Yun-Sook Kim

Risk factors for complications in patients undergoing myomectomy at the time of cesarean section

Aim:  The aim of this study was to evaluate the risk factors for complications of myomectomy at cesarean section (CS).

Primiparous singleton women with endometriosis have an increased risk of preterm birth: Meta-analyses

Objective The objective of this study was to assess the association between women with endometriosis and risk of preterm birth. Methods Two reviewers independently determined all prospective cohort study, retrospective cohort study, large population based cohort study, retrospective secondary analysis, and double blinded, multicentric, observational and cohort study, placebo-controlled, randomized clinical trial published using PubMed, Medline, Korea Education and Research Information Service, and Scopus from March 1994 through February 2016 without language restrictions comparing obstetric outcomes women with endometriosis and women without endometriosis. The meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Six studies met inclusion criteria, including 50,472 women. Among 50,472 pregnancies, 39,659 had endometriosis and 10,813 had no endometriosis. Meta-analyses were estimated with odds ratios and 95% confidence intervals using random effect analysis according to heterogeneity of studies. Results Data from six effect sizes from six studies involving 50,472 patients were enrolled. These meta-analyses showed women with endometriosis have an increased risk of preterm birth (odds ratio, 1.473; 95% confidence interval, 1.216 to 1.785). Conclusion These meta-analyses demonstrate women with endometriosis at pregnancy have an increased risk of preterm birth. Therefore, it is worthy for obstetrics to increase the careful inspection in women with endometriosis during pregnancy.

P18.15: The usefulness of ovarian volume using 3D vocal transvaginal ultrasound, antral follicle count and age as predictors of menopause in pre- and postmenopausal women

rate of 96.8% (120/124). The patients did not found the procedure especially uncomfortable or painful and reported a high rate of satisfaction (97.3%). There were 3 patients with complications (1.6%). 2 vagal reactions just after the procedure with a quick recovery, and 1 pelvic inflammatory disease treated with antibiotics for a week. Conclusion: Ultrasound-guided extraction of lost intrauterine devices is a simple and safe procedure that may be performed before more invasive measures are attempted.

Pulmonary embolism and deep vein thrombosis related to oral contraceptive use

Pulmonary embolism (PE) and deep vein thrombosis (DVT) is a serious medical problem causing considerable morbidity and mortality. Risk factors of thrombosis are surgery, trauma, pregnancy, tumor, oral contraceptive as well as genetic risk factors though genetic risk factors were found in about 5% to 10% of cases. Yasmin, a combined oral contraceptive containing ethinylestradiol 30 µg and drospirenon 3 mg was launched in the United Kingdom in 2002. We had experienced a patient, 24-year-old young woman with left inguinal pain on ambulation, and edema of left leg four months after taking Yasmin. We performed chest pulmonary angiography computed tomography (CT) and lower extremity venogram CT. She was diagnosed to PE in both lower lobes and DVT below the level of left external iliac vein, and treated by low molecular weight heparin and warfarin. We report this case with brief review of literatures.

A case of vaginal delivery in β-thalassemia minor pregnant woman

The thalassemias are a group of autosomal recessive genetic disorders of hemoglobin synthesis. The thalassemias are classifi ed into two main varieties, αand β-, depending on which of the adult globin chain is produced in reduced amounts. The β-thalassemia is the homozygous and heterozygous state, and common in the Mediterranean region. Homozygous β-thalassemia is usually associated with severe anemia. β-Thalassemia minor, the heterozygous state, is characterized by hypochromia, microcytosis and an elevated of HgA2. No treatment is required for thalassemia minor, but it is important to exclude iron defi ciency anemia and postpartum genetic counseling. Recently, β-thalassemia minor keeps rising steadily in Korea due to the increase in international marriges. Recently we have experienced a vaginal delivery in a β-thalassemia minor Vietnam woman associated with mild anemia. We describe this case with a brief review of the literature.

A CASE OF LAPAROSCOPIC TREATMENT OF THE RETROPERITONEAL ECTOPIC PREGNANCY

자궁외임신은 전체 임신의 약 2%를 차지하며, 임신 초기 임신과 관련된 사망률의 대부분을 차지한다. 초기 진단은 주로 베타 사람 융모생식샘 자극호르몬 검사와 초음파로 이루어진다. 난관에 발생하는 빈도가 가장 많고, 그 다음 간질부, 자궁각, 난소, 자궁경부, 제왕절개부위, 그리고 복강에도 발생한다. 후복막에 발생하는 자궁외임신은 매우 드물어, 대개 3,372에서 7,931분만당 1예의 발생빈도를 보이며, 수술 전 진단은 매우 어려우며, 치료는 수술적 제거이다. 내원 3주 전 무월경 5주에 소파수술 후, 갑작스런 질 출혈로 내원한 26세 여성에서 자궁외임신으로 진단 후 메토트렉세이트 다회 요법을 시행 후 실패하여 복강경 통해 후복막에 착상된 자궁외임신으로 최종 진단하여 치료한 매우 드문 예를 경험하여 간단한 문헌 고찰과 함께 보고하는 바이다.

