OBJECTIVE: To investigate the interacting effects between pregnancy and flares of systemic lupus erythematosus (SLE) and to explore the best occasion for SLE patients' conception and the management during the pregnancy. METHODS: Thirty one cases of pregnancy complicated with SLE were investigated retrospectively, among whom 18 were in remission of SLE at the beginning of conception (Group A), and the other 13 either had high-activity of the disease or were first diagnosed as SLE during the pregnancy (Group B). Various doses of prednisone were administered to control SLE. RESULTS: SLE flares still occurred in 6 cases in Group A, but in all cases in Group B. Compared with Group A, the rates of fetal loss and early delivery were significantly higher in Group B (P < 0.05), while the survival rate and the weight of the new born were notably decreased in Group B (P < 0.05). CONCLUSION Pregnancy and SLE interacted with each other unfavorably. Selection of remission stage for conception and proper management during the pregnancy could significantly improve the maternal-fetal safety.
Adult ; Female ; Humans ; Lupus Erythematosus, Systemic ; therapy ; Pregnancy ; Pregnancy Complications ; therapy ; Pregnancy Outcome ; Time Factors

Objective. This study aims to determine time and motion in the operating room in emergent, urgent and scheduled cesarean section surgeries among pregnant COVID-19 patients. Methodology. A time and motion performance evaluation study was done by computing the following parameters: pre-induction time, pre-incision time, opening time, closing time, for both decision-to-delivery interval (DDI) and overall operative time. Results. During the study period, emergent DDI average was 2 hours and 38 minutes, emergent overall operative time was 1 hour and 31 minutes, urgent DDI average was 3 hours and 51 minutes, and urgent overall operative time of 1 hour and 57 minutes. However, in both urgent and emergent cases, the recommended DDI of 30 minutes, and the average duration of 44.3 minutes for CS were not feasible. Conclusion. The COVID-19 pandemic has negatively affected the provision of surgical obstetric care and OR utilization. Due to the new safety protocol for healthcare workers and patients, there was a significant delay in DDI and overall operative time. The causes were preparation, anesthesia factors or obstetrician factors. Identifying modifiable obstacles may improve the DDI, overall operative time, and the quality of maternal and child birth care during this pandemic.
Pregnancy ; Female ; Cesarean Section ; Time and Motion Studies ; COVID-19 ; Time Perception ; Motion

OBJECTIVES: Dyspnea and palpitation are common features of pregnancy. While several theories have been put forward to explain the etiology of gestational dyspnea and palpitation, there have been few systemic studies of its incidence, severity and time-course in a group of normal women. METHODS: We interviewed postpartum women, within 3 days after delivery, about dyspnea and palpitation. Separately from this interview, we performed 24-hour ECG monitoring for obstetric patients with palpitation before delivery. RESULTS: The subjects interviewed were 261 women, of whom 37.5 percent and 11.5 percent experienced dyspnea and palpitation, respectively. These symptoms had a tendency to increase to term. The presence of arrhythmias could be documented in only 22% of patients having 24-hour Holter monitoring. CONCLUSION: Dyspnea and palpitation were common among normal pregnant women and had a tendency to increase to term.
Adult ; Arrhythmia/*physiopathology ; Dyspnea/*physiopathology ; Electrocardiography, Ambulatory ; Female ; Human ; Pregnancy ; Pregnancy Complications/*physiopathology ; Time Factors

At various intervals after first trimester therapeutic abortion, in a total of 1604 cases laparoscopic sterilization procedures were performed at Severance Hospital of Yonsei University Medical Center, Seoul, Korea, from May 1973 to October 1975. A total of 214 women were sterilized immediately after abortion, 359 were sterilized between one and 42 days after abortion and the remaining 1031 women were sterilized 43 or more days after abortion. Electrocoagulation and tubal ring were the two tubal-occlusion techniques used. The findings indicate that patients who underwent the combined abortion-sterilization procedures did not encounter higher rates of technical and/or complications than the other two groups. Only a few patients among the total study subjects had potentially serious complications which neceisstated subsequent laparotomy and hospitalization after sterilization.
Abortion, Therapeutic* ; Adult ; Female ; Human ; Korea ; Postoperative Complications ; Pregnancy ; Pregnancy Trimester, First ; Sterilization, Tubal* ; Time Factors

