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Comparison of Pregnancy Outcome According to the Types of Tuboplastic Surgery for Correction of Tubaland Peritoneal Infertility.

Kyu Sup LEE ; Chul Hee PARK

Korean Journal of Obstetrics and Gynecology.1997;40(6):1233-1243.

From January, 1988 to December, 1994, 336 cases of tuboplastic surgery were performedfor the purpose of restoration of fertility at the Department of Obstetrics and Gynecology,Pusan National University Hospital. Of these 336 cases, 269 cases were followed-up for 36months postoperatively and reviewed for evaluation and comparison of pregnancy rate andfactors influencing pregnancy outcome according to the types of surgical procedure performed.Six types of surgical procedures were performed : salpingolysis, tubal reanastomosis, tubalimplantation, fimbrioplasty, neosalpingostomy, and combined procedure.The results for the 269 cases were as follows:1. The distribution of tuboplastic surgery was 38 cases(14.1%) for salpingolysis, 142(52.85) for tubal reanastomosis, 5(1.9%) for tubal implantation, 15(5.6%) for fimbrioplasty,45(16.7%) for neosalpingostomy, and 24(8.9%) for combined procedure.2. One hundred forty-eight(55.0%) of 269 patients who underwent tuboplastic surgeryconceived postoperatively. The pregnancy rate was 44.7%(17/38) for salpingolysis, 71.8%(102/142) for tubal reanastomosis, 20.0%(1/5) for tubal implantation, 26.7%(4/15) for fimbrioplasty,24.4%(11/45) for neosalpingostomy, and 54.2%(13/24) for combined procedure.3. The term pregnancy rate was 37.5%, the ectopic pregnancy rate was 5.6%, and thespontaneous abortion rate was 8.6% in patients who underwent tuboplastic surgery.4. Among one hundred forty-eight conceived cases, one hundred twenty-six pregnancies(85.1%) occurred during the first 21 months after surgery, and almost all pregnancies wereachieved before 24 months postoperatively. The mean interval from surgery to conception was11.1 months.5. On tubal reanastomosis, 1) Concerning the site of anastomosis, the pregnancy rate was higher in the isthmic-isth-mic(87.5%) than in other groups. 2) In patients whose postoperative tubal length was less than 3cm, pregnancy was notachieved. 3) Statistically significant differences were not found in the pregnancy rates followingmicro-and macro-surgery for tubal reanastomosis(p > 0.05). 4) There were no statistically significant differences between the pregnancy ratesfollowing unilateral and bilateral surgical procedures for tubal reanastomosis(p > 0.05). 5) The pregnancy rate was statistically higher in patients who underwent tubal ligationwith ring than with electrocautery(p < 0.05). 6) There were no statistically significant differences between the pregnancy ratesaccording to the duration of sterilization(p > 0.05).6. Distal tubal obstruction treated by neosalpingostomy resulted in pregnancy rates thatwere higher with mild disease than with moderate or severe disease(p < 0.05).
Abortion, Induced ; Fallopian Tube Diseases ; Female ; Fertility ; Fertilization ; Humans ; Infertility* ; Obstetrics ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Rate ; Pregnancy* ; Pregnancy, Ectopic ; Sterilization Reversal

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Congenital Anomalies Diagnosed by Antenatal Ultrasonography.

Jae Sung CHO ; Kyung Soo KIM ; Suk Young KIM ; Tae Yoon KIM ; Hyung Min CHOI ; Young Koo LIM ; Yong Won PARK

Korean Journal of Obstetrics and Gynecology.1997;40(6):1228-1232.

