OBJECTIVE: To analysis the 10 cases of relaparotomy for intractable hemorrhage after emergency postpartum hysterectomy with massive transfusion. METHODS: Between January 1995 and December 2008, relaparotomies for intractable hemorrhage and unstable vital sign after emergency postpartum hysterectomy with massive transfusion were performed on 10 patients. Medical records were reviewed and detailed to collect clinical data including patients' clinical status, causes of bleeding, duration from hysterectomy to relaparotomy, bleeding sites, procedures for bleeding control, amount of transfusions, complications and prognosis. RESULTS: In relaparotomies, the points of bleeding were identified in all cases and multiple bleeding foci than one bleeding focus were found, and procedures for bleeding control were performed. In 8 cases, the bleeding were controlled successfully and these patients recovered without long term sequales. But in the other 2 cases, although the bleeding controls were successful during relaparotomy and bleeding amount decreased after relaparotomy, but bleeding amount increased the next day and angiographic embolizations were performed. These patients died due to multi-organ failure and continued bleeding. In one of these cases, the endotracheal intubation had been done on arrival at our hospital with postpartum hemorrhage after vaginal delivery at private clinic. In another case, the cardiopulmonary resuscitation was performed on arriving at our hospital with intractable bleeding after postpartum subtotal hysterectomy in other hospital. CONCLUSION: In most cases, bleeding controls for intractable bleeding after postpartum hysterectomy were successful during and after relaparotomy in spite of development of dilutional coagulopthy due to massive transfusion, and resulted in rapid recovery and good prognosis. Even though dilutional coagulopthy was developed because of massive transfusion, relaparotomy was safe and effective procedure for management of intractable hemorrhage after emergency postpartum hysterectomy with clotting factor replacement. If personnel and adequate clotting factor replacement are available, relaparotomy should not be delayed for management of intractable hemorrhage and unstable vital sign after emergency postpartum hysterectomy.
Cardiopulmonary Resuscitation ; Emergencies ; Hemorrhage ; Humans ; Hysterectomy ; Intubation, Intratracheal ; Medical Records ; Postpartum Hemorrhage ; Postpartum Period ; Prognosis ; Vital Signs

A 41-year-old female underwent an uneventful cesarean section, which was followed by a pulmonary saddle embolism complicated by cardiac arrest. This case shows that successful embolectomy is possible, despite a potentially lethal pulmonary saddle embolism, 34 cm in length, and intra-operative cardiopulmonary resuscitation. We report our case and discuss the anesthetic considerations based on the literature.
Adult ; Cardiopulmonary Resuscitation ; Cesarean Section ; Embolectomy ; Embolism ; Female ; Heart Arrest ; Humans ; Pregnancy ; Pulmonary Embolism

We experienced a case of acute postpartum cardiomyopathy after cesarean section. A twin-pregnant woman at 36 weeks gestation showed pregnancy-induced hypertension. After an emergency cesarean section, shortness of breath, paroxysmal dyspnea, hypertension, and tachycardia developed in the recovery room. She was diagnosed with acute peripartum cardiomyopathy.
Cardiomyopathies ; Cesarean Section ; Dyspnea ; Dyspnea, Paroxysmal ; Emergencies ; Female ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Peripartum Period ; Postpartum Period ; Pregnancy ; Recovery Room ; Tachycardia

We experienced a case of acute postpartum cardiomyopathy after cesarean section. A twin-pregnant woman at 36 weeks gestation showed pregnancy-induced hypertension. After an emergency cesarean section, shortness of breath, paroxysmal dyspnea, hypertension, and tachycardia developed in the recovery room. She was diagnosed with acute peripartum cardiomyopathy.
Cardiomyopathies ; Cesarean Section ; Dyspnea ; Dyspnea, Paroxysmal ; Emergencies ; Female ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Peripartum Period ; Postpartum Period ; Pregnancy ; Recovery Room ; Tachycardia

