RESUMO
OBJECTIVE: To assess the clinical characteristics, laboratory findings, the maternal and neonatal complications between HELLP syndrome and severe preeclampsia. METHODS: We reviewed the material and neonatal charts of 34 pregnancies complicated by HELLP syndrome and 40 pregnancies complicated by severe preeclampsia managed at our hospital between January, 2001 and December, 2005. We compared the clinical characteristics, laboratory findings, the maternal and neonatal complications between two groups. Results were compared by student T test, chi-square test. RESULTS: Our study showed that in HELLP syndrome patients had the less gestational age at admission, gestational age at delivery, the lower platelet counts, the higher AST, ALT, LDH, and the longer hospitalization period than in severe preeclampsia. Steroid (dexamethasone) use, cesarean delivery rate and MgSO4 use were more frequent in HELLP syndrome than severe preeclampsia. Neonatal birth weight was lower with HELLP syndrome. There was no significant difference in maternal and neonatal complications. CONCLUSION: HELLP syndrome need to be recognized a unique form of severe preeclampsia. It was associated with serious maternal and fetal mortality, the appropriate management would be done by early diagnosis using laboratory tests.
Assuntos
Feminino , Humanos , Gravidez , Peso ao Nascer , Diagnóstico Precoce , Mortalidade Fetal , Idade Gestacional , Síndrome HELLP , Hospitalização , Contagem de Plaquetas , Pré-EclâmpsiaRESUMO
Adnexal torsion during pregnancy is rare condition that is infrequently diagnosed preoperatively. Its incidence is 1 in 5000 during pregnancy, and adnexal torsion in the third trimester is rare. We present two cases of an adnexal torsion during the third trimester. The one had not been previously diagnosed by ultrasound and was associated with fetal distress and the other had been diagnosed having an ovary cyst by ultrasound in the first trimester. Both of patients were sent to our emergency room for sudden onset of severe low abdominal pain. Treatment was maintenance of adequate circulating intravascular volume and rapid surgical intervention.
Assuntos
Feminino , Humanos , Gravidez , Dor Abdominal , Serviço Hospitalar de Emergência , Sofrimento Fetal , Incidência , Ovário , Primeiro Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Gestantes , UltrassonografiaRESUMO
Adnexal torsion during pregnancy is rare condition that is infrequently diagnosed preoperatively. Its incidence is 1 in 5000 during pregnancy, and adnexal torsion in the third trimester is rare. We present two cases of an adnexal torsion during the third trimester. The one had not been previously diagnosed by ultrasound and was associated with fetal distress and the other had been diagnosed having an ovary cyst by ultrasound in the first trimester. Both of patients were sent to our emergency room for sudden onset of severe low abdominal pain. Treatment was maintenance of adequate circulating intravascular volume and rapid surgical intervention.
Assuntos
Feminino , Humanos , Gravidez , Dor Abdominal , Serviço Hospitalar de Emergência , Sofrimento Fetal , Incidência , Ovário , Primeiro Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Gestantes , UltrassonografiaRESUMO
Placental abnormality is the important predisposing cause of intrauterine growth retardation. Massive subchorionic hematoma is defined as a large size of maternal blood clot that separates the chorionic plate from the villous chorion and can result in serious obstetrical complications. We report a case of massive subchorionic hematoma diagnosed prenatally, and propose an additional peculiar finding detectable on both the ultrasound and magnetic resonance images: a large hematoma in the subchorionic region at 17 weeks gestation. At 18 weeks 2 days gestation, the fetus was miscarried. The clinical and pathological findings were compatible with massive subchorionic hematoma. Recurrent massive subchorionic hematoma without thrombophilic finding was observed at the next pregnancy in 17 weeks 5 days by ultrasound. The patient was managed conservatively and had successful outcome at term. So we report the case with the brief review of literatures.