The incidence of congenital anomalies is reported to be 2~3% of live born births. Inthe past, infection was one of the major cause of perinatal morbidity and mortality, butowing to the development of antibiotics and intensive care, congenital anomalies are becominga major cause of perinatal morbidity and mortality. Prenatal diagnosis of congenitalanomalies is becoming more important because appropriate perinatal care may minimize theeffect of congenital anomalies.We studied the incidence of congenital anomalies diagnosed by antenatal ultrasoundexaminations retrospectively. The study group was 13,652 pregnant women who were takenantenatal obstetric ultrasound examinations between Jan. 1, 1991 and Dec. 31, 1995. Therewere 694 cases of congenital anomalies diagnosed by antenatal ultrasonography examinations.The incidence of congenital anomalies was 5.1%. The most common congenital anomaliesby organ system was central nervous system(32.7%), and the next were urogenital(14.7%), heart(11.7%), face and neck(8.4%), multiple anomalies(8.4%), G-I(6.8%), abdominalwall defect(4.5%), skeletal(3.5%), thorax(3.2%) in order. The most common congenitalanomalies was choroid plexus cyst(8.8%), and the next were hydrocephalus(7.9%), hydronephrosis(6.5%), cystic hygroma(4.2%), anencephaly(3.9%), cleft lip and/or palate(2.9%),hydrops fetalis(2.4%), small intestinal obstruction(2.3%), multicystic kidney(2.2%), diaphragmatichernia(2.2%), omphalocele(2.0%), gastroschisis(2.0%), holoprosencephaly(1.9%),ovarian cyst(1.6%), esophageal atresia(1.4%), microcephaly(1.4%), amniotic band syndrome(1.3%), meningocele or meningomyelocele(1.3%) in decreasing order. Ultrasonography maybe a useful prenatal diagnostic method of detecting congenial anomalies.
Amniotic Band Syndrome ; Anti-Bacterial Agents ; Choroid Plexus ; Cleft Lip ; Female ; Humans ; Incidence ; Infant, Newborn ; Critical Care ; Meningocele ; Mortality ; Parturition ; Perinatal Care ; Pregnant Women ; Prenatal Diagnosis ; Retrospective Studies ; Ultrasonography*

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Ultrasonography for Evaluation of Polyhydramnios.

Young Koo LIM ; Jae Sung CHO ; Ji Soo KIM ; Yong Ju LEE ; Yong Won PARK

Korean Journal of Obstetrics and Gynecology.1997;40(6):1222-1227.

This study was undertaken to evaluate the efficiency of ultrasonography for the prenatalassessment of Polyhydramnios. From May 1988 to October 1993, 2,320 subjects hadsingle gestations undergoing fetal testing after 20 gestational weeks at the Severance Hospital.The incidence of Polyhydramnios diagnosed by amniotic fluid index was 6.8%(157/2,320). Maternal diabetes mellitus and fetal congenital anomalies diagnosed by ultrasonographywere found in 6(3.8%) and 73(46.5%) patients among the polyhydramnios group. Thecausative factor of the other cases(49.7%) was unknown. The most common fetal malformationswere central nervous system(26.0%) and gastrointestinal system anomalies(24.7%). And they were followed by abdominal wall defect(8.2%), skeletal dysplasia(8.2%),cardiac lesion(6.8%), facial lesion(5.5%), and thoracic or diaphragmatic lesion(4.5%). Theincidence of Cesarean section due to fetal distress, low 5-min Apgar score, large for getationalage, admission to intensive care nursery, and perinatal mortality was not significantlydifferent in the idiopathic polyhydramnios group compared with that of the control group(p < 0.05).We found ultrasonic examination seems to be valuable diagnostic tool to assess theamount of amniotic fluid volume and detect fetal anomalies. Also it might be essential toperform the follow-up examination in idiopathic polyhydramnios to predict the perinatal outcome.
Abdominal Wall ; Amniotic Fluid ; Apgar Score ; Cesarean Section ; Diabetes Mellitus ; Female ; Fetal Distress ; Follow-Up Studies ; Humans ; Incidence ; Critical Care ; Nurseries ; Perinatal Mortality ; Polyhydramnios* ; Pregnancy ; Ultrasonics ; Ultrasonography*

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Expression of Adhesion Molecules in Placenta and Correlation with Uterine Artery Doppler Velocimetry in Pregnancy-induced Hypertension.

Yong Won PARK ; Hyung Min CHOI ; Jae Sung CHO ; Tae Yoon KIM ; Kyung Soo KIM ; Young Ku LIM

Korean Journal of Obstetrics and Gynecology.1997;40(6):1212-1221.

