ObjectiveThe aim of this study is to describe the clinical characteristics and outcome of cancer diagnosed during pregnancy.MethodsThis is a retrospective cohort study of women who were diagnosed with cancer during pregnancy at a tertiary academic hospital between 1995 and 2013. Maternal characteristics, gestational age at diagnosis, and type, stage, symptoms and signs of cancer for each patient were retrieved from the medical records. The cancer treatment, pregnancy management and the subsequent perinatal and maternal outcomes for each cancer were assessed.ResultsA total of 87 women were diagnosed with cancer during pregnancy (172.6 cases per 100,000 deliveries). The most common cancer was breast cancer (n=20), followed by gastrointestinal (n=17), hematologic (n=13), thyroid (n=11), central nervous system (n=7), cervical (n=7), ovarian (n=5), lung (n=3), and other cancers (n=4). Eighteen (20.7%) patients terminated their pregnancies. In the 69 (79.3%) patients who maintained their pregnancies, one patient miscarried and 34 patients delivered preterm. Of the preterm babies, 24 (70.6%) were admitted to the neonatal intensive care unit and 3 (8.8%) of those expired. The maternal mortality rate was 31.0%, with highest rate seen with lung cancers (66.7%), followed by gastrointestinal (50.0%), central nervous system (50.0%), hematologic (30.8%), breast (25.0%), ovarian (20.0%) cervical (14.3%), and thyroid cancers (0%).ConclusionThe clinical characteristics and outcome of cancer during pregnancy were highly variable depending on the type of cancer. However, timely diagnosis and appropriate management of cancer during pregnancy may improve both maternal and neonatal outcome.

The aim of this study, carried out before the beginning of human papillomavirus (HPV) vaccinations as a National Immunization Program (NIP) in Korea in 2016, is to assess the ranges of perceptions and personal experience and their influences on attitudes regarding HPV vaccinations of children, among mothers of adolescent (9–14 years of age) daughters in Korea. From November 2015 to February 2016, we distributed a written questionnaire to mothers who had daughters aged 9–14 years. The questionnaire consisted of several questions, related to knowledge of HPV, personal experiences of HPV vaccination, and attitudes toward HPV vaccinations of their adolescent daughters. Of the 260 questionnaires distributed, 140 participants returned answered ones. And although only 51% of participants were aware that cervical cancer is highly related with HPV infection, 70% said they were willing to vaccinate their daughters, showing that awareness does not coincide with intention to vaccinate. Among the participants showing negative attitudes, 50% were concerned about the vaccination side effects. The more the participants’ pre-knowledge about HPV infection, and about the relationship of HPV to cervical cancer, the more positive their attitudes (P = 0.002, P < 0.001). Our study showed that, as the level of education rose, the proportion of mothers with negative attitudes toward vaccinating their adolescent daughters rose as well. Thus, the provision of correct education by health care providers and accurate information through active advertising may play an important role in increasing the vaccination rate among adolescent girls in Korea.