Assuntos
Humanos , Gravidez , Córion , Retardo do Crescimento Fetal , Feto , Hematoma , UltrassonografiaRESUMO
OBJECTIVE: Screening tests for Gestational diabetes (GDM) are performed during the 24~28 weeks of pregnancy. Therefore, in many cases, GDM is not detected during the first trimester of pregnancy while most of important organs are developed during this period. In this review, we performed a retrospective study by dividing GDM mothers into 3 groups: diabetic, impaired glucose tolerance (IGT) and normal. The medical records of mothers and neonates from these three groups were compared. METHODS: 136 out of 536 GDM patients in Holy Family Hospital from 1995 to 2005 took a 75 g OGTT 6 weeks after delivery. As a result, 28 were diagnosed as diabetes, 18 had impaired glucose tolerance, and 90 were normal. The antenatal and perinatal history of above groups were retrospetively compared. RESULTS: In the diabetic group, 46.4% of mothers had a positive family history of diabetes, where as 38% of IGT group, 31.8% of normal group had the history. Secondly, the abortion history rate for each group was 21.4%, 16.6%, 13.3%, and each group had an average HbA1C of 7.20, 5.82 and 5.69. Also, the rate of preterm labor for each group was 17.9%, 11.1%, and 4.45%. The Apgar score (1 min/ 5min) was 7.29/8.54, 7.75/8.75 and 7.89/8.97. Lastly the rate of preeclampsia for each group was 14.3%, 11.1% and 6.8%. CONCLUSION: Three groups had distinctive differences in their perinatal morbidity both before and after delivery. Therefore, in order to reduce the perinatal morbidity and mortality rate, the present frequency or timing of GDM screening test, should be reconsidered.
Assuntos
Feminino , Humanos , Recém-Nascido , Gravidez , Aborto Induzido , Índice de Apgar , Diabetes Mellitus , Diabetes Gestacional , Glucose , Teste de Tolerância a Glucose , Programas de Rastreamento , Prontuários Médicos , Mortalidade , Mães , Trabalho de Parto Prematuro , Pré-Eclâmpsia , Primeiro Trimestre da Gravidez , Estudos RetrospectivosRESUMO
OBJECTIVE: The study shows that the DFS is a questionnaire that almost effortlessly can be completed within 60-90 seconds during any moment of labor and delivery. The aim of the present study was to test the validity and reliability of the DFS, to identify its factor structure in Korea. METHODS: Review of the medical records from the department of obstetrics and gynecology from January to April 2005, a confirmed 51 patients with the diagnosis of singleton pregnancy without medical or obstetrical complications, being in 37-42 weeks. 22 primiparous and 29 multiparous women answered the Delivery Fear Scale (DFS) once during active labor, and the STAI (State-Trait Anxiety Inventory) after delivery. Reliability test to calculate Chronbach alpha and validity test to measure correlation between DFS and STAI was done. Then factor analysis was applied with the method of principal component analysis and varimax rotation. RESULTS: Korean version of DFS proved to be a reliable and valid scale statistically: Cronbach's alpha was 0.7182 in study. CONCLUSION: Women's psychological experiences during the actual process of labor and delivery are essential part of obstetrical care. Nevertheless, studies examining psychological variables concerning childbirth, are mostly performed before or after labor. The DFS measures fear during labor and delivery in an effortless and fast away. The development of the Korean version of DFS which is reliable and valid, and consists of three sub-factors may facilitate future research in the field.
