Ji-Eun Song

Comparison of clinical effects between total vaginal hysterectomy and total laparoscopic hysterectomy on large uteruses over 300 grams

Objective:  To compare intra‐ and postoperative complications, operation time, and duration of hospital stay, and to evaluate cost‐effectiveness between total vaginal hysterectomy (TVH) and total laparoscopic hysterectomy (TLH) groups.

Cervical funneling after cerclage in cervical incompetence as a predictor of pregnancy outcome

Objectives. To evaluate whether cervical funneling influences pregnancy outcome in women with short cervical length (CL) after cerclage, and to identify funneling parameters associated with pregnancy outcome. Methods. Medical records of women identified to have a short CL with or without funneling after cerclage were reviewed. Women with short CL as well as funneling were defined as cases (Funneling group), and those with short CL but no funneling were the controls (No Funneling group). We compared perinatal outcome between the two groups and analyzed the relationships between funneling parameters and pregnancy outcome. Results. Seventy-two patients were included in this study; 39 women with short CL and funneling and 33 with short CL and no funneling. The mean gestational age at delivery of the Funneling group was 33.7 weeks, as compared to 36.5 weeks for the NoFunneling group (p < 0.001). We found a significant inverse association of funneling depth as well as volume with pregnancy outcome (p < 0.001, and p = 0.005, respectively). However, funneling width was not associated with pregnancy outcome (p = 0.49). Conclusions. Funneling depth and volume may be useful predictors of pregnancy outcome after cerclage.

The effect of inflatable obstetric belts in nulliparous pregnant women receiving patient-controlled epidural analgesia during the second stage of labor

Abstract Objective: The aim of this study was to evaluate the effect of inflatable obstetric belts on uterine fundal pressure in the management of the second stage of labor. Method: Between July 2009 and December 2010, 188 nulliparous women with a singleton pregnancy at term were enrolled and only one dropped. The participants were randomized to receive either standard care (control group, n = 91) or uterine fundal pressure by the Labor Assister™ (Baidy M-520/Curexo, Inc., Seoul, Korea; active group, n = 97) during the second stage of labor in addition to standard care. The Labor Assister is an inflatable obstetric belt that is synchronized to apply constant fundal pressure during a uterine contraction. The primary endpoint was duration of the second stage of labor in women who delivered vaginally (control, n = 80 versus active, n = 93). It was not analyzed in women who delivered by cesarean section (n = 14) and delivered precipitously (n = 1). The secondary outcomes are perinatal outcomes and perineal laceration. Participants received patient-controlled epidural analgesia. Results: The 93 women in the active group spent less time in the second stage of labor when compared to the 80 women in the control group (46.51 ± 28.01 min versus 75.02 ± 37.48 min, p < 0.001). There was no significant difference in perinatal outcomes and perineal laceration between the two groups. Conclusion: The uterine fundal pressure exerted by the inflatable obstetric belt reduces the duration of the second stage of labor without complications in nulliparous women who receive patient-controlled epidural analgesia.

Developed diplopia and ptosis due to a nonfunctioning pituitary macroadenoma during pregnancy

Physiologic pituitary enlargement is common during normal pregnancy. However, symptoms such as diplopia, blurred vision and headache resulting from physiologic pituitary enlargement are very rare during pregnancy. A 39-year-old woman complained of sudden diplopia and left eye ptosis at 33th weeks of gestation. An magnetic resonance imaging (MRI) demonstrated the pituitary enlargement compressing the optic chiasm. Notwithstanding the medication of bromocriptine, her symptoms did not regress during pregnancy. At 5 months after delivery, her symptoms dramatically resolved without any surgery, and her visual acuity was normalized. Her MRI scan also revealed more decreased size of pituitary gland compared to antenatal MRI. We report a case of visual loss due to the physiologic pituitary enlargement of nonfunctioning adenoma during pregnancy, which regressed spontaneously after delivery without any surgery.

Management of Pregnancy After Conization and Radical Trachelectomy

Cervical intraepithelial neoplasia (CIN) is commonly diagnosed in women of child-bearing age. (Castle et al., 2009) The excisional treatments of CIN include cold-knife conization, laser conization, loop electrosurgical excision procedure (LEEP), and large loop excision of the transformation zone (LLETZ). CIN is also treated by ablative procedures such as laser vaporization and cryotherapy. Recently, human papilloma virus (HPV) has led to the understanding of pathogenesis and management of cervical diseases. (Moscicki et al., 2004) The screening and subsequent treatment of CIN significantly reduces the risk of invasive cervical cancer, but the impact of excisional cervical treatment on subsequent pregnancy outcome must be evaluated.