Journal of Yeungnam Medical Science

Case report

Atypical presentation of DeBakey type I aortic dissection mimicking pulmonary embolism in a pregnant patient: a case report: Sou Hyun Lee, Ji Hee Hong, Chaeeun Kim; J Yeungnam Med Sci. 2024;41(2):128-133. Published online February 5, 2024; DOI: https://doi.org/10.12701/jyms.2023.01319

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Abstract PDF: Aortic dissection in pregnant patients results in an inpatient mortality rate of 8.6%. Owing to the pronounced mortality rate and speed at which aortic dissections progress, efficient early detection methods are crucial. Here, we highlight the importance of early chest computed tomography (CT) for differentiating aortic dissection from pulmonary embolism in pregnant patients with dyspnea. We present the unique case of a 38-year-old pregnant woman with elevated D-dimer and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, initially suspected of having a pulmonary embolism. Initial transthoracic echocardiography did not indicate aortic dissection. Surprisingly, after an emergency cesarean section, a chest CT scan revealed a DeBakey type I aortic dissection, indicating a diagnostic error. Our findings emphasize the need for early chest CT in pregnant patients with dyspnea and elevated D-dimer and NT-proBNP levels. This case report highlights the critical importance of considering both aortic dissection and pulmonary embolism in the differential diagnosis of such cases, which will inform future clinical practice.

Original article

Depression, sleep quality, and body image disturbances among pregnant women in India: a cross-sectional study: Kranti S. Kadam, Aditya R. Anvekar, Vishnu B. Unnithan; J Yeungnam Med Sci. 2023;40(4):394-401. Published online May 9, 2023; DOI: https://doi.org/10.12701/jyms.2023.00087

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Abstract PDF: Background
Pregnancy is associated with a number of physical, emotional, and biological changes that can exacerbate maternal psychological disturbances, such as body image concerns and depression. Sleep disturbances during pregnancy can also have adverse impacts. This study aimed to determine the prevalence of depression, sleep disturbances, and body image concerns among pregnant women. The study also examined the relationship between these factors and pregnancy-related variables, such as bad obstetric history and whether the pregnancies were unplanned.
Methods
A cross-sectional study of 146 pregnant patients was conducted at a tertiary care center over 15 months. The patients were administered the Beck Depression Inventory, Pittsburgh Sleep Quality Index, and Body Image Concern Inventory questionnaires. Contingency tables, Fisher exact test, and Spearman correlation were used to identify underlying relationships.
Results
The prevalence of depression was 22.6%. Although body image disturbance was noted in only 2.7% of patients, 46.6% had poor sleep quality. Poor sleep was associated with primigravida status. Bad obstetric history and unplanned pregnancy were associated with depression. Depression was found to be significantly correlated with body image disturbances and poor sleep quality.
Conclusion
Psychiatric disorders were prevalent during pregnancy. This study highlights the importance of screening for depression in pregnant patients. Counselling and caregiver education can be useful for mitigating psychological disturbances. Management of pregnancies by multidisciplinary teams that include psychiatrists could be immensely useful in improving the pregnancy experiences of patients.

Case reports

Cushing syndrome in pregnancy, diagnosed after delivery: Han Byul Kim, Mi Kyung Kim, El Kim, Keun Soo Ahn, Hye Soon Kim, Nam Kyung Kim; Yeungnam Univ J Med. 2021;38(1):60-64. Published online May 22, 2020; DOI: https://doi.org/10.12701/yujm.2020.00290

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Abstract PDF

Cushing syndrome (CS) is rare in pregnancy, and few cases have been reported to date. Women with untreated CS rarely become pregnant because of the ovulatory dysfunction induced by hypercortisolism. It is difficult to diagnose CS in pregnancy because of its very low incidence, the overlap between the clinical signs of hypercortisolism and the physiological changes that occur during pregnancy and the changes in hypothalamus-pituitary-adrenal axis activity that occur during pregnancy and limit the value of standard diagnostic testing. However, CS in pregnancy is associated with poor maternal and fetal outcomes; therefore, its early diagnosis and treatment are important. Here, we report two patients with CS that was not diagnosed during pregnancy, in whom maternal and fetal morbidity developed because of hypercortisolism.