INTRODUCTION: The pathophysiology of PIH remains unclear. Recently, placental abnormalitiesare stressed as a possible cause of PIH. Abnormal shallow invasion of trophoblasts, confinedto decidua, without involving myometrium is believed to result in reduced uteroplacentalperfusion, endothelial injury, and activation of coagulation cascade system. Integrin, one of theadhesive membrane proteins, is expected to be related to the regulation of trophoblasts invasion. PURPOSE: The purpose of this study is to investigate the expression of adhesion moleculesin placenta and the correlation between uterine artery Doppler findings and integrinexpressions in the placentas of PIH patients. SUBJECTS: Thirty-six cases of severe PIH patients were enrolled in the study with 10number of normal control pregnant women. The integrin subunit expressions withimmunohistochemical staining were observed in floating villi, maternal-side cytotropholbasts, andfetal-side cytotrophoblasts. Uterine artery Doppler study was also performed, and the S/Dratio was evaluated. Abnormal Doppler findings was defined as S/D ratio>or=2.6. RESULTS: Cytoplasmic staining of villi and placental bed cytotrophoblast for theintegrin alpha1 subunit in PIH specimen was weaker than those in normal controls. Theexpression of integrin beta1 subunit was negative for both controls and PIH group. Thepositive cytoplasmic stain was observed among PIH placenta in contrast to normal control inwhich the expression of integrin beta4 subunit was not detected. The expression of alpha v beta3 introphoblast with PIH was positive staining, but not in control group. Uterine artery Dopplervelocimetry was performed in 25 cases with PIH. Trace(+/-) or - staining of integrin alpha1 subunit were observed in 60.0% of abnormal S/D(>or=2.6) group, 20.0% of normal S/Dratio group patients, respectively. Trace or + staining of integrin beta4 subunit were observedin 50.0% of abnormal S/D group and 6.7% of normal S/D group and this is in statisticallysignificant. Trace or + staining of integrin alpha v beta3 subunit were observed 70.0% ofabnormal S/D group and 26.7% of normal S/D group, and this statistically significant. CONCLUSION: In PIH the abnormality in the invasion of cytotrophoblats results inabnormal integrin subunit expression, but it is also correlated to the abnormal uterine arteryDoppler velocimetry which shows a S/D ratio of greater than 2.6. Thus, the uterine arteryDoppler velocimetry reflects abnormal placentation.
Animals ; Antigens, CD29 ; Cytoplasm ; Decidua ; Female ; Humans ; Hypertension, Pregnancy-Induced* ; Integrin alpha1 ; Integrin alphaV ; Integrin beta4 ; Integrins ; Membrane Proteins ; Mice ; Myometrium ; Placenta* ; Placentation ; Pregnancy ; Pregnant Women ; Rheology* ; Trophoblasts ; Uterine Artery*

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A Clinical Analysis of Severe PreeclamsiaHypertensive Disorders.

Young Seok SEO ; Chan Ho SONG ; Sang Hyuk LIM ; Sun Kook PARK ; Keun Il SONG ; Sang Ryun NAM

Korean Journal of Obstetrics and Gynecology.1997;40(6):1200-1211.

