Uterine artery embolization was introduced to arrest post-partum hemorrhage 20 years ago. It has also been used to control severe hemorrhage from uterine gestational trophoblast tumors, carcinoma of the uterus, uterine arteriovenous malformations, and cases of pelvic trauma. More recently, transcatheter uterine artery embolization is a new treatment for uterine leiomyoma. A 33-year old married woman with 2 children had a history of heavy pelvic pain and pressure. Ultrasound and MRI investigation showed a bulky 12 x 10cm submucosal myoma in right lower uterine segment. The both uterine artery embolization was performed via a bilateral femoral artery. We present a case in which successful embolization of the uterine arteries in a woman with submucosal myoma resulted in a subsequent transcervical expulsion of large pieces of the dominant fibroid after 3 month of treatment with a brief review.
Adult ; Arteriovenous Malformations ; Child ; Female ; Femoral Artery ; Hemorrhage ; Humans ; Leiomyoma ; Magnetic Resonance Imaging ; Myoma* ; Pelvic Pain ; Trophoblastic Neoplasms ; Ultrasonography ; Uterine Artery Embolization* ; Uterine Artery* ; Uterus

OBJECTIVE: Since the management of pregnancy is gestational age dependent, accurate knowledge of the dating of gestational age is essential. The gestational age calculation system(GACS) was made to get a precise informations of exact gestational age of pregnant mothers. METHODS: Using the personal computer and Microsoft Visual Basic soft ware, the GACS program was made to meet obstetrician's desire. This program is designed and embodied to calculate gestational age controlling many variables such as last menstrual period(LMP), expectant date of confinement(EDC), gestational age on the calculating date, ultrasonographical gestational age, and conceptional date. RESULTS: The accurate gestational age was displayed by GACS according to various input data. The work sheet of whole gestational age can be printed by GACS. CONCLUSION: The GACS is a tool to calculate gestational age of pregnant mothers precisely. This can be used very conveniently and informatively by obstetric clinicians. We recommend this program for the members of perinatologists and obstetricians.
Gestational Age* ; Humans ; Microcomputers* ; Mothers ; Pregnancy

Using 3D ultrasound, bilateral chylothorax was diagnosed antenatally in the second trimester. Apparently stable, bilateral pleural effusion progressed rapidly to severe hydrops with facial edema during observation, and then we decided bilateral pleural-amniotic shunt operation. Here we present a case where drainage of pleural effusion by a double reverse pig tail stent made by ourself was achieved, although placement of the thoracoamniotic shunt resulted in near complete drainage of bilateral pleural effusion with normalization of intrathoracic anatomic relationships, subsequent resolution of fetal hydrops, but the ultimate outcome was unsuccessful due to the internalization of one catheter and unknown sudden death. We think that ongoing research is required to further evaluation about complications associated with this procedure, specifically failure of function due to obstruction, migration of the catheter,
Catheters ; Chylothorax* ; Death, Sudden ; Drainage ; Edema ; Female ; Humans ; Hydrops Fetalis ; Pleural Effusion ; Pregnancy ; Pregnancy Trimester, Second ; Stents ; Tail ; Ultrasonography