OBJECTIVE: To evaluate the feasibility of laparoscopic salpingectomy using one-port in tubal pregnancy compared to conventional laparoscopic surgery. METHODS: From June 2008 to June 2011, 63 women were treated with laparoscopic salpingectomy due to tubal pregnancy, which was diagnosed by ultrasonography. These patients were divided into two groups. Of these 63 patients, 32 women were treated with conventional laparoscopic salpingectomy (CLS) in group I, 31 women underwent laparoscopic salpingectomy using one port (OPLS) in group II. In group I, rigid 0degrees or 30degrees, 10 mm laparoscope, rigid instruments were used. In group II, 30degrees, 10 mm laparoscope, rigid or flexible angulated tip instruments were used during the surgery. We reviewed and compared clinical characteristics, clinical outcomes of these patients. RESULTS: Patients in Group I were compatible with the patients in group II in clinical characteristics. Clinical outcomes were not different between two groups in terms of Hemoglobin change (g/dL), hospital stay (days), hemoperitoneum (mL), transfusion. Mean operative time was significantly longer in group II (59.7+/-15.7 min vs. 46.5+/-15.0 min, p=0.001). The mean length of skin incision was obviously shorter in group II; the difference was highly statistically significant (15.5+/-3.0 mm vs 23.5+/-3.0 mm, p<0.001). CONCLUSION: It seems that OPLS is feasible alternative to CLS to treat hemodynamically stable patients without complications. Additionally, this technique also results in better cosmetic outcomes than CLS. Randomized prospective clinical studies with larger scale are necessary in the future to confirm these results.
Cosmetics ; Female ; Hemoglobins ; Hemoperitoneum ; Humans ; Laparoscopes ; Laparoscopy ; Length of Stay ; Operative Time ; Pregnancy ; Pregnancy, Tubal ; Salpingectomy ; Skin

BACKGROUNDFor patients with severe endometriosis, the spontaneous pregnancy rates have been reported to be near 0 due to extreme distortion of normal pelvic anatomy. Surgery is one of the treatment options; however, if patients failed to conceive after surgery, in vitro fertilization (IVF) is effective. The objective of this retrospective study was to determine the clinical characteristics of IVF/intracytoplasmic sperm injection (ICSI) in patients with stage III/IV endometriosis, and to determine the impact of the interval from surgery to IVF/ICSI on outcome.

METHODSOne hundred and sixty patients who were diagnosed with stage III/IV endometriosis underwent IVF/ICSI cycles between February 2004 and June 2009 were enrolled. The mean interval from surgery to IVF, number of oocytes retrieved, fertilization rate, implantation rate, embryos transferred, and good embryos transferred were compared between two age groups (35 years).

RESULTSThe mean interval from surgery to IVF was (37.9+/-28.9) months for the group35 years of age. Twenty-five IVF/ICSI cycles (12.8%) were performed during the first year after surgery, and 34.9% IVF/ICSI cycles were performed 2 years after surgery. No significant differences existed between the two groups with respect to the fertilization rate, implantation rate, number of embryos transferred, number of good embryos, clinical pregnancy rates, live birth rates, and cumulative clinical pregnancy rates (P>0.05). The probability of cumulative clinical pregnancies was 75%, 50%, and 25% ((29.0+/-4.8), (61.0+/-7.6), and (120.0+/-16.9) months after surgery, respectively).

CONCLUSIONSFor infertile patients with stage III/IV endometriosis, the optimal time to conceive by IVF/ICSI is <2 years after surgery; nevertheless, most of the patients took a longer time to conceive.

Adult ; Endometriosis ; surgery ; Female ; Humans ; Pregnancy ; Pregnancy Rate ; Retrospective Studies ; Sperm Injections, Intracytoplasmic ; Time Factors

OBJECTIVETo investigate the main correlative factors affecting the pregnancy rate of intrauterine insemination (IUI) by means of analyzing 186 patients and 216 cycles of IUI.

METHODSComparisons were made between different pregnancy rates from five respects: infertility reasons, stimulation and natural cycles, different protocols for stimulating ovulation (CC group, CC + hMG group, hMG group), two methods for semen treatment (swim-up and gradient centrifugal), and insemination time (endometrial thickness and E2 levels at the day of hCG injection, and times of IUI).

