/-1.3 years) and BMI (23.5+/-2.4 vs 24.01+/-2.7 kg/m2) among two groups (p> or =0.05 for each). There was also no statistical difference in the indications of IVF among two groups; ovulation factor (27 cycles vs 23 cycles), tubal factor (7 vs 8), male factor (8 vs 7) and other factor (3 vs 4) (p> or =0.05). The duration of ovulation induction in metformin group was significantly shorter when compared with control group (10.1+/-2.3 vs 13.8+/-2.2 days, p<0.05). Total doses of FSH-HP in metformin group were significantly less than that in control group (30.3+/-11.5 vs 39.9+/-11.7 ampules, p<0.05). There was no difference in the number of aspirated oocytes (10.5+/-4.7 vs 9.6+/-3.6), the fertilization rate (65.9+/-17.4% vs 63.2+/-25.9%), implantation rate (30.3+/-11.5% vs 38.1+/-17.3%) and the number of good quality embryo (5.0+/-1.8 vs 4.7+/-2.5, p< or =0.05). Clinical pregnancy rate was higher in metfomin group (33.3% vs. 23.8%), although statistically not significant. CONCLUSION: Although more randomized study is needed, metformin therapy in PCOS patients undergoing IVF has possibility of reducing the duration of COH and the gonadotropin doses.

The Effectiveness of a Preoperative Use of Misoprostol in Laparoscopically Assisted Vaginal Hysterectomy / 대한산부인과학회지

OBJECTIVE: To investigate the effectiveness of a single preoperative dose of rectal misoprostol in laparoscopically assisted vaginal hysterectomy (LAVH). METHODS: Between October 2003 and July 2004, 63 patients underwent LAVH with a single preoperative dose of rectal misoprostol 400 microgram at Grace women's hospital. To compare efficacy of a single preoperative dose of rectal misoprostol, 63 patients underwent LAVH without misoprostol were sampled during same period at Grace women's hospital. Clinicopathological variables were collected from the review of medical record and compared between two groups. Included variables were age, parity, BMI, uterus weight, largest myoma diameter, operation time, 24 hr Hb change, blood loss during operation, postoperative morbidity and postoperative complication. Associations between variable were studied using paired t-test. RESULTS: There were no significant differences in age, parity, BMI, uterus weight, largest myoma diameter between each groups. Comparing each groups in operative outcomes, estimated blood loss (155.0 +/- 97.8 mL vs 220.1 +/- 82.5 mL) and 24 hr Hb change (1.10 +/- 0.53 g/dL vs 1.57 +/- 0.46 g/dL) were significantly reduced in misoprostol group. CONCLUSION: A single preoperative dose of rectal misoprostol is a simple, reliable method for reducing intraoperative blood loss in LAVH.

A Case of Edward Syndrome with Choroid Plexus Cyst / 대한산부인과학회잡지

Trisomy 18 is the second most common chromosomal anomaly which reach to live birth next to Down syndrome. Several methods were proposed to screen patients on the risk of Edward syndrome like maternal serum levels of total human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and unconjugated estriol or free beta hCG with AFP, but the serum screening has only 67% detection rate with a 7.2% of false positive rate. Therefore, in order to overcome the limitations which the serum markers have, detailed ultrasound examination is also necessary and sensitivity of 80% was reported. We report a case of Trisomy 18 fetus in which choroid plexus cyst was the only abnormal sonographic finding.

The Impact of Fetal Echocardiography on the Treatment and Outcome of Congenital Heart Disease: Report of Fetal Diagnosis of Congenital Heart Disease in 2001 at CHA Hospital

PURPOSE: Prenatal diagnosis of congenital heart disease has been made by fetal echocardiography and its clinical impact on the outcome of CHD cases has been analysed. METHODS: A prospective study was performed for the fetal diagnosis of CHD for the standard risk pregnancy, confirmed postnatally or at second study and/or at autopsy and/or follow up at CHA hospital in 2001. Incidence of CHD has been calculated and compared to the incidence of CHD of the prescreening period(1992.3-1995.2). RESULTS: There were 66 cases of CHD prenatally during the study period. CHD consisted of 7 cases of ventricular septal defects(VSD), 7 cases of tetralogy of Fallot(TOF), 5 cases of heterotaxy, 5 cases of double outlet right ventricle(DORV), 5 cases of severe pulmonary stenosis(PS), 3 cases of hypoplastic left heart syndrome(HLHS), 3 cases of coarctation, 3 cases of critical aortic stenosis(AS), 3 cases of pulmonary atresia with intact ventricular septum(PA IVS). Among 66 fetal CHD cases, 30 cases of CHD has been terminated, 1 case died in utero and 23 cases has been delivered at cardiac center through planned delivery. The most common factors of termination were extracardiac and chromosomal anomaly. 17 cases of false negative diagnosis were small VSD and mild PS that couldn't be diagnosed in fetal stage. There was no false positive diagnosis. There were 30 cases of CHDs born in 2001 at CHA hospital. 28 cases were diagnosed postnatally. Among 30 cases of CHDs, there were 18 cases of VSD(17 small VSD), 6 cases of mild PS, 4 ASD, 1 PDA. Incidence rate of CHD in 2001 and period 1992.3-1995.2 were 5.95 and 10.15/1,000 livebirth respectively. CONCLUSION: The data suggested that all of the significant CHDs could be diagnosed prenatally accurately by fetal echocardiography. And the incidence rate of CHD has been decreased by 41.4%. And the most of the complex CHD has been transferred to the cardiac center for planned delivery or has been terminated. The rate of termination was 45.5%.

Efficacy of Maternal Serum Corticotropin Releasing Factor Levels in Diagnosis of Pregnancies Complicated by Preterm Labor / 대한산부인과학회잡지

Human placenta synthesizes bioactive corticotropin releasing factor(CRF), a 41 amino acid peptide, which displays identical immunological, biological, and chemical characteristics to hypothalamic CRF. Placental CRF enters the maternal circulation and stimulates release of local placental prostaglandin E2 and F2alpha that have a central role in the mechanisms controlling uterine contractility and cervical softening. A large number of clinical investigators has suggested that placental CRF may be involved in mechanisms leading to labor. As well as CRF`s rises in term pregnancy, maternal serum CRF levels are also elevated in pregnancies complicated by preterm labor. So the clinical use of maternal serum CRF levels as a predictor of preterm labor was proposed. Therefore, we have carried out a prospective study on the efficacy of maternal serum CRF levels in diagnosis of preterm labor. In this study, the subjects consisted of 30 women admitted for the treatment of preterm labor and another 30 women with normal pregnancies between 28 and 36 completed weeks of gestation, and their serum CRF levels were assessed. The results were as follows: 1. In both groups, serum CRF levels were increased as being associated to gestational ages, especially in late pregnancy. 2. In a comparative study between two groups, the serum CRF values of pregnancies complicated by preterm labor were significantly higher than their values of control group(p0.05).