Ho-Yen Chueh

Postpartum urinary retention after cesarean delivery.

To investigate the incidence of postpartum urinary retention (PUR) after cesarean delivery and determine which obstetric factors contribute to this problem.

Management of primary abdominal pregnancy: twelve years of experience in a medical centre

Background. The aim of this study was to evaluate our institutions 12‐year experience in managing primary abdominal pregnancy by laparotomy or laparoscopy. Methods. We identified 11 cases of primary abdominal pregnancy treated at our institution between January 1994 and December 2005, and separated the cases into 2 groups based on type of surgical management. The outcome measures we evaluated were operative time, blood loss and duration of hospital stay. In addition, the incidence rates for all types of ectopic pregnancy were recorded. Analysis excluded secondary abdominal pregnancy. Results. Of the 11 primary abdominal pregnancies, 6 were treated with laparotomy and 5 with laparoscopy. The laparoscopy group had significantly better results in operative time, blood loss and hospital stay (p<0.05). The difference in gestational age was not significant (p = 0.141), even after excluding the patient whose abdominal pregnancy was only identified after cesarean delivery. Conclusion. Our experience shows a trend toward better management of primary abdominal pregnancy with laparoscopy. These patients had shorter operative time, reduced blood loss, and fewer days in hospital then patients treated with laparotomy. Choice of management should depend on the patients condition, gestational age of the pregnancy, and the physicians clinical experience.

Sonographic diagnosis of a uterine defect in a pregnancy at 6 weeks' gestation with a history of curettage

We present the early diagnosis and successful surgical treatment of uterine perforation. This was a rare case of cystic change of a uterine perforation, which was diagnosed by sonography during the first trimester of pregnancy. Surgical closure of the uterine wall defect was successful. Copyright

Parental decisions regarding prenatally detected fetal sex chromosomal abnormality and the impact of genetic counselling: An analysis of 57 cases in Taiwan

Objective:u2003 To analyse parental decisions regarding pregnancies with sex chromosome abnormalities (SCA).

A hepatoid carcinoma of the ovary.

A rare case of primary hepatoid carcinoma of the ovary in a 64-year-old Taiwanese woman, who had high serum levels of afetoprotein (AFP) and CA-125, is reported. Histologically, the tumor resembled hepatocellular carcinoma by its architectural and cytological features. To date, no more than 10 cases have been reported in the literature. Clinically, our case was allocated as an ovarian carcinoma Stage IIIc. Poor prognosis was expected from reviewing the previous reports. However, the patient in our case had a relatively successful 5-year survival through proper chemotherapy and radiotherapy.

Presence of a single fetal major anomaly in a twin pregnancy does not increase the preterm rate.

Objective:u2002 To evaluate whether the presence of one major anomaly in a twin pregnancy would affect the perinatal outcome of the unaffected co‐twin.

Pitfalls in the differential diagnosis of a pelvic cyst: Lessons from a post‐menopausal woman with bladder diverticulum

We present a case of non‐obstructive bladder diverticulum in a 75‐year‐old post‐menopausal woman. An ovarian cyst was previously suspected, which resulted in a futile exploratory laparotomy without making any definite diagnosis, 1 year earlier. During this admission, transvaginal ultrasound‐guided cyst aspiration was arranged to determine the nature of the presumed ‘recurrent’ cyst and to relieve the symptoms. Prior to cyst aspiration, up to 700u2003ml of urine through urinary catheterisation and the gradual disappearance of the ‘cyst’ alerted us to the possibility of a bladder diverticulum, which was later confirmed by retrograde cystography. This case illustrates the lessons that despite considerable researches having been done on enhancing sonographic accuracy, diagnosis based on imaging alone is likely to be associated with multiple pitfalls. Recognising the common pitfalls and integrating clinical information and alertness with ultrasonic features remains the mainstay of sonographic differential diagnosis.