Citations

Citations to this article as recorded by

Endogenous Cushing’s syndrome during pregnancy
Nada Younes, Matthieu St-Jean, Isabelle Bourdeau, André Lacroix
Reviews in Endocrine and Metabolic Disorders.2023; 24(1): 23. CrossRef
Cushing Syndrome in Pregnancy: A Case Presentation and Review of Literature
HamidReza Samimagham, Ava Ziaei, Mohammad Tamaddondar, Mitra Kazemi Jahromi
Journal of Kermanshah University of Medical Sciences.2023;[Epub] CrossRef

Spontaneous resolution of serous retinal detachment caused by choroidal mass after a first trimester abortion: You Hyun Lee, Yu Cheol Kim; Yeungnam Univ J Med. 2020;37(3):242-245. Published online April 6, 2020; DOI: https://doi.org/10.12701/yujm.2020.00087

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Abstract PDF

Pregnancy-related ocular diseases develop mostly in the third trimester of pregnancy. Here, we describe a case of a pregnant woman with a choroidal mass that caused a serous retinal detachment during the first trimester of pregnancy. The patient’s condition resolved spontaneously after an abortion.

Citations

Citations to this article as recorded by

Clinical features and therapeutic management of choroidal osteoma: A systematic review
Li Zhang, Qi-Bo Ran, Chun-Yan Lei, Mei-Xia Zhang
Survey of Ophthalmology.2023; 68(6): 1084. CrossRef
FPR2 serves a role in recurrent spontaneous abortion by regulating trophoblast function via the PI3K/AKT signaling pathway
Anna Li, Shuxian Li, Chongyu Zhang, Zhenya Fang, Yaqiong Sun, Yanjie Peng, Xietong Wang, Meihua Zhang
Molecular Medicine Reports.2021;[Epub] CrossRef

Original article

Clinical factors that affect the pregnancy rate in frozen-thawed embryo transfer in the freeze-all policy: Seo Yoon Hwang, Eun Hye Jeon, Seung Chul Kim, Jong Kil Joo; Yeungnam Univ J Med. 2020;37(1):47-53. Published online September 27, 2019; DOI: https://doi.org/10.12701/yujm.2019.00346

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Abstract PDF

Background
This study was conducted to analyze clinical factors that can affect pregnancy rates in normal responders undergoing the freeze-all policy in in vitro fertilization.
Methods
We evaluated 153 embryo transfer cycles in 89 infertile women with normal response to controlled ovarian stimulation (COS). After COS, all embryos were cultured to the blastocyst stage, and good quality blastocysts were vitrified for elective frozen-thawed embryo transfer (FET). Clinical variables associated with COS and the results of COS and culture, including the number of retrieved oocytes, fertilized oocytes, and frozen blastocysts were compared between the pregnant group and the non-pregnant group.
Results
After a single cycle of COS for each patient, 52 patients became pregnant while 37 did not. Significant differences were observed in the number of matured oocytes, fertilized oocytes, frozen blastocysts, and transferred embryos. The number of frozen blastocysts in the pregnant group was almost twice that in the non-pregnant group (5.6±3.1 vs. 2.8±1.9, p<0.001). The area under the receiver operating characteristic curve for the 4 frozen blastocysts was 0.801 in the pregnant group.
Conclusion
In the freeze-all policy, the number of matured oocytes, number of fertilized oocytes, and number of frozen blastocysts might be predictive factors for pregnancy.