RESULTSThe pregnancy rates resulting from male and cervix factors (29.82%, 25.00%) were significantly higher than those from other factors. There were few statistical differences in the pregnancy rates between stimulation and natural cycles (19.54% vs 16.67%), between the three different protocols for stimulating ovulation (CC 6.50%, CC + hMG 14.28%, hMG 22.30%), between gradient centrifugal and swim-up methods (20.13% vs 16.13%) and between one-time IUI and two-time IUI (19.73% vs 17.39%) (P > 0.05). However, the pregnancy rates were statistically correlated with the endometrial thickness at the day of hCG injection and different E2 levels of the follicles over 14 mm in diameter (P < 0.05).

CONCLUSIONIUI is of more applied value for infertility caused by male and cervix factors. With these factors in view, to choose the most suitable insemination time is the key to increasing pregnancy rate.

Estradiol ; blood ; Female ; Humans ; Insemination, Artificial ; methods ; Male ; Pregnancy ; Pregnancy Rate ; Time Factors

OBJECTIVETo investigate the outcome of pregnancy in women after surgical treatment of tubal pregnancy and measures to improve the rate of successful postoperative pregnancy.

METHODSA retrospective study was conducted among 424 women who underwent surgical treatment for tubal pregnancy between Jan 1999 and Jan 2004. All patients desiring a second pregnancy were followed up for 18-72 months for the outcome. Cumulative fertility and recurrence curve were compared and calculated by life-table.

RESULTSOf the 424 women with tubal pregnancy, 177 (41.7%) had intrauterine pregnancy after the operation, while 102 (24.1%) had recurrent ectopic pregnancy. Among the 177 women with intrauterine pregnancy, 85 (48.02%) became pregnant within 6 months after the operation, 133 (75.14%) within one year, and the cumulative intrauterine pregnancy rate approached 94.92% within 2 years. But among the 102 women with recurrent ectopic pregnancy, only 10 (9.8%) were pregnant within 6 months after the operation, and 49 (48.04%) within 18 months, with a cumulative ectopic pregnancy rate of 67.65%.

CONCLUSIONFor women receiving surgery for ectopic pregnancy, the chance for intrauterine pregnancy can be the greatest within 6 months after operation and reduced markedly after 2 years, when recurrent ectopic pregnancy can be likely. Early plans for pregnancy and hydrotubation following the surgery may prove beneficial for raising the chances for postoperative intrauterine pregnancy.

Adult ; Female ; Fertility ; physiology ; Humans ; Postoperative Period ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Tubal ; surgery ; Retrospective Studies ; Time Factors

BACKGROUND: In general, pregnancy is considered a hypercoagulable state, and an increased incidence of thromboembolic phenomena have been reported in pregnant women. A thrombelastography (TEG) measures whole blood coagulation and fibrinolysis, and has been used to manage coagulation defects in patients. The purpose of this study was to establish the physiologic changes in the coagulation and fibrinolytic systems in a normal term pregnancy using a TEG. METHODS: A TEG was performed in 31 nonpregnant women and 31 healthy pregnant women using native whole blood. The TEG variables included reaction time (R), clot formation time (K), maximum amplitude (MA), alpha angle, TEG coagulation index and percentage of reduction in MA at 30 minutes (LY30) and 60 minutes (LY60). Other laboratory tests such as hemoglobin (Hgb), hematocrit (Hct), platelet count (PC) and routine coagulation tests such as prothrombin time (PT), activated partial thromboplastin time (aPTT) and bleeding time (BT) were measured in all women. RESULTS: The R and K were significantly decreased in pregnant women compared with nonpregnant women (P < 0.05). The MA, alpha angle, LY30 and LY60 were significantly increased in pregnant women compared with nonpregnant women (P < 0.05). The TEG coagulation index was significantly greater in pregnant women compared with nonpregnant women (P < 0.05). CONCLUSIONS: In this study, the TEG showed that term pregnant women were in a hypercoagulable state and had increased fibrinolysis.
Bleeding Time ; Blood Coagulation ; Female ; Fibrinolysis ; Hematocrit ; Humans ; Incidence ; Partial Thromboplastin Time ; Platelet Count ; Pregnancy ; Pregnant Women* ; Prothrombin Time ; Reaction Time ; Thrombelastography*

Adult ; Chorionic Gonadotropin, beta Subunit, Human ; blood ; Female ; Humans ; Ovarian Cysts ; complications ; Postpartum Hemorrhage ; etiology ; Pregnancy ; Pregnancy Complications ; Time Factors