Traditionally, preeclamptic women who meet established criteria for severe disease aredelivered expeditiously. Although delivery is always appropriate thrapy for the mother, itmay not be for the fetus remote from term. The purpose of this investigation was to evaluatethe differences of pregnancy and neonatal outcome of severe preeclampsia and normalpregnancy, especially before 34 weeks gestational age, and to determine whether aggressiveor expectant management of severe preeclampsia before 34 weeks is more beneficial tomaternal and fetal outcome. A hundred and twenty consecutive pregnancies complicated bysevere preeclampsia and a hundred and twenty normal pregnancies were stuided.The results were as follows:1. The incidence of severe preeclampsia was 3.9%(130 of 3328). The 26~30 year oldage group was most common, 43%(52 patients).2. In case of study between severe preeclamptic patients and normal pregnant patient,there was no differences regarding gestational age at delivery, birth weight, cesarean sectionrate, incidence of RDS, perinatal death. The 1min/5 min Apgar scores of severe preeclampsiais significantly lower than control group(6/7 vs 7/8, p < 0.05). Neonates with SGA(small for gestational age) were found in 29% neonates of patients with severe preeclampsia,which is significantly higher than normal pregnancy group(6%, p < 0.05).3. There was no significant difference between expectant(n=10) and aggressive(n=21)management group less than 34 weeks gestation regarding the gestational age of admissionand delivery, blood pressure, proteinuria, serum creatinine, hemoglobin, hematocrit, pletelets,liver enzymes, and LDH. Only the prolongation of gestational age in the expectant managementgroup is significantly higher than in the aggressive management group(7 vs 2 days,p < 0.05).4. The neonatal and pregnancy outcome of expectant(n=10) and aggressive managementgroup(n=15) were as follow: The birth weight in the expectant management groupis lower than in the aggressive management group(1316.7+/-668.8g vs 1576.2+/-428.7 g, p < 0. 05). The incidence of SGA in the expectant management group is higher than in theaggressive management gorup(50% vs 27%, p=not significant). There was no significant differencebetween expectant and aggressive management group regarding the 1 min/ 5 minApgar score, the cesarean section rate, and the frequency of respiratory distress syndrome,cerebral hemorrhage, renal failure, sepsis, DIC of neonates.
Birth Weight ; Blood Pressure ; Cesarean Section ; Creatinine ; Dacarbazine ; Female ; Fetus ; Gestational Age ; Hematocrit ; Hemorrhage ; Humans ; Incidence ; Infant, Newborn ; Mothers ; Pre-Eclampsia ; Pregnancy ; Pregnancy Outcome ; Proteinuria ; Renal Insufficiency ; Sepsis

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A Common Genetic Variant of the Angiotensin Converting Enzyme(ACE) Gene and Pregnancy InducedHypertensive Disorders.

Cheong Rae ROH ; Duk Kyung KIM ; Byung Koo YOON ; Soon Ha YANG ; Jae Hyun CHUNG ; Duk Soo BAE ; Je Ho LEE

Korean Journal of Obstetrics and Gynecology.1997;40(6):1189-1199.

BACKGROUND: The angiotensin coverting enzyme(ACE) gene(encoding kininase II, EC3.4.15.1) contains a polymorphism based on the presence(insertion [I]) or absence(deletion[D]) within an intron of a 287bp nonsense DNA domain, resulting in three genotypes(D/I) and I/I homozygotes, and I/D heterozygotes). Alu insertion is associated with lowerACE level than deletion allele(D) and it was observed that D/D individuals have twice theACE activity of I/I patients. Pregnancy induced hypertension(PIH) probably results fromdominating pressor systems owing to loss of antagonizing vasodilator autacoids. AngiotensinII is an extremely potent arteriolar vasoconstrictor. Overactivity or failure to supressresponsiveness to the increased activity of angiotensin II, which is generated by ACE,would seem to be a reasonable basis for the vasoconstriction of PIH. The aim of this studyis to evaluate the relationship between ACE genotype and PIH. METHODS: Blood sampling was taken from 39 patients with PIH. The hypertensivedisorders, confirmed at postpartum follow up, were classified as gestational hypertensionwithout proteinuria, preeclampsia(mild and severe) and eclampsia. The diagnosis ofpreeclampsia was made according to the American College of Obstetrics and Gynecology criteriaof hypertension and proteinuria(>300 mg/24 hr urine). Genomic DNA was extractedfrom blood sample. After PCR amplification of the respective fragments from intron 16 ofthe ACE gene, size fractionation and visualization by electrophoresis were performed. RESULTS: PIH group(including gestational hypertension, mild and severe preeclampsia: frequency of I allele 0.756 and D allele 0.244) had more I allele and less D allele whencompared with normal population(frequency of I allele 0.609 and D allele 0.391)(p < 0.05).And PIH group had more I/I homozygote individuals showing significant distortion fromHardy-Weinberg equilibrium of ACE genotype(p < 0.05). Moreover, severe preeclampsiagroup alon(frequency of I allele 0.759 and D allele 0.241) had more I allele and less Dallele when compared with normal population and had significantly more I/I homozygoteindividuals. CONCLUSION: As pregnancies with PIH had more ACE I allele and I/I homozygoteindividuals. PIH could be associated with I allele of the ACE gene. Considering the observedcodominant association between the D-I polymorphism and plasma ACE activity, our resultis in favor of the thesis that PIH primarily arises from defective synthsis of vasodilatingautacoids and renin-angiotensin system exerts secondary vasoconstrictive action. However,the relationship between ACE genotype and defective vasodilating mechanism during pregnancyis unknown at present.
Alleles ; Angiotensin II ; Angiotensins* ; Autacoids ; Diagnosis ; DNA ; Eclampsia ; Electrophoresis ; Female ; Follow-Up Studies ; Genotype ; Gynecology ; Homozygote ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Introns ; Obstetrics ; Peptidyl-Dipeptidase A ; Plasma ; Polymerase Chain Reaction ; Postpartum Period ; Pre-Eclampsia ; Pregnancy* ; Proteinuria ; Renin-Angiotensin System ; Vasoconstriction