OBJECTIVE: A Clinical Study of Placenta P#revia done by cesarean section and the study of preterm delivery that is major cause of premature motality even thought expected managment of placente previa. METHODS: This study was evaluated for the clinical analysis on the 641 patients with placenta previa among total deliveries of 56,120 cases at the St. Mary and Holy Family hospital of Catholic University from Jan. 1,1989 to Dec.31,1997. RESULTS: The following results were obtained: 1. The total incidence of placenta previa was 1.14%. 2. The incidence of placenta previa increases with age. 3. Placenta previa has occurred more often in multipara(60.2%) than primipara(39.8%), and placenta previa has occurred more often in women who had experienced abortion(71.8%) than women who hadnt(28.2%). 4. The types of placenta previa distributed 326 cases of totalis(50.9%), 110 cases of partialis(17.2%), 99 cases of marginal(15.4%) and 106 cases of low lying placenta(16.4%). 5. The fetal presentation distributed 557 cases of vertex(86.9%), 49 cases of breech(7.6%), 28 cases of transverse lie(4.4%). 6. The types of uterine incision included 543 cases of low sepnent transverse incision(84.7%), 46 cases of classical incision(7.2%), 9 cases of inverted T incision and 43 cases of cesarean hysterectomy(6.7%). 7. Premature delivery of placenta previa prior to completion of 37 weeks was 186 cases(29.0%) and low birth infant less than 2,500gm was 128 cases(20.0%).and perinatal mortality rate was 28.0 per 1,000. 8. During delivery, 278 cases of placenta previa(43.4%) were transfused with mean 3.6 pints. Incidence of vaginal bleeding was 49.3% of placenta previa,mean admission day until delivery was about 5 day. CONCLUSION: there is a strong association between advancing age and incidence of placenta previa, and then. the risk increases with parity & the number of abortion. Considering the mean volume of blood loss more than 3 pints of blood should be prepared befor delivery.
Cesarean Section ; Deception ; Female ; Humans ; Incidence ; Infant ; Labor Presentation ; Parity ; Parturition ; Perinatal Mortality ; Placenta Previa* ; Placenta* ; Pregnancy ; Uterine Hemorrhage

OBJECTIVE: This study was designed to detect genes specifically expressed in severe preeclamptic placentas. METHODS: Placenta tissues were collected immediately after delivery from 5 preeclamptic patients and 5 normal pregnant women. Total RNAs of each placenta were extracted and hybridized for a cDNA microarray. Of the microarray data, four up-regulated genes (DSCR4, GPA, PCDHGB1, Hemogen) and four down-regulated genes (IL1R2, MGST1, GAS1 GREB1) were selected and reverse transcriptase-polymerase chain reaction was used to confirm the results of cDNA microarray. RESULTS: The expression fold for each up-regulated gene was 2.2 times for DSCR4, 2.7 times for PCDHGB1, 3.5 times for Hemogen, 5.2 times for GPA on the cDNA microarray. The expression fold for each down-regulated gene was 3.3 times for IL1R2, 4.2 times for MGST1, 4.9 times for GAS1 and 2.3 times for GREB1 on the cDNA microarray. The expression fold for each up- regulated gene was 5.21 times for DSCR4, 3.01 times for PCDHGB1, and 4,53 times for Hemogen and 2.2 times for GPA on RT-PCR. The expression fold for each down-regulated gene was 2.7 times for IL1R2, 2.22 times for MGST1, 2.53 times for GAS1 and 1.83 times for GREB1 on the RT-PCR. CONCLUSION: DSCR4, PCDHGB1, Hemogen and GPA as the up-regulated genes and IL1R2, MGST1, GAS1 and GREB1 as the down-regulated genes, which were found and selected by the cDNA microarray, might be considered to be novel biomarkers for preeclampsia.
Biomarkers ; Chimera ; Female ; Gene Expression ; Humans ; Microarray Analysis ; Oligonucleotide Array Sequence Analysis ; Placenta ; Pre-Eclampsia ; Pregnant Women ; RNA