Assuntos
Feminino , Humanos , Gravidez , Ansiedade , Diagnóstico , Ginecologia , Coreia (Geográfico) , Prontuários Médicos , Obstetrícia , Parto , Análise de Componente Principal , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: The purpose of this study was to establish the distribution and obstetric outcomes in women with congenital uterine malformations. METHODS: A review of the medical records from the department of obstetrics and gynecology from January 1995 to June 2004 were diagnosed 79 patients with congenital uterine malformations. All of the cases were divided into groups according to classification of ASRM (American Society for Reproductive Medicine), which is based on the degree of failure of normal development of the female genital tact. The obstetric outcomes were compared between the groups. Statistical processing of the material was carried with Pearson chi square test. RESULTS: 79 patientss with congenital uterine malformations were diagnosed by operation or imaging studies. Symmetric congenital uterine malformations, consisting of bicornuate uterus (45.6%), septate uterus (19.0%), and uterus didelphys (31.6%), were the most common, constituting 96.2% of the malformations. Two patients (2.5%) had unicornuate uterus and one patient (1.3%) had arcuate uterus. No cases of the agenesis type and T-shaped uteri were found. 196 pregnancies occurred in the 74 patients. Only 43.4% of the pregnancies reached term, while 8.2% resulted in preterm delivery, and 48.4% terminated as miscarriages. CONCLUSION: Obstetric complications occur more frequently among women with congenital uterine malformations than among women in general. Knowledge concerning of congenital uterine malformations is important in recognizing and managing the obstetric complications that may result.
Assuntos
Feminino , Humanos , Gravidez , Aborto Espontâneo , Classificação , Ginecologia , Prontuários Médicos , Obstetrícia , ÚteroRESUMO
Virtually all monochorionic twin placentas contain vascular connections between the circulatory domains of each twin. In contrast, vascular anastomoses are generally thought not to occur in fused, dichorionic placentation. In the twin-to-twin transfusion syndrome (TTTS) one twin is preferentially perfused by blood from the cotwin via unbalanced placental vascular anastomoses. This vascular shunting results in twins born with discrepant weights, colors and hemoglobins. When one of the TTTS criteria was not present, the pregnancy was defined as "pseudo" TTTS. In pregnancies complicated by "pseudo" TTTS indicate that small twins have abnormal cord insertion more frequently than large twins. We present a case of vascular anastomoses in dichorionic diamniotic-fused placentas resulting in "pseudo" TTTS with a brief review of the literatures concerned.
Assuntos
Feminino , Humanos , Gravidez , Transfusão Feto-Fetal , Placenta , Placentação , Pesos e MedidasRESUMO
OBJECTIVE: To determine whether severity of proteinuria or urinary protein fractional analysis correlates with adverse maternal and fetal outcomes in women with severe preeclampsia. METHODS: Thirty-six women diagnosed of severe preeclampsia from January, 2002 to April, 2003 were studied. The correlation between proteinuria or urinary albumin fraction, and maternal mean arterial pressure, neonatal birth weight, 1 minute apgar score were analyzed statistically. Thirty-six patients were divided into two groups according to the pattern of urinary protein fraction. One group was a selective proteinuria group if the albumin fraction was over 70%, and another was a non-selective proteinuria group if the fraction was below 70%. The maternal and neonatal outcomes were compared between the two groups. RESULTS: Significant positive correlation was observed between proteinuria and mean arterial pressure, between urinary albumin fraction and neonatal birth weight. Negative correlation was significantly present between proteinuria and neonatal birth weight, 1 minunte apgar score, between proteinuria and albunin fraction. Increased proteinuria, higher mean arterial pressure, higher serum uric acid level, lower creatinine clearance, lower neonatal birth weight, and lower 1 minunte Apgar score were observed in the non-selective proteinuria group than those in the selective proteinuria, although there was no statistical significance. CONCLUSION: With increasing proteinuria and decreasing albumin fraction, there is increased risk of adverse maternal and fetal outcome. Proteinuria fractional analysis by electrophresis might provide useful information regarding the prediction of pregnancy outcomes.