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A Clinical Study of Sex Chromosomal Abnormalities.

Ook Hwan CHOI

Korean Journal of Obstetrics and Gynecology.1997;40(6):1178-1188.

To provide current information on sex chromosome abnormalities to obstetricians andgynecologists who encounter such diagnoses and who counsel prospective parents faced withthe prenatal diagnosis of a sex chromosome abnormalities. I reviewed 116 patients' clinical data and results of karyotype which proven sexchromosome abnormalities in cytogenetic unit of Department of Ob. and Gyn., PNUH during theperiod of 1993. Aug.~1996. Dec.The results of the analysis of karyotyping in sex chromosome abnormalities in these 116cases are like following.1. Peak age group when diagnosed abnormal sex chromosome is 26~35 years old inmen(46 among 56 cases) and 16~30 years old in women(40 among 60 cases).2. The most common primary reason of abnormal sex chromosome is sterility inmen(48 among 56 cases) and amenorrhea in women(36 among 60 cases).3. The most common referred primary reason in Klinefelters syndrome issterility(44 among 49 cases) and in Turners syndrome is primary amenorrhea(27 among55 cases).4. The most common type of abnormal sex chromosome is Klinefelters syndrome inmen(49 among 56 cases) and Turners syndrome in women(55 among 60 cases).5. In my 116 cases of abnormal sex chromosome, numerical abnormalities are 67 cases,mosaicisms 28 cases, structural abnormalities 13 cases, XY female 6 cases, and XX male2 cases. So the most common abnormal sex chromosome is numerical abnormality.6. In my 55 cases of Turners syndrome, XO karyotypes are 26 cases, X, abnormal X are11 cases, and mosaic pattern are 18 cases. So the most common karyotype in Turnerssyndrome is standard pattern(45,X).In conclusion, abnormal sex chromosome were very important causes of infertility,amenorrhea, abnormal pubertal development, ambiguous genitalia, and stature. Therefore,these patients must taken cytogenetic study, and obstetrics and gynecologists provideaccurate and comprehensive genetic counseling.
Amenorrhea ; Chromosome Aberrations* ; Cytogenetics ; Diagnosis ; Disorders of Sex Development ; Female ; Genetic Counseling ; Humans ; Infertility ; Karyotype ; Karyotyping ; Klinefelter Syndrome ; Obstetrics ; Parents ; Prenatal Diagnosis ; Sex Chromosome Aberrations ; Sex Chromosomes ; Turner Syndrome

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In Vitro Culture of Human Endometrial and Cytotrophoblast Cells.

Bo Yon LEE ; Seung Bo KIM

Korean Journal of Obstetrics and Gynecology.1997;40(6):1171-1177.

Implantation is a cascade of process which fertilized conceptal tissue move into maternalendometrium. Recently, with development of life science, the informations about humanimplantation process have been important topic with regard to the reproductive medicaltechnology. However, the precise mechanism and the factors involved in the process is notclearly understood, because the human experiments have been inhibited due to ethical andreligious views to the point. To study the human implantation process, we develop the modelto culture the human endometrium and trophoblast in vitro. The microscopic findings ofcultured monolayer of endometrial glandular epithelium and stroma in respond to co-culturedtrophoblast cells were observed. As results, trophoblasts didn't change the microscopicmorphology of endometrial glandular layer. However, trophoblast cells destructed the higherconcentration of epidermal growth factor in culture media. These results suggests thatepidermal growth factor may be a important factor for trophoblast invasion to stromal layerand trophoblast may invade the glandular layer by different mechanism to endometrial stroma.
Biological Science Disciplines ; Culture Media ; Endometrium ; Epidermal Growth Factor ; Epithelium ; Female ; Humans* ; Trophoblasts*

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Effect of Human Cord Serum on the Hormone Production by Mouse Oocyte Cumulus Complexes in vitro.

