ADVANCES IN OBSTETRICS AND GYNECOLOGY

In recent years, the smoking rate has been decreasing in men and increasing in women. It is about 20% in pregnant women. Smoking during pregnancy may pose risks such as fetal retardation of growth and premature separation of normally implanted placenta. Conventional antismoking guidance is insufficient in its effects. Thus our hospital launched a brief (about 2.5 minutes) antismoking session called "Light" to encourage more outpatient smokers to quit smoking. We compared the success rate of smoking cessation between the Light session and the antismoking outpatient service to find effective methods for antismoking guidance. In pregnant women, the success rate was 27.8% in the Light session and 88.9% in the antismoking outpatient service. The guidance time required for a pregnant woman to quit smoking was 9 minutes in Light and 101 minutes in the outpatient service. The number of pregnant women who successfully quit smoking per hour of antismoking guidance was 6.7 in Light and 0.6 in the outpatient service. Therefore, even brief antismoking guidance such as Light can be effective. Light is a model of antismoking guidance applicable to busy clinical practice. Combining Light with the antismoking outpatient service and other antismoking measures will encourage more smokers to quit smoking. [Adv Obstet Gynecol, 59 (2) : 71-76, 2007 (H19.5)]

View full abstract

Show abstractHide abstract

Endometrial thickness is an extremely important factor when undergoing ET during the HRT cycle. The traditional treatment for thickening the endometrium has been the oral administration of conjugated estrogens (Premarine(R)). Recently however positive results have been obtained by replacing this treatment with percutaneous absorption of estradiol using estradiol (Femiest(R)).
In this study, we report on 3 cases involving an improvement of endometrial thickness under HRT after changing treatment from oral administration to percutaneous absorption.
Case 1: 37 y.o. patient with ovarian dysfunction. Conjugated estrogens were administered during the HRT cycle. Endometrial thickness at time of ET was only 5.4mm. We therefore cancelled all treatment. We changed to a treatment of percutaneous absorption from the next cycle. After this change in treatment, endometrial thickness increased to 8.0mm. Following treatment, this patient successfully became pregnant.
Case 2: 31 y.o. patient with tubal factor. We administered hMG by step down method; however endometrial thickness at time of ET was only 7.5mm. We therefore cancelled all treatment, changing to percutaneous absorption from the next cycle. After this change in treatment, endometrial thickness increased to 8.8mm. Following treatment, this patient successfully became pregnant.
Case 3: 38 y.o. patient with ovarian dysfunction, partner with male infertility factor. We started administering conjugated estrogens, however the endometrial thickness at ET was only 6.7mm. We therefore cancelled all treatment, again changing to percutaneous absorption from the next cycle. After this change in treatment, endometrial thickness increased to 9.1mm. Following treatment, this patient successfully became pregnant.
The above examples suggest that estradiol percutaneous absorption using estradiol may indeed be a more effective treatment for increasing the thickness of the endometrium during HRT than estradiol oral administration using conjugated estrogens. More study however is necessary to confirm these conclusions.[Adv Obstet Gynecol,59 (2):77-81,2007 (H19.5)]

View full abstract

Download PDF (470K)

Here we report a case of giant aborting myoma that was hard to diagnose. The patient, a 37-year-old woman, gravida 0, para 0, visited a previous doctor with a complaint of being wracked with fever (about 38.5 °C) for one week. She was referred to our clinic because of a tumor emerging from the vaginal ostium.
About 2 cm of degenerative tumor was seen emerging from the vaginal ostium and was revealed to be a giant tumor in the vagina. About 200 ml of bloody pus flowed out from the vaginal cavity that the tumor occupied. Anemia (Hb7.1g/dl), severe inflammation (WBC10500/μl, neutrophil fraction 84.5%), and slightly high blood SCC (2.1ng/ml) were observed. Magnetic resonance imaging (MRI) and ultrasonography (USG) revealed an intra-vaginal giant tumor between the uterine body and the vaginal ostium, but these images could not clarify the relationship between the uterine body and the tumor. After 3 days from admission, an enema for constipation caused the entire caulescent tumor to break out of the vagina with genital bleeding. On this point, we diagnosed the tumor as a giant aborting myoma. Immediately, vaginal myomectomy was performed with a blood transfusion of 3 units of MAPs because of massive genital bleeding. Pathological findings revealed degenerative leiomyoma. After 2 months, MRI revealed no obvious myoma and no abnormality in the uterus. The patient is receiving follow-up treatment as an outpatient at the hospital, and she has no complaints of menstrual abnormalities. [Adv Obstet Gynecol, 59(2) : 82-86 ,2007 (H19.5)]

View full abstract

Register with J-STAGE for free!