Clear cell adenocarcinoma (CCAC) of uterine cervix is very rare tumor and only 4%-9% of entire adenocarcinoma appears to be diagnosed as clear cell type. Risk factors and pathogenesis of this disease are not exactly revealed. The intrauterine exposure to diethylstilbestrol (DES) and associated non-steroidal estrogen during pregnancy before 18 weeks is the only known risk factor, and also hormonal changes or genetic causes are suggested as the risk factors. We report a case of CCAC in the uterine cervix of 52-year-old virgin who had never been exposed to DES, with a brief review of related literature. Copyright © 2012. Korean Society of Obstetrics and GynecologyClear cell adenocarcinoma (CCAC) of the uterine cervix is a rare disease accounting for only 4% of all adenocarcinomas of the uterine cervix. Though the etiology and pathogenesis are not clear, several studies have linked the occurrence of vaginal CCAC in young women with intrauterine exposure to the synthetic nonsteroidal estrogenic hormone, diethylstilbestrol (DES). Other factors reported to be associated with the development of CCAC are microsatellite instability, human papillomavirus infection, bcl-2 protein overexpression, and p53 gene mutation. CCAC is refractory to chemotherapy or radiation therapy, and its prognosis is poorer than that of squamous cell carcinoma of the same organ. We experienced a case of CCAC in the uterine cervix of 52-yearold virgin who had never been exposed to DES and report this case with a brief review of related literature. Case ReportA 52-year-old woman had suffered vaginal spotting for about 3 months. She visited a local gynecologist and liquid based cytology (Papanicolaou smear) was done at uterine cervix by the gynecologist. The cytology showed atypical endocervical cells that favored neoplastic changes, which then she was referred to our outpatient department for further evaluation and management. She had no history of coitus and had never been exposed to in utero exogenous steroid hormone. The vaginal examination and inspection showed caulifl ower-like mass of the cervix (Fig. 1). On rectal examination, the left parametrium was free and right parametrium was moderately thickened. High-risk human papillomavirus (hrHPV) test at uterine cervix done by hybrid capture II was negative. Histological diagnosis by punch biopsy was CCAC of the uterine cervix. Magnetic resonance imaging showed a solid mass, 1.6×2.9×2.5 cm in diameter (Fig. 2). This solid mass was protruding from the posterior lip of the cervix and extending to the upper vagina. Positron emission tomography-computed tomography was also performed, and there was evidence of tumor expansion neither to parametrium nor to endometrium. No involvement of pelvic and para-aortic lymph nodes was found. Parameters from blood chemistry studies and the levels of tumor markers were all CASE REPORT Korean J Obstet Gynecol 2012;55(3):192-196 http://dx

ObjectiveTo investigate the neonatal outcome according to the gestational age at delivery and to determine the optimal timing for delivery in uncomplicated monochorionic and dichorionic twin pregnancies.MethodsThis is a retrospective cohort study of women with uncomplicated twin pregnancies delivered at or beyond 35 weeks of gestation from 1995 to 2013. The primary outcome was neonatal composite morbidity, which was defined as when either one or both twins have one or more of the followings: fetal death after 35 weeks gestation, admission to neonatal intensive care unit, mechanical ventilator requirement, respiratory distress syndrome and neonatal death. To determine the optimal gestational age for delivery according to chorionicity, we compared the neonatal composite morbidity rate between women who delivered and women who remained undelivered at each gestational week in both monochorionic and dichorionic twin pregnancies.ResultsA total of 697 twin pregnancies were included (171 monochorionic and 526 dichorionic twins). The neonatal composite morbidity rate significantly decreased with advancing gestational age at delivery and its nadir was observed at 38 and ≥39 weeks of gestation in monochorionic and dichorionic twins, respectively. However, the composite morbidity rate did not differ between women who delivered and women who remained undelivered ≥36 and ≥37 weeks in monochorionic and dichorionic twins, respectively.ConclusionOur data suggest that the optimal gestational age for delivery was at ≥36 and ≥37 weeks in uncomplicated monochorionic and dichorionic twin pregnancies, respectively.

Uterine arteriovenous malformation (AVM) is a rare entity in gynecology with fewer than 100 cases reported in the literature. Due to abnormal connection between arteries and veins without an intervening capillary system, recurrent and profuse vaginal bleeding is the most common symptom which can be potentially life-threatening. Uterine AVM can be either congenital or acquired. Acquired AVM is reported as a consequence of previous uterine trauma such as curettage procedures, caesarean section or pelvic surgery. It is also associated with infection, retained product of conception, gestational trophoblastic disease, malignancy and exposure to diethlystilboestrol. We herein report a case of acquired uterine AVM located on the right lateral wall after intrauterine instrumentation for laparoscopic left salpingectomy due to left tubal pregnancy. The patient was successfully treated with embolization.

Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.

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