Citations

Citations to this article as recorded by

Even high normal blood pressure affects live birth rate in women undergoing fresh embryo transfer
Huijun Chen, Xiaoli Zhang, Sufen Cai, Jian Li, Sha Tang, Carl-Friedrich Hocher, Benjamin Rösing, Liang Hu, Ge Lin, Fei Gong, Bernhard K Krämer, Berthold Hocher
Human Reproduction.2022; 37(11): 2578. CrossRef

Case report

Isolated tubal torsion in the third trimester of pregnancy managed with simultaneous salpingectomy and cesarean section: Seong Nam Park; Yeungnam Univ J Med. 2019;36(1):59-62. Published online December 14, 2018; DOI: https://doi.org/10.12701/yujm.2019.00024

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Abstract PDF

Isolated tubal torsion is an uncommon cause of acute abdomen in pregnancy. Tubal torsion may occur in the absence of adnexal disease. Diagnosing tubal torsion is especially difficult in pregnancy because no precise preoperative radiological and biochemical investigations have been conducted. Most patients are diagnosed during surgery. Here, we present a case of isolated tubal torsion in a pregnant woman at 35 weeks and 6 days of gestation that was managed with salpingectomy and cesarean section simultaneously.

Citations

Citations to this article as recorded by

Adnexal torsion in pregnancy: A systematic review of case reports and case series
Hamidreza Didar, Hanieh Najafiarab, Amirreza Keyvanfar, Bahareh Hajikhani, Elena Ghotbi, Seyyedeh Neda Kazemi
The American Journal of Emergency Medicine.2023; 65: 43. CrossRef
Isolated Tubal Torsion in a Term Pregnancy: Case Report and Systematic Review of Literature of the Last 10 Years
Ferdinando Antonio Gulino, Carla Ettore, Gianfranco Morreale, Stefano Siringo, Emanuele Russo, Marco D'Asta, Francesco Cannone, Giuseppe Ettore
Frontiers in Surgery.2022;[Epub] CrossRef
Laparoscopic surgery for fallopian tube torsion due to benign tumour in the third trimester of pregnancy: a case report and literature review
Jae Yoon Jo, In Ae Cho, Jeong Kyu Shin, Soon Ae Lee, Won Jun Choi
Journal of Obstetrics and Gynaecology.2022; 42(7): 2566. CrossRef

Case Reports

A successful management after preterm delivery in a patient with severe sepsis during third-trimester pregnancy: Moni Ra, Myungkyu Kim, Mincheol Kim, Sangwoo Shim, Seong Yeon Hong; Yeungnam Univ J Med. 2018;35(1):84-88. Published online June 30, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.1.84

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Abstract PDF: 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℃, 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.

Successful delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a twin pregnancy: Yu-Jin Koo; Yeungnam Univ J Med. 2018;35(1):135-139. Published online June 30, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.1.135

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Abstract PDF: There has been a significant increase in the number of multiple pregnancies that are associated with a high risk of preterm delivery among Korean women. However, to date, delayed-interval delivery in women with multiple pregnancy is rare. We report a case of delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a dichorionic diamniotic twin pregnancy. The patient presented with vaginal leakage of amniotic fluid at 16 weeks of gestation and was diagnosed with a preterm premature rupture of membranes. Three days later, the first twin was delivered, but the neonate died soon after. The second twin remained in utero, and we decided to retain the fetus in utero to reduce the morbidity and mortality associated with a preterm birth. The patient was managed with antibiotics and tocolytics. Cervical cerclage was not performed. The second twin was delivered vaginally at 34 weeks and 5 days of gestation, 128 days after the delivery of the first-born fetus. This neonate was healthy and showed normal development during the 1-year follow-up period. Based on our experience with this case, we propose that delayed-interval delivery may improve perinatal survival and decrease morbidity in the second neonate in highly selected cases.

A Case of Spontaneous Uterine Rupture of the Unscarred Uterus in 14 Weeks Gestation.: Jeong Suk Kim, Jin Hee Kim, Yeun Kyoung Bae, Yoon Ki Park; Yeungnam Univ J Med. 2004;21(2):251-255. Published online December 31, 2004; DOI: https://doi.org/10.12701/yujm.2004.21.2.251

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Abstract PDF: Spontaneous uterine rupture of the unscarred uterus during the second trimester of pregnancy is rare, but it is a surgical emergency. Because it results in rapid deterioration of patient and high mortality despite of prompt operation and massive transfusion, early diagnosis and proper management are critical for optimizing patient care. We present a case of spontaneous uterine rupture with fetal death in 14 weeks gestation with a brief review of literatures.