OBJECTIVE: To evaluate the expression of vascular endothelial growth factor (VEGF) and matrix metalloproteinases (MMPs) in the progression of cervical cancer. METHODS: A total 87 specimens of uterine cervix, representing 6 normal epithelium, 11 intraepithelial neoplasm, 25 cervical carcioma in situ (CIS), 19 cervical microinvasive carcinoma and 26 cervical invasive carcinoma, were evaluated. All specimens were prepared with tissue array method which can allow evaluation many specimens in one slide. The protein expressions of VEGF and MMPs (MMP-2, MMP-9) were evaluated by immunohistochemical staining. RESULTS: The protein expressions of VEGF and MMP-2 were increased significantly with the progression of cervical cancer (p<0.05), but there was no statistically significant difference in MMP-9 expression (p>0.05). The VEGF and MMP-2 expressions revealed positive correlations with the progression of cervical cancer. CONCLUSIONS: The VEGF, MMP-2 in each or together may play a role in the progression of cervical cancer.
Carcinoma in Situ ; Cervix Uteri ; Epithelium ; Female ; Matrix Metalloproteinases ; Uterine Cervical Neoplasms ; Vascular Endothelial Growth Factor A

Retroperitoneal hemorrhage caused by intra-abdominal vascular injury during pregnancy or puerperium is rare, but a very fatal complication. Massive retroperitoneal hemorrhage causes the high mortality rate of mother and fetus. But the difficulty of diagnosis and rarity may delay prompt treatment. We experienced a case of massive retroperitoneal hemorrhage, which was caused by a suspected left lumbar artery aneurysm rupture on the fifth day of vaginal delivery. The patient was successfully treated by surgery and arterial embolization. We reported this case with a brief review of literature.
Aneurysm* ; Arteries* ; Diagnosis ; Fetus ; Hemorrhage ; Humans ; Mortality ; Mothers ; Postpartum Hemorrhage ; Postpartum Period ; Pregnancy ; Rupture ; Rupture, Spontaneous* ; Vascular System Injuries

Unclassified type occupies about 5 to 10 percent of all ovarian sex cord stromal tumors. Diagnosis is very difficult and subjective because tumors show insufficient differentiation to ovarian or testicular line or display insufficient findings to diagnose as a gynandroblastoma in spite of divergent differentiation. To our knowledge sixty-two cases have been reported in the pathology literatures as yet. The behavior of this group of tumors has not been adequately studied but is similar to granulose cell tumors or Sertoli-Leydig cell tumors. We present a case of unclassified sex cord-stromal tumor which has been experienced in our hospital with brief review of the literature.
Diagnosis ; Female ; Ovary ; Pathology ; Sertoli-Leydig Cell Tumor ; Sex Cord-Gonadal Stromal Tumors*

The cervical pregnancy is a rare condition representing less than 1% of ectopic gestations. But, it is potentially life-threatening condition because of profuse hemorrhage and requires hysterectomy in some cases. With ultrasound, diagnosis can be made earlier and conservative management is attempted in order to preserve the reproductive potential. Most cervical pregnancies are implanted within the cervical canal below the internal os of the cervix. However, we experienced one case of a unique viable cervical pregnancy in anterior lip of the cervix and treated successfully by local injection of potassium chloride into gestational sac and systemic methotrexate treatment.
Cervix Uteri* ; Diagnosis ; Female ; Gestational Sac ; Hemorrhage ; Hysterectomy ; Lip* ; Methotrexate* ; Potassium Chloride* ; Potassium* ; Pregnancy* ; Ultrasonography

We experienced a case of fetal supraventricular tachycardia (SVT) with fetal ascites diagnosed at 29 weeks of gestation in 29 year-old primigravida woman. Transplacental fetal therapy with maternal oral antiarrhythmic agent (verapamil, diltiazem) resulted in restoration of normal fetal sinus rhythm and disappearance of fetal ascites. At birth, the infant did not show any cardiac arrhythmia and hydropic appearance.
Adult ; Arrhythmias, Cardiac ; Ascites* ; Diltiazem ; Female ; Fetal Therapies ; Humans ; Hydrops Fetalis ; Infant ; Parturition ; Pregnancy ; Tachycardia, Supraventricular* ; Verapamil

Pregnancy complicated by aplastic anemia is uncommon condition with the significant morbidity and mortality rates. the main complication to mother is hemorrhage due to thrombocytopenia and sepsis due to leukopenia and mortality rate in pregnancy complicated by aplastic anemia is more than 20%. But it remain controversy whether pregnancy play a pathogenic role in the development of the disease. We experienced a patient with severe aplastic anemia in pregnancy who was treated with supportive transfusion of red blood cells and platelets and so we present it here with brief review of literature.
Anemia, Aplastic* ; Erythrocytes ; Hemorrhage ; Humans ; Leukopenia ; Mortality ; Mothers ; Pregnancy* ; Sepsis ; Thrombocytopenia