OBJECTIVE: The purpose of this study was to evaluate the outcome and safety of vaginal delivery after previous cesarean birth. METHODS: This study was based on 303 cases of delivery with previous cesarean birth at Masan, Fatima Hospital from May, 1997 to April, 1998. Among them, 62 cases had performed trial of labor. We had made a comparison between elective repeat section group and trial of labor group by analizing the frequency, successful rate, maternal morbidity, perinatal morbidity and mortality. RESULTS: Among 303 cases with previous cesarean birth, trial of labor was done in 62 cases(20.5%). Among trial of labor group, vaginal delivery was done in 54 cases (87.1%) and repeat section was done in 8 cases(12.9%). Indications for elective repea section before the onset of labor were refuse trial of labor(51.9%), request for tubal ligation(17.4%), and previous section > or =2(7.5%), etc. The successful rate of vaginal delivery according to indication for previous cesarean birth was 85.0%(17/20) in the cases of dystocia and 88.1%(37/42) in the cases except dystocia. The successful rate was not influenced by the indication for previous cesarean birth(P>0.05). There were no maternal death or uterine rupture in the cases of trial of labor. There were no significant difference between elective repeat section group and trial of labor group in maternal morbidity, perinatal morbidity and mortality(P>0.05). CONCLUSION: Under strict indications, vaginal delivery subsequent to cesarean birth may be safe, and can reduce the rate of cesarean section that was increased constantly.
Apgar Score ; Cesarean Section ; Dystocia ; Eclampsia* ; Female ; Fetal Distress ; Fetus ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Maternal Death ; Mortality ; Parturition ; Parturition* ; Perinatal Mortality ; Pre-Eclampsia* ; Pregnancy ; Premature Birth ; Respiration, Artificial ; Rheology ; Trial of Labor ; Umbilical Arteries* ; Uterine Rupture

OBJECTIVES: The purpose of this study was to evaluate the efficacy and safety of magnesium sulfate and ritodrine hydrochloride in the management of preterm labor. METHODS: This study was undertaken to assess the clinical efficacy & safety of magnesium sulfate and ritodrine hydrochloride on 120 patients admitted with preterm labor from Jul. 1, 1996 to Dec. 31, 1998. RESULTS: 1. The incidence of preterm labor was showed 6.0~7.7% of total number of delivery. 2. The risk factors of the preterm labor were premature rupture of membrane, severe preeclampsia, previous preterm delivery, twin pregnancy, placenta previa, fetal anomaly, incompetent cervix, placental abruption, and uterine myoma in order, but 28.6% of preterm labor had no apparent risk factors. 3. The days gained in uterus was not statistically different between the magnesium sulfate group and the ritodrine group (p<0.05) but longer in the two groups than the control group. And the delivery time was also not statistically different between the magnesium sulfate group and the ritodrine group (p<0.01) but significantly increased in the two groups than the control group. 4. The rate of complete and incomplete success was similar as 12.5% and 35% (total success rate 47.5%) in the magnesium sulfate group, 7.5% and 45% (total success rate 52.5%) in the ritodrine group but only 2.5% and 27.5% (total success rate 30%) was showed in the control group. 5. The side effects were much more in the ritodrine group than the magnesium sulfate group. The patients requiring second-line therapy were similar in the both groups but the main cause was uncontrolled uterine contraction in the magnesium sulfate group, and intolerable side effects in the ritodrine group. 6. The pulse rate was not statistically different in magnesium sulfate group but markedly increased in ritodrine group (p<0.05). After managements of preterm labor, the serum potassium and ionized calcium level was significantly decreased in the two groups (p<0.05, p<0.01). CONCLUSION: There was not significantly different efficacy and safety of magnesium sulfate and ritodrine hydrochloride in the management of preterm labor.
Abruptio Placentae ; Calcium ; Female ; Heart Rate ; Humans ; Incidence ; Leiomyoma ; Magnesium Sulfate* ; Magnesium* ; Membranes ; Obstetric Labor, Premature* ; Placenta Previa ; Potassium ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Twin ; Risk Factors ; Ritodrine* ; Rupture ; Uterine Cervical Incompetence ; Uterine Contraction ; Uterus

In acquired immunodeficiency syndrome (AIDS) patients, immune reconstitution inflammatory syndrome (IRIS) due to Mycobacterium avium complex (MAC) infection is one of the most difficult IRIS types to manage. We report an unusual case of MAC-associated IRIS. At first the patient was diagnosed human immunodeficiency virus (HIV) infection after he was admitted with pneumocystis pneumonia. After starting antiretroviral therapy he presented unmasked IRIS with MAC infection. Next, he was hospitalized with continuous loose stools and new-onset fever. Investigation included computed tomography (CT), which showed homogeneous enhancement and enlargement of the lymph nodes (LN), elevation of ferritin (>1,650 ng/mL) and lactate dehydrogenase (306 IU/L) levels, and F- fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan, which showed increased FDG uptake. These findings were highly indicative of lymphoma. We performed laparoscopic biopsy of the mesenteric LN, and the biopsy culture grew MAC. So we made a diagnosis of MAC-associated. Therefore, IRIS must be considered as a possible diagnosis when AIDS patients develop new symptoms or exhibit exacerbations of existing symptoms. Furthermore the biopsies should be conducted.
Acquired Immunodeficiency Syndrome ; Biopsy ; Diagnosis ; Electrons ; Ferritins ; Fever ; HIV ; Humans* ; Immune Reconstitution Inflammatory Syndrome* ; Iris ; L-Lactate Dehydrogenase ; Lymph Nodes ; Lymphoma* ; Mycobacterium avium Complex* ; Mycobacterium avium* ; Mycobacterium* ; Pneumonia, Pneumocystis

In acquired immunodeficiency syndrome (AIDS) patients, immune reconstitution inflammatory syndrome (IRIS) due to Mycobacterium avium complex (MAC) infection is one of the most difficult IRIS types to manage. We report an unusual case of MAC-associated IRIS. At first the patient was diagnosed human immunodeficiency virus (HIV) infection after he was admitted with pneumocystis pneumonia. After starting antiretroviral therapy he presented unmasked IRIS with MAC infection. Next, he was hospitalized with continuous loose stools and new-onset fever. Investigation included computed tomography (CT), which showed homogeneous enhancement and enlargement of the lymph nodes (LN), elevation of ferritin (>1,650 ng/mL) and lactate dehydrogenase (306 IU/L) levels, and F- fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan, which showed increased FDG uptake. These findings were highly indicative of lymphoma. We performed laparoscopic biopsy of the mesenteric LN, and the biopsy culture grew MAC. So we made a diagnosis of MAC-associated. Therefore, IRIS must be considered as a possible diagnosis when AIDS patients develop new symptoms or exhibit exacerbations of existing symptoms. Furthermore the biopsies should be conducted.
Acquired Immunodeficiency Syndrome ; Biopsy ; Diagnosis ; Electrons ; Ferritins ; Fever ; HIV ; Humans* ; Immune Reconstitution Inflammatory Syndrome* ; Iris ; L-Lactate Dehydrogenase ; Lymph Nodes ; Lymphoma* ; Mycobacterium avium Complex* ; Mycobacterium avium* ; Mycobacterium* ; Pneumonia, Pneumocystis