We present a case of complete vaginal stenosis in a woman diagnosed with Sheehan’s syndrome. The patient delivered at full-term 5 months prior, and experienced massive postpartum bleeding at that time. During evaluation of persistent amenorrhea, we found that her vaginal orifice was completely adhesive and obstructed. Prior to corrective surgery, we managed the patient with an oral contraceptive to induce uterine bleeding into the vaginal outflow tract. After three cycles of an oral contraceptive, we could confirm that there was no stenotic lesion in the vaginal cavity as a hematocolpos was created. Adhesiolysis with scar revision for the vaginal stenosis was successfully performed; it was found that the lesion was limited to only the distal part of the vaginal outlet. Complete vaginal stenosis in reproductive age women with hypopituitarism has not been reported. The artificial induction of hematometrocolpos before surgery was useful in determining the extent of the stenotic lesion, and assured safety.
Adhesives ; Amenorrhea ; Cicatrix ; Constriction, Pathologic* ; Female ; Hematocolpos ; Hemorrhage ; Humans ; Hypopituitarism ; Postpartum Period ; Uterine Hemorrhage

Stem cells are undifferentiated cells capable of self-renewal and differentiation into various cell lineages. Stem cells are responsible for the development of organs and regeneration of damaged tissues. The highly regenerative nature of the human endometrium during reproductive age suggests that stem cells play a critical role in endometrial physiology. Bone marrow-derived cells migrate to the uterus and participate in the healing and restoration of functionally or structurally damaged endometrium. This review summarizes recent research into the potential therapeutic effects of bone marrow-derived stem cells in conditions involving endometrial impairment.
Bone Marrow ; Cell Lineage ; Endometrium* ; Female ; Humans ; Physiology ; Regeneration* ; Stem Cells* ; Therapeutic Uses ; Uterus

Endometriosis is defined by the presence of extrauterine endometrial tissue and presents with symptoms of dysmenorrhea, chronic pelvic pain, and impaired fertility. This condition often follows a chronic progressive course with favorable recurrence, even after surgical or medical treatment. The etiology or exact pathophysiology of endometriosis remains to be clarified, although it is thought to be a complex and multifactorial disease. Prior epidemiological or population-based studies have reported several risk factors related to endometriosis, such as environmental, menstrual, habitual, and lifestyle factors. Moreover, anthropometry has been found to be significantly associated with the diagnosis of endometriosis, as a lower body mass index is associated with an elevated risk of endometriosis. Here, we review studies that have examined the association between body size and the risk of endometriosis and discuss the clinical and biological significance of the relationship between adiposity and endometriosis.

Endometriosis is characterized by the implantation of endometrial cells outside the uterus. This hormone-dependent disease is highly prevalent among women of reproductive age. Clinical symptoms of endometriosis include dysmenorrhea, pelvic pain, and infertility, which can negatively impact the overall quality of life of those affected. The medical treatment of endometriosis serves as an important therapeutic option, aimed at alleviating pain associated with the condition and suppressing the growth of endometriotic lesions. As such, it is employed as an adjuvant therapy following surgery or an empirical treatment after the clinical diagnosis of endometriosis. Dienogest, a fourth-generation progestin, has received approval for the treatment of endometriosis in many countries. A growing body of evidence has demonstrated its efficacy in managing endometriosis-associated pain, preventing symptoms, and reducing lesion recurrence. In this review, we examine the clinical efficacy, safety, and tolerability of dienogest in treating endometriosis. We also provide updated findings, drawing from clinical studies that focus on the long-term use of this medication in patients with endometriosis.