We present two cases of acute interstitial pneumonia (AIP) during the second trimester of pregnancy managed by mechanical ventilation, high dose corticosteroids. We described clinical course, laboratory data and imaging studies. Case 1) A 29-year-old woman, G1P1, was referred for aggravated continuous coughing, sputum and dyspnea, pleuritic chest pain and mild fever for 3 weeks at 24(+3) weeks of gestation. There were coarse breathing sounds with crackles on the both lung field. Her chest X-ray showed diffuse haziness in both lungs with suspicious nodular opacities and suggested pneumonia. HRCT showed diffuse ground glass opacities with interstitial thickening and suspicious fine nodular infiltration in both lungs suggesting acute interstitial pneumonia combined with ARDS. Because her symptoms were more aggravated, she was performed mechanical ventilation treatment. After that, she was performed cesarean hysterotomy and delivered a dead male 850grams. After her symptoms were much more improved. All antibiotics were stopped and reduced the doses of steroids, she was discharged with t-tube capped state. Case 2) A 33-year-old woman, G1P1, was referred for continuous coughing, sputum and dyspnea for 3 months and low abdominal discomfort at 24(+4) weeks of gestation. There were coarse breathing sounds with rales on the both lung field. Her chest X-ray showed diffuse haziness in both lungs with suspicious nodular opacities and suggested interstitial pneumonia. HRCT showed diffuse ground glass opacities with some intralobular and interlobular interstitial thickening and suspicious fine nodular infiltration in both lungs suggesting acute interstitial pneumonia or miliary TBc combined with ARDS. She was treated with antibiotics, oxygen, high dose corticosteroids, and tocolytics. There was no evidence of TBc in the bronchoscopy. She showed decreased mentality and decreased O2 saturation below 90% in spite of mechanical ventilation, high dose steroids and IVGV therapy. She delivered a boy of 870 g (Apgar score 1/5). After delivery, she was expired due to combined aggravating DIC. Her baby was expired at the next day, too. The outcome of AIP is fatal, reporting 59~100% mortality rate. The clinical course, laboratory data and treatment are not well established due to rarity of this disease entity. Chest X-ray and HRCT may be helpful in diagnosis and high dose steroid and immunosuppressive agents usually used but the efficacy is not guaranteed.
Adrenal Cortex Hormones ; Adult ; Anti-Bacterial Agents ; Bronchoscopy ; Chest Pain ; Cough ; Dacarbazine ; Diagnosis ; Dyspnea ; Female ; Fever ; Glass ; Humans ; Hysterotomy ; Immunosuppressive Agents ; Lung ; Lung Diseases, Interstitial* ; Male ; Mortality ; Oxygen ; Pneumonia ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy* ; Respiration, Artificial ; Respiratory Sounds ; Sputum ; Steroids ; Thorax ; Tocolytic Agents

PURPOSE: To determine the means, medians and reference intervals for TSH (thyroid-stimulating hormone) and fT4 (free thyroxine) for each month of gestation and for three trimesters in Korean pregnant women. METHODS: Serum samples were collected from 265 pregnant women with singleton gestation. Levels of TSH, fT4 were measured by immunoassay. After exclusion of subjects with positive antimicrosomal autoantibodies, the means, medians and reference intervals based on 2.5th and 97.5th percentiles for TSH, fT4 were determined. RESULTS: The study population consisted of 94 women in first trimester, 49 women in second trimester, and 122 women in third trimester. The trimester-specific reference intervals were: TSH (1st trimester: 0.03~2.72, 2nd: 0.27~2.29, and 3rd: 0.03~2.88 mIU/L), fT4 (1st trimester 4.50~19.75, 2nd: 4.70~12.98 and 3rd: 5.07~11.84 pg/mL). fT4 levels were significantly lower in the second and third trimesters. TSH levels were lower in the first trimester than second and third trimester, with gradual elevation in the second and third trimester. CONCLUSION: Levels of TSH, fT4 during pregnancy differ from those in non-pregnant women. Gestational age specific reference intervals will play a cental role in screening and diagnosis of thyroid disorders. Further studies for normal reference ranges during pregnancy are needed to create reference intervals in Korean pregnant women.
Autoantibodies ; Female ; Gestational Age ; Humans ; Immunoassay ; Mass Screening ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Pregnant Women ; Reference Values ; Thyroid Function Tests ; Thyroid Gland ; Thyrotropin

