• Clinical and Experimental Reproductive Medicine
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• 제46권1호
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• pp.30-35
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• 2019

Objective: Bilateral uterine artery ligation (UAL) is a fertility-preserving procedure used in women experiencing postpartum hemorrhage (PPH). However, the long-term effects of this procedure on ovarian function remain unclear. The aim of this study was to investigate whether bilateral UAL compromised ovarian reserve and ovarian blood supply. Methods: This prospective study included 49 women aged between 21 and 36 years who had undergone a cesarean section for obstetric indications. Of these, 25 underwent uterine bilateral UAL to control intractable atonic PPH. The control group consisted of 24 women who had not undergone bilateral UAL. Standard clinical parameters, the results of color Doppler screening, and ovarian reserve markers were assessed in all participants at 6 months after surgery. The clinical parameters included age, parity, cycle history, body mass index, and previous medication and/or surgery. Color Doppler screening findings included the pulsatility index (PI) and resistance index (RI) for both the uterine and ovarian arteries. The ovarian reserve markers included day 3 follicle-stimulating hormone (FSH) levels, antral follicle count, and $anti-M\ddot{u}llerian$ hormone (AMH) levels. Results: There were no significant differences in the ovarian reserve markers of day 3 FSH levels, antral follicle count, and AMH levels between the study and control groups (p> 0.05 for all). In addition, no significant differences were observed in the PI and RI indices of the uterine and ovarian arteries (p> 0.05 for all). Conclusion: In this study, we showed that bilateral UAL had no negative effects on ovarian reserve or ovarian blood supply, so this treatment should be used as a fertility preservation technique to avoid hysterectomy in patients experiencing PPH.

• The Korean Journal of Physiology and Pharmacology
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• 제9권3호
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• pp.165-172
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• 2005

The aim of this study was to determine the roles of ET-1 and NO on uterine blood flow in pregnancy. Uterine arteries were isolated from 17 nonpregnant and 12 pregnant women. Nonpregnant group included patients with median age of $48.6{\pm}2.3$ years who underwent hysterectomy, because of myoma. Pregnant group included patients with median age of $31.3{\pm}1.4$ years undergoing cesarean delivery. ET-1 and ET-2 induced concentration-dependent contraction in isolated nonpregnant and pregnant uterine arteries. The contractile response and maximal contraction were increased in pregnant uterine arteries. In nonpregnant uterine arteries, there was no contraction in response to ET-3, whereas pregnancy induced concentration-dependent contraction by ET-3. Tissue nitrite/nitrate level and immunohistochemical staining of eNOS and iNOS were increased in pregnant uterine arteries, compared with nonpregnant uterine arteries. In addition, the expressions of eNOS and iNOS mRNA were significantly increased in pregnancy. Moreover, contractions by ET isopeptides, including ET-1, were enhanced, and immunohistochemical staining of ET-1 and ET-1 mRNA expression was increased in pregnant uterine arteries. These results suggest that NO production by increased NOS activity, especially eNOS activity, is related to placental and uterine blood flow. Furthermore, ET-1 appears to play a pathophysiological role in pregnant complications such as hypertension.

• Clinical and Experimental Reproductive Medicine
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• 제42권4호
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• pp.163-168
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• 2015

Objective: To investigate the impact of fibroids on the blood flow of the uterine and subendometrial arteries and in vitro fertilization (IVF) outcomes. Methods: In this study, we analyzed 86 IVF/intracytoplasmic sperm injection (ICSI) cycles in which a gonadotropin-releasing hormone antagonist protocol was used for controlled ovarian stimulation between January 2008 and March 2009. The subjects comprised 86 infertile women with (fibroid group, n=43) or without (control group, n=43) uterine fibroids. Results: Patient characteristics were similar between the fibroid and control groups. The IVF/ICSI outcomes in patients with fibroids were similar to those of patients in the control group. The resistance index (RI) and pulsatile index (PI) of the uterine and subendometrial arteries on the day of embryo transfer were also comparable between the two groups. IVF outcomes and uterine hemodynamics in patients with multiple (${\geq}2$) fibroids were similar to those of patients with a single fibroid. However, clinical pregnancy and implantation rates were significantly lower in patients with fibroids who experienced uterine cavity distortion than in patients with fibroids who had a normal uterine cavity (both p<0.05). The RI and PI of the subendometrial artery were significantly higher on the day of embryo transfer in patients with fibroids who experienced uterine cavity distortion than in patients with fibroids who had a normal uterine cavity (both p<0.05). Conclusion: Fibroids which distorting the uterine cavity might impair the subendometrial artery blood flow clinical pregnancy rate and embryo implantation rate in infertile patients undergoing IVF. Otherwise, IVF outcomes were not influenced by the presence of uterine fibroids.