Assuntos
Feminino , Humanos , Gravidez , Índice de Apgar , Pressão Arterial , Peso ao Nascer , Creatinina , Pré-Eclâmpsia , Resultado da Gravidez , Proteinúria , Ácido ÚricoRESUMO
OBJECTIVE: Pregnant women have various fears and expectations regarding the impending birth. Fears can influence the course of the delivery and post-partum period. The DFS (Delivery Fear Scale) measures fear during labor and delivery in an effortless and fast away. The aim of this study were to compare DFS score and parity, maternal age, history of abortion, baby gender during an early stage of active labor (cervix dilatation 3-5 centimeters). METHODS: Review of the medical records from the department of obstetrics and gynecology from January 2004 to December confirmed 151 patients with the diagnosis of singleton pregnancy without medical or obstetrical complications, being in 37-42 weeks. 86 primiparous and 65 multiparous women answered the Delivery Fear Scale (DFS) once during active labor. Mann-Whitney test was applied to test possible differences between DFS and variable factors. Difference were considered to be statistically significant at p<0.05. RESULTS: Primiparous women had higher scores on the DFS than multiparous women during active labor. But DFS was not associated with maternal age, history of abortion, baby gender during an early stage of active labor. CONCLUSION: Women's psychological experiences during the actual process of labor and delivery are essential part of obstetrical care. Nevertheless, studies examining psychological variables concerning childbirth, are mostly performed before or after labor. The understanding of a fear during labor is to support the woman in labor in a way that decrease fear and the development of the DFS may facilitate future research in the field.
Assuntos
Feminino , Humanos , Gravidez , Diagnóstico , Dilatação , Ginecologia , Idade Materna , Prontuários Médicos , Obstetrícia , Paridade , Parto , GestantesRESUMO
OBJECTIVE: To determine obstetric outcome in infants > or =4,500 g according to delivery mode. METHODS: Records of 271 mothers and infants weighing > or =4,500 g over a 11-year period (1993~2003) were retrospectively reviewed. Maternal and perinatal outcomes were compared in relation to delivery mode. RESULTS: The frequency of macrosomia ranged 0.38% in 4,500 g or more. Vaginal delivery was achievable in 78/271 (28.8%) of women allowed to labor, of which 71.2% were operative. In macrosomia frequency correlations to parity showed 33.9% (92 cases) in primiparous women, 66.9% (179 cases) in multiparous women. According to the type of delivery, cesarean section has proven to be the most popular mode. The cesarean section group had a higher incidence of maternal BMI (> 25 kg/m2). The frequency of diabetes, hypertension, low Apgar score at 5 and 10 minutes was similar in both groups. CONCLUSION: It would be appropriate to have definite diagnostic schemes and adequate choice of delivery method for macrosomia. Maternal height, weight, BMI (body mass index) may associated with fetal body weight and delivery mode.
Assuntos
Feminino , Humanos , Lactente , Gravidez , Índice de Apgar , Cesárea , Macrossomia Fetal , Peso Fetal , Hipertensão , Incidência , Mães , Paridade , Estudos RetrospectivosRESUMO
Ovarian cysts are common incidental findings in term infants and, if unusually large, may result in dystocia, torsion, or rupture. We report the case in which serial sonographic examination revealed changing pattern of cystic ovarian mass from hypoechogenic to well defined multiseptated echogenic during pregnancy. Postnatal T2-weighted MR images revealed a multilocular with high signal density. After delivery a laparotomy was performed, and a twisted ovary measuring 6.7x5x4.5 cm was removed. Ovarian torsion was left-sided and had been almost autoamputated. The resected specimens were nontense, thin walled cysts, filled with hemorrhage like fluid. Histological examination demonstrated the presence of lymphangioma with widespread hemorrhage and necrosis. The neonate did well after the procedure.
Assuntos
Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Distocia , Hemorragia , Achados Incidentais , Laparotomia , Linfangioma , Necrose , Cistos Ovarianos , Ovário , Ruptura , UltrassonografiaRESUMO
Otocephaly is a rare malformations comprising hypoplasia or absence of the mandible (agnathia), ventromedial displacement and often fusion of external ears (synotia or otocephaly), and hypoplasia of the oral cavity (microstomia) and tongue (hypoglassia). This developmental complex represents a malformation of the first and second branchial arches and occurs sometimes with holoprosencephaly. We present the ultrasound detection of otocephaly and holoprosencephaly with cyclopia in a fetus of 27 gestational weeks 6 days. The use of three-dimensional (3-D) ultrasound made additional diagnostic ultrasound tomograms possible, and the volume reconstructions improved the imaging and the understanding of the condition.