Yu Il LEE ; Hyun Jeong PARK ; Young Suk KWON

Korean Journal of Obstetrics and Gynecology.1997;40(6):1162-1170.

In our previous study, it was shown that human cord serum stimulated cumulus expansionin vitro by cumuli oophori isolated from mice primed with pregnant mare serum gonadotropin(PMSG), and suggested that there were some gonadotropin-like components stimulating cumulusexpansion in human cord serum. In this paper we assess whether there are gonadotropinstimulating cumulus expansion in human cord serum and sex steroid hormone production fromoocyte cumulus complexes(OCCs). The contents of follicle stimulating hormone(FSH) andluteinizing hormone(LH) were measured in human cord serum: follicle stimulating hormone levelwas basal, but luteinizing hormone was as high as 142.4 mIU/ml even in inactivated serum.After short term culture(4hr), with or without OCCs, medium containing 0.4% bovine serumalbumin(BSA) as control or 10% human cord serum(HCS) was collected and analyzed for itscontent of estradiol, progesterone and testosterone. Little or no sex steroid contents were detectedin any control media with or without OCCs. In contrast, a moderate or small amount ofsex steroid contents was detected in culture medium containing cord serum. OCCs secretedminute but not significant amounts of estradiol, progesterone, and testosterone when culturedin media containing cord serum. After 4, 8, and 22hr culture with OCCs, similar patterns ofcumulus expansion were observed in media containing cord serum, human chorionic gonadotropin(HCG) instead of luteinizing hormone(LH), and HCS plus HCG. However, no cumulus expansionwas observed in any control media.It is suggested that luteinizing hormone in human cord serum induces cumulus expansionand affects the secretion of sex steroid hormones by OCCs during culture.
Animals ; Chorion ; Estradiol ; Follicle Stimulating Hormone ; Gonadal Steroid Hormones ; Humans* ; Lutein ; Luteinizing Hormone ; Mice* ; Oocytes* ; Progesterone ; Testosterone

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B-lymphocyte, T-lymphocyte and Subsets in Unexplained Recurrent Spontaneous Abortion.

Chi Heum CHO

Korean Journal of Obstetrics and Gynecology.1997;40(6):1157-1161.

The depressed cell-mediated immunity in pregnant women may play an important role inthe protection of the fetus from rejection by the mother. In this of view, many studieshave been performed to evaluated of lymphocyte subsets in recurrent spontaneous abortionwomen. However, because of the discordance in published data, auther have reevaluatedperipheral blood T-lymphocyte, B-lymphocyte and subsets defined by monoclonal antibodieswith immunobead method for 37 recurrent spontaneous abortion women and 30 normal healthywomen.The results were as follows. No significant difference was observed in the componentratio of the B cell. The component ratio of T lymphocyte in study group(70.5+/-10.1%) wassignificantly decreased in control group(79.7+/-3.1%)(p < 0.001). The component ratio of Nullcell in study group(19.0+/-10.1%) was higher than control group(9.4+/-2.6%)(p < 0.001). In thecomponent ratio of T4 cell, no statistically difference were observed in both groups. In thecomponent ratio of T8 cell, study group(28.4+/-9.5%) was significantly lower than controlgroup(38.4+/-3.2%)(p < 0.001). T4/ T8 ratio in the study group(1.58+/-0.70%)was significantly higher than control group(1.09+/-0.14%)(p < 0.001).In the component ratio of T/B cell, no statistically differences were observed.In conclusion, decreased T8 cell component ratio and increased T4/T8 component ratio may be play an important role in recurrent spontaneous abortion.
Abortion, Spontaneous* ; B-Lymphocytes* ; CD4-Positive T-Lymphocytes ; CD8-Positive T-Lymphocytes ; Female ; Fetus ; Humans ; Immunity, Cellular ; Lymphocyte Subsets ; Lymphocytes ; Mothers ; Pregnancy ; Pregnant Women ; T-Lymphocytes*

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