• Nuclear Medicine and Molecular Imaging
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• 제41권1호
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• pp.68-69
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• 2007

A 44-year-old female underwent three-phase bone scintigraphy for an evaluation of right hip joint pain. The blood-flow and blood-pool images show a pelvic blush with a photopenic center (doughnut) prior to bladder filling. On the three hour delayed image, the pelvic uptake disappeared. The scintigraphic findings indicated the possibility of an early pregnancy. However, plain radiography demonstrated an intrauterine device. A uterine doughnut developed as a result of photon attenuation of intrauterine device.

• Clinical and Experimental Reproductive Medicine
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• 제36권4호
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• pp.293-300
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• 2009

목 적: 본 연구는 배아이식일의 자궁동맥혈류가 인간 체외수정술에서 임신예후의 예측인자가 될 수 있는지 알아보기 위해 시행되었다. 연구방법: 51회의 체외수정술 주기에 대해 전향적인 임상 관찰로 시행되었으며 혈청 estradiol 농도는 hCG 투여일에 측정되었고, 자궁동맥 박동율 (PI)과 저항율 (RI)은 배아이식 3일째에 측정되었다. 결 과: 51회의 주기 중 22주기에서 임상적으로 임신이 확인되었고 (43.1%), 착상률은 14.7%였다. 자궁동맥 PI와 RI는 혈청 estradiol 농도과 의미 있는 음의 상관관계 (p<0.05)를 보였으며 자궁혈류량은 임신된 그룹과 임신 되지 않은 그룹에서 차이가 없었다. 임신율은 PI가 3.0 이상인 군에서 PI가 3.0 이하인 군보다 조금 높게 측정되었으나 통계학적인 유의성은 없었다. 결 론: 배아이식일의 자궁동맥 PI와 RI는 체외수정술에서 임신의 예측인자로는 효용성이 떨어지지만 estradiol 농도와는 음의 상관관계를 보여 자궁혈류와 estradiol 농도가 상관관계가 있음을 알 수 있다.

• 한국가축번식학회지
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• 제18권2호
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• pp.141-150
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• 1994

전자현미경에 의해 자궁부착 전후의 돼지 수정란의 형태형성 및 분화에 따른 배발생 과정을 검토하였다. 돼지 초기배는 자궁이주후 균일하게 자궁에 배분되기전 약 2~3일간은 자궁각의 proximal portion에 존재하며, 임신 4일째에 할구와 할구의 경계를 상실하는 tight한 gap junction을 가진 상실배로 발달한다. 배반포를 형성하는 시기에 estradiol 17$\beta$는 compact한 상실배를 cavitated blastocyst로 발달을 촉진시키면서, steroid hormone이 이후의 배발생을 지배한다. Hatching의 시기는 교배후 6~7일경 zona pellucida을 둘러사고 있는 glycoprotein의 thinning과 lysis에 의해 이루워지는데, hatching 과정은 embryo의 세포수와 무관하였으며, 이때의 embryo의 직경은 0.5~1.0mm인 것을 본 실험에서 확인하였다. 12일경부터는 embryo는 prostaglandins, IGF-binding protein, retinol binding protein, plasminogen activator등의 단백질이 풍부해 이들 인자가 elongation 개시 후보로 고려될 수 있었다. 또한 이 시기의 embryo는 embryonic disc로 발달시 progesterone과 estrogen을 estradiol 17$\beta$로 전활할 수 있으며, 이러한 변화와 함께 spherical stage로부터 tubular 혹은 filamentous form으로 변형되었다. Estrogen이 임신을 통해 prostagladins의 분비를 uterine lumen에 지시하는지는 알 수 없으나 13일 경을 전후해 conceptus estrogen이 uterine arterial blood flow, uterine vasular permeability을 증가시키는 것으로 나타났으며, 자궁에서 protein과 calcium, PGF2$\alpha$, plasminogen inhibitor를 증가시키는 것으로 나타났다. 이 시기의 자궁 변화와 함께 embryo의 attachment는 trophoblast와 uterine membrane사이의 느슨한 결합에 의해 개시되었으며, 18일경 uterine과 trophoblastic microvili의 interdigitation에 의해 완성된다. 이 시기에 conceptus attachment를 위해 필요한 uterine microvili에서의 glycocalyx의 형성과 endometrial epithelium의 erosion을 야기하기 위해 plasminogen activator을 분비하였으며, 반면 자궁에서 plasminogen 역할을 하는 것은 estrogen이며, blastocyst cell 표면의 lectin binding이 attachment에 중요한 역할을 한다. 이상과 같은 일련의 과정을 거친 초기배는 성공적인 임신으로 유도된다고 본다. 따라서, 본 연구는 이상과 같이 착상을 전후한 시기의 배를 전자현미경에 의해 형태형성의 변화를 특히 착상을 전후해 배 취사율이 높은 시기를 대상으로 분석하였다. 이 분석 시기중 성공적인 착상성공율은 56%(71/126)였다.