Assuntos
Região Branquial , Diagnóstico , Orelha Externa , Feto , Holoprosencefalia , Mandíbula , Boca , Língua , UltrassonografiaRESUMO
OBJECTIVE: To study the clinical characteristics of ovarian tumors accompanied with pregnancy. METHODS: A review was performed of 310 cases of ovarian tumors surgically resected during pregnancy from January 1990 to December 2001. RESULTS: The incidence of ovarian tumor in pregnancy was one in 181.5 deliveries and that of malignant neoplastic tumor was one in 6,251 deliveries. Among 310 cases undergoing ovarian surgery, tumor-like lesions were 110 cases (35.5%), benign tumors were 191 cases (61.6%), and malignant tumors were 9 cases (0.3%), respectively. One hundred and twenty cases of dermoid cyst (38.7%) occured most frequently, followed by 47 cases of corpus luteal cyst (15.2%), and 40 cases of simple cyst (12.9%). One hundred and ninety nine cases (64.2%) of ovarian tumors were greater than 6 cm in diameter and 189 cases (61%) were preoperatively diagnosed in 1st trimester, and 62 cases (20%) were detected incidentally during cesarean section. In complicated cases, the torsion of ovarian tumor was found in 48 cases (71.6%), the cases of rupture were 16 (23.9%), and misdiagnosed cases as appendicitis were 3 (4.5%). According to outcome of pregnancy, abortions were 19 cases (6.1%), vaginal deliveries were 43 cases (13.9%), and cesarean sections were 169 cases (53.5%). CONCLUSION: Although the incidence of malignant ovarian tumor is low, the overall incidence of ovarian tumor in pregnance is increasing. Because ovarian tumors complicating pregnancy are often entirely unsuspected, careful examination of all pregnant women in early pregnancy must be considered.
Assuntos
Feminino , Humanos , Gravidez , Apendicite , Cesárea , Cisto Dermoide , Incidência , Gestantes , RupturaRESUMO
OBJECTIVE: Although a common clinical problem, no uniform definition for fear of childbirth has been settled. The purpose of this study was to identify the association of serotonin in labor. METHODS: A prospective study of serotonin and review of the medical records from the department of obstetrics and gynecology, Catholic University of Korea Holy Family Hospital from January 2004 to May confirmed 30 patients with the diagnosis of singleton pregnancy without medical or obstetrical complications, being in 37-42 weeks. Blood sampling of serotonin was done during labor according to cervix dilatation. Sample collection series on patients latent phase (before labor begins S1), active phase (cervix dilatation 3-5 cm S2), second stage (cervix dilatation full S3), third stage (at delivery of placenta within 24 hours S4), cord artery blood (S5) could be administered. Patient were divided into two groups. From this group 17 patients (G1) who were initial serotonin normal concentration (1.5-7.5 ng/mL), and 13 patients (G2) who were initial serotonin high concentration. RESULTS: The concentration of serotonin of G1 were S1-5.8 +/- 0.8 ng/mL, S2-7.2 +/- 2.5 ng/mL, S3-8.5 +/- 3.7 ng/mL, S4-6.5 +/- 1.5 ng/mL, S5-4.9 +/- 1.2 ng/mL. The serotonin concentration of G2 were S1-10.1 +/- 2.7 ng/ mL, S2-11.2 +/- 5.2 ng/mL, S3-10.3 +/- 3.9 ng/mL, S4-11.8 +/- 8.6 ng/mL, S5-5.0 +/- 1.0 ng/mL. CONCLUSION: The association of serotonin in labor was studied that the change of serotonin concentration was determined according to initial serotonin concentration. This difference of initial serotonin concentration will be studied about genetic polymorphism and factor by molecular biology.