P49.01: Three‐dimensional (3D) volume measurement of the cervix from 8 weeks to 41 weeks' gestation compared to conventional transvaginal cervical length and width

Objectives: To assess the feasibility and diagnostic criteria for vaginal and uterine fistulas using transvaginal pelvic sonography and color Doppler. Methods: We report on nine consecutive cases of vaginal and uterine fistulas (four rectovaginal, three vesicovaginal and two vesicouterine) diagnosed by transvaginal pelvic ultrasound and color Doppler between January 1996 and February 2006. Results: Diagnosis and localization of the fistulas were performed sonographically and confirmed using standard physical, rentgenographic and/or cystoscopic techniques. Seven cases were treated surgically and two were treated conservatively. All treated cases were successful (Table). Sonographic criteria for vesicovaginal fistulas included: (1) delineating a defect in the bladder and vaginal walls, (2) demonstrating passage of urine through the fistula tract (jet phenomenon) using colored Doppler with back flow (from the vagina back to the bladder) upon mechanical compression of the transducer. Criteria for rectovaginal fistulas included a defect in the rectal wall, and visualization of air bubbles passing through the fistula tract.

Women with Endometriosis, Especially Those Who Conceived with Assisted Reproductive Technology, Have Increased Risk of Placenta Previa: Meta-analyses

Background Many women with endometriosis have become pregnant through assisted reproductive technology (ART), and have often experienced placenta previa (PP) during pregnancy. The objective of this study was to assess the association between women with endometriosis, especially those who conceived with ART, and the risk of PP. Methods Two reviewers independently determined studies that were considered suitable for meta-analyses published in various medicine-related databases from March 1, 2004 through July 31, 2017 without language restrictions. Eight studies met the inclusion criteria, with a combined sample size of 21,930 women. Of these 21,930 pregnancies, 6,256 had endometriosis (endometriosis) and 15,674 had no endometriosis. Four of these studies included 8,161 women who conceived with ART, 1,640 of whom had endometriosis (endometriosis + ART), and 6,521 of whom did not have endometriosis. Meta-analyses were estimated with odds ratios (ORs) and 95% confidence intervals (CIs) using random effect analysis according to heterogeneity of studies. Results These meta-analyses showed women with endometriosis (endometriosis) have an increased risk of PP (OR, 4.038; 95% CI, 2.291–7.116; P = 0.000). These results showed women who conceived with ART (endometriosis + ART), have a substantially increased risk of PP (OR, 5.543; 95% CI, 1.659–18.523; P = 0.005). Conclusion These meta-analyses demonstrate women with endometriosis have an increased risk of PP.

A Case of Granular Cell Tumor of the Clitoris in a Postmenopausal Woman

Granular cell tumor (GCT) is a rare soft tissue tumor that derived from Schwann cells. Most are benign, less than 2% are malignant and, in the malignant cases, the prognosis of survival is poor. Most of these tumors are less than 3 cm in size, and they are more common in black women. The disease usually occurs in the 40s to the 60s and occurs after menopause, but there are few cases reported in adolescence. A 45-year-old woman visited the outpatient clinic with a solid mass that developed 2 years ago and present to date on the left side of the clitoris. After complete resection, pathologic examination proved to be a granular cell. The patient has been living without recurrence for one year. We report the first case of the GCT of the clitoris in postmenopausal woman in Korea with a brief review of the literature.

A case of ruptured gravid uterus at 35 weeks' gestation after cornual resection

임신 중 자궁파열은 드물게 발생하지만, 모성 및 태아사망까지 초래할 수 있는 치명적인 산과적 응급 질환이다. 파열부위의 출혈이 가장 흔한 합병증으로, 자궁파열 시 사망률은 파열 진단시기와 즉각적인 수술에 달려 있기 때문에 자궁파열을 의심할 수 있는 이러한 증상과 징후를 보이는 경우에는 신속한 진단과 처치가 필요하다. 이러한 자궁파열의 가장 흔한 원인은 기존의 제왕절개술 반흔의 파열이며, 다른 원인으로는 태위이상, 분만 2기의 난산, 유도분만, 무통분만, 조기분만과 42주 이후 분만 등이 있다. 저자들은 1년 전 자궁각절제술 시행 후 임신 35주에 조기진통 치료 중 발생한 자궁파열을 경험하여 보고하는 바이다.