Three cases of symphysis pubis separation associated with delivery.: Jae Hong Ahn, Young Jin Jang, Dong Hyuk Lee, Young Gi Lee, Yoon Ki Park; Yeungnam Univ J Med. 2000;17(1):93-98. Published online June 30, 2000; DOI: https://doi.org/10.12701/yujm.2000.17.1.93

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Abstract PDF: Symphysis pubis separation is an uncommon but not rare complication of delivery. Characteristic symptoms of symphyseal separation include suprapubic pain and tenderness which radiate to the back or legs, difficult ambulation, and bladder dysfunction. Clinical history, presenting symptoms, and response to therapy are sufficient to make the diagnosis, although radiographic documentation of symphyseal separation by x-ray or ultrasound are frequently used to confirm the diagnosis. The underlying etiology of symptomatic symphyseal separation has not been fully elucidated. Associations with macrosomia, pathological joint loosening, and increased force placed on the pelvic ring have been suggested as possible etiologies. Conservative therapy, including bed rest, pelvic binders, ambulation devices, and mild analgesics usually result in complete recovery within 4-16 weeks. Our experience of three cases of peripartum symphysis pubis separation delivered from 1998 to 1999 were reviewed with related articles.

A case of Adnexal Torsion in Pregnancy.: Kwang Young Hwang, Kyung Sook Jeon, Bong Gyu Lee, Eun Ji Lee, Tae Hyung Lee, Min Whan Koh; Yeungnam Univ J Med. 1999;16(1):137-140. Published online June 30, 1999; DOI: https://doi.org/10.12701/yujm.1999.16.1.137

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Abstract PDF: Adnexal torsion is not a common surgical emergency in Obstetrics and Gynecology. and is not observed frequently during pregnancy with its incidence being one out of about 5,000 pregnancies: Pregnancy is a factor that encourages torsion. The traditional treatment for ischemic and twisted adnexa consists of oophorectomy or salpingo-oophorectomy. with early diagnosis, a conservative approach is recommended in cases of young women to assure future fertility. with a brief review ofliterature, we report a case of unilateral salphingo-oophorectomy during pregnancy due to adnexal torsion with the delivery of a normal baby.

Two Cases of Combined Pregnancy Following IVF-ET.: Kyung Ah Lee, Yang Soo Kwak, Kuk Sun Han, Min Whan Koh, Tae Hyung Lee; Yeungnam Univ J Med. 1997;14(1):262-268. Published online June 30, 1997; DOI: https://doi.org/10.12701/yujm.1997.14.1.262

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Abstract PDF: Combined intrauterine and ectopic (heterotopic) pregnancy occurs in approximately 1 in 30,000 spontaneous gestations. Heterotopic gestations are increased in women who have had reconstructive pelvic surgery, Pelvic inflammatory disease and artificial ovarian hyperstimulation. Patients who require assisted reproductive technologies, such as in vitro fertilization / embryo transfer and gamete intrafallopian transfer, also have an increased risk of a heterotopic pregnancy. We experienced two cases of combined pregnancy following IVF-ET. Following is a report of these cases with a brief review of references.

Original Articles

Values of Alpha-fetoprotein of Maternal Serum in Normal Pregnancy.: Mok Jin Kim, Kuk Sun Han, Jae Hong An, Jeung Ho Suh, Young Gi Lee, Yoon Kee Park, Tae Hyung Lee; Yeungnam Univ J Med. 1997;14(1):168-174. Published online June 30, 1997; DOI: https://doi.org/10.12701/yujm.1997.14.1.168