Assuntos
Feminino , Humanos , Gravidez , Artérias , Colo do Útero , Diagnóstico , Dilatação , Ginecologia , Coreia (Geográfico) , Prontuários Médicos , Biologia Molecular , Obstetrícia , Parto , Placenta , Polimorfismo Genético , Estudos Prospectivos , SerotoninaRESUMO
OBJECTIVE: The purpose of this study was to evaluate female victims of sexual assault and assess the similarities and differences between them. METHODS: Case files and photographs of 59 women examined at Holy Family hospital for sexual assault during Jan 1, 1991 to Dec 31 2001 were reviewed. RESULTS: The mean age of the patients was 17.12 (+/-11.50). 45 (76.3%) of assailants were strangers to the victims. 35 (59.3%) had genital injuries and 8 (13.6%) needed surgical treatments. No victim was pregnant and 17 (28.8%) was reported to police. CONCLUSION: Sympathetic concern in the treatment of women who come forward to report the experience of sexual assaults will result in more reporting of rape. The victims need to be educated at home, at school, and by their primary care providers to avoid situations in which they could make themselves vulnerable to sexual assault, and they should be taught the importance of immediately reporting their assault and seeking medical care.
Assuntos
Feminino , Humanos , Polícia , Atenção Primária à Saúde , EstuproRESUMO
OBJECTIVE: To determine the effect of magnesium sulfate (MgSO4) on the expression of caspase-3 and caspase-9 of cytotrophoblasts in vitro under normal and hypoxic condition as assessed immunoblot analyses. METHODS: Normal cytotrophoblasts were isolated from second trimester placentas and cultured in several physiologically relevant concentrations of MgSO4 under standard tissue culture condition (20% O2) or hypoxic condition (1-2% O2). Cytotrophoblasts apoptosis was estimated by TUNEL staining and by immunoblotting for Caspase-9 and Caspase-3. RESULTS: The apoptotic index was highest in cytotrophoblasts cultured under hypoxic conditions for 36 hour in the absence of MgSO4 and was showed decreasing tendency by the addition of MgSO4 under the same condition. The expression of Caspase-9 did not change under both standard condition and hypoxic condition with increasing MgSO4 concentrations, but the expression of Caspase-3 decreased under hypoxic condition with increasing of MgSO4 concentrations. CONCLUSION: MgSO4 might protect cytotrophoblasts from apoptosis under hypoxic condition.
Assuntos
Feminino , Humanos , Gravidez , Hipóxia , Apoptose , Caspase 3 , Caspase 9 , Immunoblotting , Marcação In Situ das Extremidades Cortadas , Sulfato de Magnésio , Magnésio , Placenta , Segundo Trimestre da Gravidez , TrofoblastosRESUMO
OBJECTIVE: To determine the expression of vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF) and intercellular adhesion molecule (ICAM-1) in placenta from pregnancies complicated by severe preeclampsia and normal pregnancies. METHODS: Placental tissues were obtained from 10 normotensive pregnancies (control group) and 20 severe preeclamptic pregnancies (preeclamptic group). Immunohistochemical staining of placental tissue was used to determine tissue expression of VEGF, PDGF and ICAM-1. The intensity of staining was evaluated by scoring as 0, 1, 2 and 3. RESULTS: Immunolocalization of VEGF and PDGF was significantly observed in the syncytotrophoblast with less intense staining in intravillous stromal cells and intravillous endothelial cells of fetal vessels in preeclamptic group. There were no differences in immunolocalization of staining in control group. Intensity of VEGF and PDGF immunostaining in syncytotrophoblast was significantly increased in preeclamptic group. However, immunolocalization and the intensity of ICAM-1 staining were not significantly different in both groups. CONCLUSION: The expression of VEGF and PDGF in the syncytotrophoblast was significantly up-regulated in severe preeclamptic placenta. These up-regulation of VEGF and PDGF might reflect that placental ischemia and hypoxic state in severe preeclampsia induce VEGF and PDGF in the syncytotrophoblasts of placenta. However the unchanged pattern of ICAM-1 expression in severe preeclampsia suggests that ICAM-1 is unlikely to be a factor by which the adverse pregnancy outcome arises in severe preeclampsia.
