ADVANCES IN OBSTETRICS AND GYNECOLOGY

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<Objective> To evaluate results of laparoscopic management of ovarian tumors during pregnancy, and compare them with results obtained using laparotomy. <Methods> During January 2001 - May 2009, 6 pregnant patients underwent laparoscopic management of ovarian tumors under general anesthesia; 28 pregnant patients underwent laparotomy of ovarian tumor with spinal anesthesia. Tumor size, gestational age at the time of surgery, operation time, blood loss, hospital stay duration and CRP value on post operation day 1 were evaluated. <Result> In the laparoscopic management group, tumor sizes were 5-13 cm (mean 7.6 cm), gestational ages at the time of surgery were 10-16 weeks (mean 13 weeks), operating times were 39-117 min (mean 84.2min) and hospital stays after surgery were 5-8 days (mean 6.3 days). Blood loss was slight in all cases. CRP value on post operation day1 were 0.21-1.24 (mean 0.83). In the laparotomy group, tumor sizes were 4.9-17.6 cm (mean 8.6 cm), gestational ages were 10-22 weeks (mean 15 weeks), operating times were 29-112 min (mean 57.7 min), blood losses were low-277 g (mean 76.5 g), hospital stays after surgery were 6-11 days (mean 8.9 days) and CRP value post operation day1 were 0.14-5.27 (mean 1.82). Statistically significant differences between the two groups were found in blood loss, hospital stay after the surgery and CRP value on post operation day1. <Conclusion> Laparoscopic management of ovarian tumor during pregnancy is useful in appropriate cases. [Adv Obstet Gynecol, 62 (1) : 1-6, 2010 (H22.2)]

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Pregnancy in a rudimentary uterine horn is an extremely rare and serious condition associated with uterine rapture and increased maternal morbidity. We reported a case of rudimentary uterine horn pregnancy which could be diagnosed and managed before rupture. A 23-year-old primigravida woman was suspected as an ectopic pregnancy and referred to our hospital at 12 weeks of pregnancy. Using transvaginal sonography (TV-USG) we observed thick endometrium without gestational sac in her uterus and large tumor on the left side of the uterus. We found large gestational sac with live fetus of 12 weeks of pregnancy in the tumor. The wall of the tumor was 1.37cm thick and showed the same density as a myometrium. Magnetic resonance imaging (MRI) revealed no communication between endometrium and gestational sac. She was diagnosed as rudimentary uterine horn pregnancy and laparotomy was performed at 13 weeks of pregnancy. We found the 8cm tumor and numerous convoluted vessels were observed on the surface of the tumor. We removed rudimentary uterine horn including the fetus and repaired with two layers. During operation we did not detect the communication between uterine cavity and the tumor using dye infusion from the uterine cervix.Using TV-USG and MRI we diagnosed rudimentary uterine horn pregnancy before rupture and successfully managed. [Adv Obstet Gynecol, 62 (1) : 7-10, 2010 (H22.2)]

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