• Journal of Yeungnam Medical Science
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• 제22권1호
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• pp.43-51
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• 2005

자궁경부 종괴형 자궁경부임신은 빠른 진단과 치료를 요하는 산과적 응급 상황으로 특징적인 초음파 및 MRI 소견을 정확하게 숙지하고 있어야 한다. 특징적인 초음파 소견으로는 혈중 ${\beta}$-HCG 수치가 상승되어 있는 환자에서 자궁경부의 확장, 심하게 불균일한 종괴, 색도플러 검사에서 강한 혈류, 영양막주위 혈류 양상 등이 있다. 특징적인 MRI 소견으로는 자궁경부의 종대, T2-강조영상에서 심하게 불균일한 혼합 신호강도, 가장자리의 저신호강도의 띠, 조기에 강하게 조영증강되는 결절성 부분 등이 있다.

• Journal of Yeungnam Medical Science
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• 제35권1호
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• pp.84-88
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• 2018

A 33-year-old woman visited the emergency department presenting with fever and dyspnea. She was pregnant with gestational age of 31 weeks and 6 days. She had dysuria for 7 days, and fever and dyspnea for 1 day. The vital signs were as follows: blood pressure 110/70 mmHg, heart rate 118 beats/minute, respiratory rate 28/minute, body temperature $38.7^{\circ}C$, and oxygen saturation by pulse oximetry 84% during inhalation of 5 liters of oxygen by nasal prongs. Crackles were heard over both lung fields. There were no signs of uterine contractions. Chest X-ray and chest computed tomography scan showed multiple consolidations and air bronchograms in both lungs. According to urinalysis, there was pyuria and microscopic hematuria. She was diagnosed with community-acquired pneumonia and urinary tract infection (UTI) that progressed to severe sepsis and acute respiratory failure. We found extended-spectrum beta-lactamase producing Escherichia coli in the blood culture and methicillin-resistant Staphylococcus aureus in the sputum culture. The patient was transferred to the intensive care unit with administration of antibiotics and supplementation of high-flow oxygen. On hospital day 2, hypoxemia was aggravated. She underwent endotracheal intubation and mechanical ventilation. After 3 hours, fetal distress was suspected. Under 100% fraction of inspired oxygen, her oxygen partial pressure was 87 mmHg in the arterial blood. She developed acute kidney injury and thrombocytopenia. We diagnosed her with multi-organ failure due to severe sepsis. After an emergent cesarean section, pneumonia, UTI, and other organ failures gradually recovered. The patient and baby were discharged soon thereafter.

• Journal of Acupuncture Research
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• 제39권3호
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• pp.182-189
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• 2022

To evaluate the effectiveness of electroacupuncture treatment for primary dysmenorrhea (PD), a literature review of a randomized controlled trials (RCTs) was performed where electroacupuncture was used as a treatment intervention in patients diagnosed with PD. Relevant clinical studies (N = 226) were retrieved from multiple databases according to the study inclusion/exclusion criteria, and interventions and outcomes were analyzed. As a result of the review, there were 6 RCTs which met the criteria. In all 4 studies that measured pain indicators (visual analog scales), electroacupuncture showed significantly positive changes. In addition, positive changes were observed in most indicators (MMDQ, PGF2a, PGE2, 6-keto PGF1, TXB2, clinical efficacy score, uterine arterial blood flow parameters, and blood viscosity). 2 studies showed that electroacupuncture had a stronger therapeutic effect than NSAIDs. No major side effects were reported. Electroacupuncture may be an effective and safe treatment for PD however, further RCTs are required.

• 셀메드
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• 제13권14호
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• pp.19.1-19.16
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• 2023

Objectives: To compare the efficacy of polyherbal Unani formulations in heavy menstrual bleeding due to endometrial hyperplasia. Methodology: A prospective, randomized comparative trial was conducted at Govt. Nizamia Tibbi College. Group A (n=20) received Itrifal Aftimoon 5g orally BID from menstruation day 3 to day 21 plus suprapubic Marham Dakhilyun application and per vaginally Marham Dakhilyun (5g) and Roghan Gul (10ml) application from menstruation day 5 to day 14. Group B (n=20) received Gulnar Farsi (2g), Phitakri Biryan (0.25g), Dammul Aqwain (0.25g), and Geru (2g), 2.5g powder orally BID, menstruation day 3 for 20 days plus Douche Bargh Sambhalu then Ḥamūl of Safuf Mazu (2g), Kalijiri (2g) and Roghan Gul (10ml) from menstruation day 3 to day 12 for 3 consecutive cycles. The primary outcome was pelvic ultrasound findings of endometrial thickness. The secondary outcome measures were improvement in haemoglobin percentage, change in menstrual flow and menstrual pattern. The level of significance was 5%. Results and conclusion: The intragroup comparison showed that the mean endometrial thickness at baseline and after treatment in groups A and B was extremely significantly different (P<0.0001). The intragroup comparison showed the mean haemoglobin percent at baseline and after treatment in group, A was significantly different (P<0.0001). After treatment, 50% and 60% of participants had normal duration and menstrual blood loss after treatment from baseline in Groups A and B respectively. However, further, phase II and III randomized standard controlled trials in larger samples are recommended to assess the efficacy of these group medicines.