Assuntos
Feminino , Gravidez , Células Endoteliais , Molécula 1 de Adesão Intercelular , Isquemia , Placenta , Fator de Crescimento Derivado de Plaquetas , Pré-Eclâmpsia , Resultado da Gravidez , Células Estromais , Regulação para Cima , Fator A de Crescimento do Endotélio VascularRESUMO
OBJECTIVE: This study was conducted to investigate the presence and pattern of Hyrtl anastomosis, and to examine the effect that each type has on obstetrical outcome. METHODS: This study was carried out from January of 2001 to May of 2003 on 904 randomly selected patients who had given birth by Cesarean section or vaginal delivery at Catholic University Holy Family Hospital. Immediately proceeding delivery, barium sulfate was infused into the umbilical artery. This was followed by umbilical artery dissection to grossly confirm Hyrtl anastomosis. In order to evaluate the effect that each type of anastomosis has on obstetrical outcome, we retrospectively examined chart for birth weight, Apgar score, results of cord blood gas analysis, obstetrical complications, etc. RESULTS: Out of the 904 cases studied, 99.7% possessed Hyrt's anastomosis with frequency according to type as follows: 50.8% oblique, 48.0% transverse, 1.8% of anastomosis between one umbilical artery and the branch of the other, 1.6% of fusion of branches of each umbilical artery, 0.6% of anastomosis represented by two separate vessels between umbilical arteries, 0.1% of anastomosis between branches of each umbilical artery, 0.1% lacking anastomosis, and 0.2% of a single umbilical artery. In terms of obstetrical outcome, there was no significant difference for term and preterm infants in the frequency of type of Hyrtl's anastomosis according to birth weight, maternal age, Apgar score, obstetrical complications, etc. CONCLUSION: In an attempt to verify the presence and type of Hyrtl anastomosis, 8 types of Hyrtl's anastomosis were found, of which the oblique and transverse variety were the most common. There was no significant difference in the types of Hyrtl's anastomosis in relation to obstetrical outcome. Frequency was also similar with oblique and transverse types being the most common. Further studies detailing anatomical features of and blood flow/volume through the anastomosis are required in order to better understand the effects of Hyrtl's anastomosis on obstetrical outcome.
Assuntos
Feminino , Humanos , Recém-Nascido , Gravidez , Índice de Apgar , Sulfato de Bário , Peso ao Nascer , Cesárea , Sangue Fetal , Recém-Nascido Prematuro , Idade Materna , Parto , Estudos Retrospectivos , Artéria Umbilical Única , Artérias UmbilicaisRESUMO
OBJECTIVE: The purpose of this study is to evaluate the clinical and pathological characteristics of granulosa cell tumor of the ovary. METHODS: Between 1990 and 2000, 27 patients with granulosa cell tumor of the ovary treated in the Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea were identified and reviewed retrospectively for patient profiles, International Federation of Gynecologists and Obstetricians (FIGO) disease stage, mode of therapy, and length of survival. RESULTS: The median age at diagnosis was 43.9 years (range 9-75 years). Tumors were 70.3% (19/27) stage I, 7.5% (2/27) stage II, 11.1% (3/27) stage III, and 11.1% (3/27) stage IV. There was a 15% association between granulosa cell tumor and endometrial hyperplasia. All patients underwent cytoreductive surgery, and 14 patients followed by postoperative chemotherapy. One patient received adjuvant pelvic radiotherapy and 3 patients were treated with adjuvant pelvic radiotherapy and chemotherapy. The survival rate in stage I was 100.0% after 5 years, and in stage II-IV was 62.5% after 5 years. Overall survival was 88.8% at 5 years. Mitotic index influenced the survival rate; with less 10/10 HPF the survival was 100% in 5 years, and with more or equal 10/10 HPF the longest survival was 44 months. CONCLUSION: Although most granulosa cell tumors of the ovary are slow growing, wide variation is possible, with high mitosis counts leading to a worse prognosis. However, it is difficult to predict early or late recurrences using pathologic parameters. It is therefore important that patients with theses tumors are followed up indefinitely.