Although listeria monocytogenes is widely distributed in nature, it rarely causes clinical infection in previously healthy people. However, this microorganism may cause severe infectious disease in pregnant women and newborns due to impaired cell-mediated immunity. Various clinical symptoms have been described such as sepsis, central nervous system infections, endocarditis, gastroenteritis and localized infections. A clinical presentation of listeriosis in an early third trimester pregnant woman and in a preterm infant is emphasized in addition to taking a careful patient history, early empirical administration of antibiotics, aggressive ventilation therapy and also pharmacological support.
Anti-Bacterial Agents ; Central Nervous System Infections ; Communicable Diseases ; Endocarditis ; Female ; Gastroenteritis ; Humans ; Immunity, Cellular ; Infant, Newborn ; Infant, Premature ; Listeria monocytogenes ; Listeriosis* ; Pregnancy ; Pregnancy Trimester, Third* ; Pregnant Women* ; Sepsis ; Ventilation

OBJECTIVE: The objective of this study is to report outcomes of apical and posterior pelvic organ prolapse repair using posterior transvaginal mesh kit. METHODS: Thirty four consecutive patients with apical or posterior pelvic organ prolapse over pelvic organ prolapse quantification (POP-Q) stage 2 were repaired by posterior transvaginal mesh kit at the Korea University Guro Hospital between July 2007 and June 2011. Postoperative follow-up visits were scheduled at 1, 6 months after surgery, with question about side effects and POP-Q exam. RESULTS: Thirty four consecutive patients who underwent posterior transvaginal mesh kit had completed 6 month follow up. The demographics are the mean age 65.9+/-8.6 years, the mean body mass index 26.4+/-3.0 kg/m2 and the mean parity 3.6+/-1.5. Overall anatomic cure rates of apical pelvic organ prolapse and rectocele were 91.7%, 92.6%, respectively. The Ap, Bp scores improved significantly after operation (p<0.01). No patient presented healing abnormality. CONCLUSION: Posterior transvaginal mesh kit is effective and safe for treatment of apical and posterior pelvic organ prolapse.
Body Mass Index ; Demography ; Female ; Follow-Up Studies ; Humans ; Korea ; Parity ; Pelvic Organ Prolapse ; Rectocele

Abnormal attachment of the placenta (Placenta accreta, increta, and percreta) is an uncommon but potentially lethal cause of maternal mortality from massive postpartum hemorrhage. A 33-yr-old woman, who had been diagnosed with a placenta previa, was referred at 30 weeks gestation. On ultrasound, a complete type of placenta previa and multiple intraplacental lacunae, suggestive of placenta accreta, were noted. For further evaluation of the placenta, pelvis MRI was performed and revealed findings suspicious of a placenta increta. An elective cesarean delivery and subsequent hysterectomy were planned for the patient at 38 weeks gestation. On the day of delivery, endovascular catheters for balloon occlusion were placed within the hypogastric arteries, prior to the cesarean section. In the operating room, immediately after the delivery of the baby, bilateral hypogastric arteries were occluded by inflation of the balloons in the catheters previously placed within. With the placenta retained within the uterus, a total hysterectomy was performed in the usual fashion. The occluding balloons were deflated after closure of the vaginal cuff with hemostasis. The patient had stable vital signs and normal laboratory findings during the recovery period; she was discharged six days after delivery without complications. The final pathology confirmed a placenta increta.
Adult ; Arteries/*surgery ; *Catheterization ; Cesarean Section ; Female ; Gestational Age ; Humans ; Hysterectomy/*methods ; Placenta/*blood supply/ultrasonography ; Placenta Accreta/*surgery/ultrasonography ; Placenta Previa/*surgery/ultrasonography ; Postpartum Hemorrhage/*prevention & control ; Pregnancy ; Treatment Outcome

Purpose: This study aimed to investigate the perceptions and behaviors of Korean women of reproductive age in regards to contraception counseling. Materials and Methods: The study sample was collected in Korea and comprised 1011 women aged 20–44 years and 150 obstetrics and gynecology (OB/GYN) doctors. Participants completed online questionnaires assessing their current methods of contraception, knowledge of and satisfaction with contraceptive methods, and willingness to learn about and use other contraceptive methods. Results: Women used condoms (74.2%), natural methods (cycle control or withdrawal, 52.4%), and combined oral contraceptives (COCs) (36.9%) more frequently than long-acting reversible contraception (LARC) methods, such as hormone-releasing intrauterine system (IUS) (4.5%), copper-intrauterine devices (3.3%), and subdermal implants (1.4%). Although the proportion of women who used LARC was low, those who used hormone-releasing IUS or subdermal implants reported high levels of satisfaction. The findings revealed discordant results between women and OB/GYN doctors regarding the initiation and quality of information provided by doctors about contraception and overall satisfaction with counseling. Most women (83.1%) expressed a desire to have more information about various contraceptive methods. More than 60% of women reported a willingness to use LARC, such as hormone-releasing IUS or subdermal implants, when provided with detailed information in counseling. Conclusion The majority of Korean women are familiar with condoms and natural methods, but lack knowledge about alternative contraceptive methods, including LARC. Women who used LARC reported higher levels of satisfaction than those who used other methods.