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Abstract PDF: Alphafetoprotein(AFP) is a glycoprotein synthesized by the fetus early in gestation by the yolk sac and later by the gastrointestinal tract and liver. The concentration of AFP is highest in fetal serum and amniotic fluid around 13th week, and 32nd week in maternal serum. Some conditions are associated with abnormal maternal serum AFP concentration. For examples, neural tube defects, omphalocele, renal anomalies are associated with elevated maternal serum AFP and fetal death, chromosomal trisomies are associated with low level of maternal serum AFP. So maternal serum AFP screening plays a significant role in assessing candidates for prenatal diagnosis and prenatal counselling in pregnant women. This study evaluates the normal ranges of AFP using enzyme immunoassay in normal pregnant women. We studied 500 normal pregnant women who visited the Department of Obstetrics & Gynecology, Yeungnam Medical Center, Yeungnam University during the period through January, 1993 to September, 1996. The group of the study were selected randomly at various gestational ages from 8 to 41 weeks. The results were summarized as follows: 1. The lowest level of AFP in our study group was 2.1ng/ml at 8 weeks of gestation. Thereafter serum alpha-fetoprotein concentrations rose rapidly to reach a peak value at 32nd week. 2. The mean levels of AFP in the primipara and multipara were 166.37+/-12.06ng/ml, and 223.78+/-14.00ng/ml, respectively, showing stastiscally significant difference between these two groups(p<0.01). 3. The mean levels of AFP between mothers who delivered male and female babies were 192.96+/-13.00ng/ml, and 194.29+/-13.84ng/ml, respectively, without statistically significant difference(p>0.05). 4. The normal ranges of maternal serum AFP according to each gestational week were evaulated.

Insulin Resistance in Late Pregnant Rats.: Myung Heup Chun, Yong Woon Kim, So Young Park, Jong Yeon Kim, Suck Kang Lee; Yeungnam Univ J Med. 1995;12(2):319-330. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.319

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Abstract PDF: The influence of normal late pregnancy on insulin action and insulin secretion was studied in the Sprague-Dawley female rats. On 20th day after mating, intravenous glucose tolerance test(IVGTI) was performed in non pregnant control and pregnant rats. As results of IVGTT, glucose disappearance rate was not significantly different in both groups, but secretory response of insulin was significantly(p<0.05) increased in pregnant rat. And the ratio of insulin/ .glucose was significantly higher in pregnant rats, which means existence of insulin resistance. These insulin resistance was overcomed by increased secretory response of pancreatic insulin. Insulinogenic index( A insulin/glucose - 5 min) was highly significantly (r=0.62, p<0.01) correlated with progesterone concentration. Glycogen level and amounts of "C-glucose incorporated into glycogen after IVGTT were significantly(p<0. 05) decreased in the liver, but were not changed significantly in soleus. Glycogen synthase activity of soleus and liver was not differ significantly in the both groups. Insulin binding at varying concentrations of insulin to crude membrane of pregnant liver was not significantly different from control. In conclusions, although these pregnant rats were normal glucose tolerance due to increased secretory response of insulin, that was correlated with progesterone concentration, pregnant rat had insulin resistance. The mechanisms of insulin resistance were not related to defect of insulin binding phase and glycogen synthase, but suggest pre-receptor and/or postreceptor phase.

Case Report

An aortic dissection in pregnant woman - a case report -.: Hyeong Min Lee, Eun Pyo Hong, Dong Hyup Lee, Jung Cheul Lee, Sung Sae Han, Dong Gu Sin, Young Jo Kim, Bong Sup Shim; Yeungnam Univ J Med. 1993;10(1):253-259. Published online June 30, 1993; DOI: https://doi.org/10.12701/yujm.1993.10.1.253

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Abstract PDF

We have experienced a case of aortic dissecting aneurysm in pregnant woman. She felt initially severe chest pain which was radiated to the neck on the 3days before delivery. Thereafter dyspnea and generalized edema were developed for 1 month after delivery. She was diagnosed as aortic dissectLn, Debakey type-II. During cardiopulmonary bypass, the selective cerebral perfusion was done through the right and left commom carotid arteries. Aortic replacement with Hemashield vascular graft and reimplantation of innominate artery, resuspension of aortic valve, repair of intimal tear were performed. The postoperative course was uneventful.

Citations

Citations to this article as recorded by

A Case of Ascending Aortic Dissection with Severe Aortic Regurgitation Diagnosed by Echocardiography
Sung-Hee Kim, Ok-Kyoung Lee
The Korean Journal of Clinical Laboratory Science.2020; 52(4): 425. CrossRef

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