Prevalence and contributing factors of severe perineal damage following episiotomy-assisted vaginal delivery

OBJECTIVEnThis study was conducted to investigate the risk factors of third- and fourth-degree lacerations following vaginal deliveries in Taiwanese women, and to offer clinical guidance for the reduction of severe perineal lacerations.nnnMATERIALS AND METHODSnA total of 1879 women who underwent vaginal deliveries assisted by midline episiotomy at a tertiary hospital were included. Obstetric risk factors were analyzed for women with and without third- and fourth-degree lacerations.nnnRESULTSnTwo hundred and five deliveries (10.9%) resulted in third- or fourth-degree lacerations. Parity, duration of first and second stages of labor, rate of instrument-assisted vaginal deliveries, the newborns birth weight and head circumference, and the ratio of the newborns birth weight to maternal body mass index were significantly different between women with and without severe perineal lacerations. Logistic regression demonstrated that nulliparity (odds ratioxa0=xa03.626, pxa0<xa00.001), duration of second stage of labor (odds ratioxa0=xa01.102, pxa0=xa00.044), instrument-assisted vaginal delivery (odds ratioxa0=xa04.102, pxa0<xa00.001), and newborns head circumference (odds ratioxa0=xa01.323, pxa0<xa00.001) were independent risk factors of severe perineal lacerations. Instrument-assisted vaginal delivery was a common independent risk factor for severe lacerations shared between primiparous and multiparous women.nnnCONCLUSIONSnWith regard to severe perineal lacerations during vaginal delivery, there are multiple obstetric contributory factors despite routine episiotomy, among them, nulliparity, longer labor duration, greater newborn head circumference, and instrument-assisted vaginal delivery. The latter should only be performed after careful evaluation.

Inadvertent superovulation and intrauterine insemination during pregnancy: a lesson from an ectopic gestation.

It is believed that follicular development and ovulation is suppressed during the early period of gestation in humans. In this report, we describe a patient who underwent ovarian hyperstimulation following a “presumed” menstrual bleeding. The case illustrates that the ovaries during early pregnancy seem to respond normally to exogenous gonadotrophin stimulation. Despite ongoing pregnancy, the high plasma concentrations of gonadotrophins have rescued pituitary and ovarian insensitivity. Normal follicular development and even ovulation are allowed to occur. Moreover, it is mandatory to preclude pregnancy before commencing superovulation and assisted reproductive technology.

Persistent stress urinary incontinence during pregnancy and one year after delivery; its prevalence, risk factors and impact on quality of life in Taiwanese women: An observational cohort study

OBJECTIVEnThe study was to investigate the prevalence and risk factors of stress urinary incontinence (SUI) and its impact on the quality of life during pregnancy and 12 months after delivery.nnnMATERIALS AND METHODSn866 women delivering their newborns at a tertiary hospital were recruited. All women were asked to complete several questionnaires including demographic and obstetric data, Short Form 12 health survey (SF-12), Urogenital Distress Inventory Short Form (UDI-6), and Incontinence Impact Questionnaire Short Form (IIQ-7). All women were interviewed via telephone to answer the same questionnaires at 12 months postpartum.nnnRESULTSnThere were 446 (51.5%) self-reported SUI women during pregnancy. Out of 560 women delivered vaginally, 70 (12.5%) had SUI at 12 months postpartum; in 306 women undergoing Cesarean delivery, 22 (7.2%) experienced SUI 12 months after delivery. Risk factors of SUI during pregnancy included body weight and body mass index at first visit. At 12 months postpartum, parity stood out as the risk factor of persistent SUI in vaginal delivery group, but no significant risk factor was found in Cesarean group. Women with SUI during pregnancy featured worse mental component summary (MCS) score of SF-12, compared to women without SUI. At 12 months postpartum, women with persistent SUI in vaginal delivery group had higher mean UDI-6 and IIQ-7 scores than those without SUI.nnnCONCLUSIONnPersistent SUI is more prevalent in the vaginal delivery group than Cesarean group. Both SUI during pregnancy and after childbirth have negative impact on the quality of life in women undergoing vaginal delivery.