Purpose: This study aimed to investigate the perceptions and behaviors of Korean women of reproductive age in regards to contraception counseling. Materials and Methods: The study sample was collected in Korea and comprised 1011 women aged 20–44 years and 150 obstetrics and gynecology (OB/GYN) doctors. Participants completed online questionnaires assessing their current methods of contraception, knowledge of and satisfaction with contraceptive methods, and willingness to learn about and use other contraceptive methods. Results: Women used condoms (74.2%), natural methods (cycle control or withdrawal, 52.4%), and combined oral contraceptives (COCs) (36.9%) more frequently than long-acting reversible contraception (LARC) methods, such as hormone-releasing intrauterine system (IUS) (4.5%), copper-intrauterine devices (3.3%), and subdermal implants (1.4%). Although the proportion of women who used LARC was low, those who used hormone-releasing IUS or subdermal implants reported high levels of satisfaction. The findings revealed discordant results between women and OB/GYN doctors regarding the initiation and quality of information provided by doctors about contraception and overall satisfaction with counseling. Most women (83.1%) expressed a desire to have more information about various contraceptive methods. More than 60% of women reported a willingness to use LARC, such as hormone-releasing IUS or subdermal implants, when provided with detailed information in counseling. Conclusion The majority of Korean women are familiar with condoms and natural methods, but lack knowledge about alternative contraceptive methods, including LARC. Women who used LARC reported higher levels of satisfaction than those who used other methods.

OBJECTIVE: The aim of the present study was to evaluate changes of vascular endothelial growth factor levels in maternal circulating blood during normal pregnancies and examine their relationship with maternal platelet counts. METHODS: The 33 subjects were selected from healthy normotensive women from the antenatal clinic at Korea University Medical Center, Guro Hospital. Blood samples for VEGF were taken at 7 to 8 weeks' gestation, 16 to 18 weeks' gestation, 24 to 26 weeks' gestation, 30 to 32 weeks' gestation, 37 to 41 weeks' gestation. Serum and plasma were extracted from all samples, and VEGF concentrations were measured in duplicates by competitive enzyme immunoassay. The 23 of them, the platelet counts were performed with an automated blood Coulter counter. RESULTS: Serum VEGF levels during normal pregnancies were mean 6.73 ng/mL at 7-8 weeks' gestation, 7.88 ng/mL at 16-18 weeks' gestation, 7.18 ng/mL at 24-26 weeks' gestation, 8.42 ng/mL at 30-32 weeks' gestation, 14.03 ng/mL at 37-41 weeks' gestation. Plasma VEGF levels were mean 5.50 ng/ mL at 7-8 weeks' gestation, 7.23 ng/mL at 16-18 weeks' gestation, 7.98 ng/mL at 24-26 weeks' gestation, 7.35 ng/mL at 30-32 weeks' gestation, 14.05 ng/mL at 37-41 weeks' gestation. The trends in the mean VEGF levels were similar between serum and plasma, with stable levels until 30 to 32 weeks' gestation, and then the levels were increased. There was no significant difference between serum VEGF levels and plasma VEGF levels (p=0.236) and no correlation between circulating VEGF levels and platelet counts. CONCLUSION: Our data suggests that platelets may not be the origin of elevated VEGF levels in normal pregnancies because there was no correlation between VEGF levels and platelet counts.
Academic Medical Centers ; Blood Platelets* ; Female ; Humans ; Immunoenzyme Techniques ; Korea ; Plasma ; Platelet Count* ; Pregnancy* ; Vascular Endothelial Growth Factor A*