OBJECTIVE: To evaluate the efficacy and predictors of success of methotrexate (MTX) treatment in selected cases of unruptured tubal pregnancies. METHODS: This study was retrospectively performed in 36 women who had diagnosed unruptured tubal pregnancies. Patients received intramuscular MTX. Serial beta-hCG measurement was performed weekly, and success was defined as the achievement to beta-hCG concentration of 10 mIU/mL without surgical intervention. Surgical intervention was performed for presumed tubal rupture. Pretreatment serum concentration of beta-hCG, the size of tubal mass and gestational sac by transvaginal ultrasonography were measured to evaluate the predictors of MTX therapy. RESULTS: 29 patients (81%) were successfully treated by MTX systematic treatment. There were not significant differences in the patient's age, parity, gestational age and the size of tubal ectopic mass, but significant differences in the gestational sac size and serum beta-hCG concentration between success group and failure group of MTX treatment. The mean time for achieving successful treatment was 33.8 days. The success rate of systemic MTX was significantly decreased and resolution time was prolonged if the initial pretreatment serum beta-hCG was 10,000 mIU/mL or gestational sac size was >or=1 cm. CONCLUSION: Pretreatment serum beta-hCG concentration and gestational sac size are important predictors of success of MTX treatment in women with unruptured tubal pregnancy.
Female ; Gestational Age ; Gestational Sac ; Humans ; Methotrexate* ; Parity ; Pregnancy ; Pregnancy, Ectopic* ; Pregnancy, Tubal ; Retrospective Studies ; Rupture ; Ultrasonography

OBJECTIVE: This study was performed to prove the significance of the oligohydramnios in the intrauterine growth restriction. METHODS: Eighty two patients were identified to have intrauterine growth restriction with oligohydramnios (Group of IUGR+Oligihydramnios) and fifty six patients were identified to have intrauterine growth restriction without oligohydramnios (Group of IUGR) on ultrasound examination from January 1st, 2005 to December 31st, 2007 at St. Vincent Hospital of Catholic University of Korea. Perinatal outcomes were compared between two groups. RESULTS: Statistically significant differences were not shown between two groups in the maternal characteristics and fetal clinical features except amniotic fluid index and the duration between diagnosis and delivery. The incidence of hyperbilirubinemia and complications in the urogenital system were significantly increased in the group of IUGR+ Oligihydramnios. The other complications were not shown significant difference between two groups. CONCLUSION: Oligohydramnios may not seem to be significant predictor of adverse neonatal outcome of IUGR except the development of hyperbilirubinemia and urogenital complications.
Amniotic Fluid ; Female ; Fetal Growth Retardation ; Humans ; Hyperbilirubinemia ; Incidence ; Korea ; Oligohydramnios ; Pregnancy ; Urogenital System

OBJECTIVE: The ovine fetus responds to hemorrhage with a 10-20 fold increase in plasma erythropoietin (EPO) concentration at 24 hr and a return toward normal at 48 hr after the hemorrhage. The objective of the present study was more accurately to compare the magnitude and time course of the plasma EPO response after fetal hemorrhage. METHODS: Chronically catheterized, 12 of late gestation ovine fetus were gradually hemorrhaged 40% of their blood volume over 2 hr (1ml/min). Plasma was sampled for EPO concentration at 1, 2, 3, 4, 6, 8, 10, 12, 16, 20, 24, 30, 36 hr after initiating the hemorrhage were collected at these times. Radioimmunoassay was used to measure plasma EPO concentrations. Analysis of variance was used for statistical analysis. RESULT: After a slow hemorrhage in the ovine fetus (1ml/min over 2hr), plasma EPO concentration increased significantly at 4hr (2.3 times basal values), reached a maximum at 16 hr (33.3 times basal values), and declined thereafter. CONCLUSION: We studied change in time course of the fetal plasma EPO after slow hemorrhage and recent studies have shown that the fetal kidney, liver and placenta express EPO mRNA. These observation suggest that plasma EPO increase may be mediated by a tissue specific up-regulation of EPO transcription in the fetal kidney, liver and placenta. We have studied change in Epo mRNA expression in various fetal tissue after slow haemorrhage.
Blood Volume ; Catheters ; Erythropoietin* ; Fetus ; Hemorrhage* ; Kidney ; Liver ; Placenta ; Plasma* ; Pregnancy ; Radioimmunoassay ; RNA, Messenger ; Sheep ; Up-Regulation