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Objective: To investigate the effect of ramosetron after gynecological laparoscopic surgery on the recovery of bowel function. Methods: A prospective randomized controlled trial conducted at Kyung Hee University hospital, South Korea, from August 2016 to September 2017. Patients were randomized to receive either 10 mg dexamethasone before induction of anesthesia (control group C), followed by intravenous administration of patient-controlled analgesia (IV-PCA) or 2 ml normal saline before induction of anesthesia and 0.6 mg ramosetron (study group R) administered with IV-PCA. Results: A total of 88 patients were enrolled. Times to first flatus (group C 23.98 ± 6.31 vs. group R 27.14 ± 9.56 h; P = 0.148) and first defecation (group C 36.16 ± 16.04 vs. group R 43.41 ± 20.01 h; P = 0.138) showed no statistically significant differences. No significant differences were observed in the frequency of postoperative nausea and vomiting (PONV) and demand for additional analgesics. Multiple linear regression for analysis of factors affecting time to first flatus revealed no significant results. Conclusion: Ramosetron did not delay bowel movement recovery after gynecologic laparoscopic surgery and was as effective as dexamethasone in regulating PONV. Ramosetron can be used with IV- PCA without concerns about delay in recovery of bowel function. Clini calTr ials.gov registration number: NCT02849483. [ABSTRACT FROM AUTHOR]

Aim: To report our initial experience with robotic single‐port myomectomy (RSPM) using the da Vinci SP surgical system and to evaluate the feasibility of the procedure. Material and Methods: This prospective observational study was performed at a university teaching hospital from January 2019 to December 2019. Sixty‐one women with symptomatic fibroids received RSPM. Results: Based on seven resected fibroids and a maximal diameter of resected fibroids <10 cm, the women were arbitrarily divided into two groups. The mean number and maximal diameter of the removed fibroids were 3.7 ± 3.8 (2.3 ± 1.8 in Group 1 vs. 7.2 ± 5.3 in Group 2) and 7.6 ± 2.9 cm (6.8 ± 1.6 in Group 1 vs. 9.5 ± 4.3 in Group 2), respectively. The mean operation time, hemoglobin change, and hospital stay were 149.9 ± 72.9 min (123.8 ± 43.8 in Group 1 vs. 217.6 ± 89.4 in Group 2), 2.3 ± 1.0 g/dL (2.1 ± 0.9 in Group 1 vs. 2.7 ± 1.2 in Group 2), and 4.5 ± 0.8 days (4.4 ± 0.8 in Group 1 vs. 4.7 ± 0.9 in Group 2). There was no conversion to multi‐port laparoscopy or laparotomy nor were there any major complications. Conclusions: RSPM using the da Vinci SP surgical system is feasible surgical modality for women with symptomatic fibroid and is expected to increase indications of single‐port myomectomy by solving many of the ergonomics problems inevitably accompanying single‐port laparoscopic myomectomy. [ABSTRACT FROM AUTHOR]

Study Objective: To identify factors that prolong total operative time (TOT) in robotic-assisted laparoscopic myomectomy (RALM).Design: Retrospective cohort study.Setting: Tertiary university hospital.Patients: Women who underwent RALM between April 2009 and May 2019 conducted by a single high-volume gynecologic surgeon.Interventions: Patients' demographic data and intraoperative records were obtained. The association between the perioperative characteristics and TOT was analyzed.Measurements and Main Results: A total of 584 cases met the inclusion criteria, with a mean TOT of 231.6 ± 86.7 min. The mean patient age was 36.3 ± 5.5 years, and the patients had a mean of 4.2 ± 4.0 myomas. The dominant myoma had a mean diameter of 7.6 ± 2.6 cm. The mean total weight of the extracted myomas removed was 202.2 ± 152.6 g. From multiple regression analysis, the following perioperative factors were intimately associated with the TOT: ① body mass index, ② the number of myomas, ③ weight of total myomas, ④ location of dominant myoma, ⑤ type of da Vinci robot system, ⑥ endometrial cavity opening during the operation, ⑦ intraoperative blood loss, and ⑧ patient hospitalization period. The number of myoma was most closely related to the TOT, with an R2 value of 0.330. All of the above factors with the exception of the type of robot system and location of dominant myoma were related to the console time. Age, parity, history of previous abdominal surgery, surgical indication, diameter, and FIGO classification were not associated with the TOT.Conclusion: With an accurate identification of the perioperative parameters above, we can improve the quality of RALM by counselling, selecting an appropriate patient selection, and preoperative planning. [ABSTRACT FROM AUTHOR]

Background: Although uterine leiomyoma causes many problems, including infertility, there are few studies that have investigated the epidemiologic characteristics of uterine leiomyoma in South Korea. The aim of this study is to estimate the prevalence and incidence of uterine leiomyoma in South Korea and analyze the treatment trends. Materials and Methods: Women of reproductive age (15–54 years) were selected from the Korean National Health Insurance Service (NHIS) sample cohort dataset, which was collected from 2002 to 2013. Patients with uterine leiomyoma were identified by ICD-10 (International Codes of Disease, 10th Edition) and intervention codes. Prevalence and incidence were calculated from the NHIS cohort dataset and the treatment trends were analyzed for diagnosed patients. Results: The prevalence in overall age groups increased from 0.96% in 2002 to 2.43% in 2013, and the 1-year incidences of all age groups increased. The 26–30 age group showed the highest rate of 1-year incidence increase (2.14-folds, 0.33% in 2003 to 0.70% in 2013). The proportion of myomectomy increased from 22% in 2002 to 49% in 2013, whereas the proportion of hysterectomy decreased from 78% to 45%. Conclusions: The prevalence and incidence of uterine leiomyoma are increasing in South Korea as time progresses, and the rate of incidence increase is higher in younger reproductive women. Overall trends in uterine leiomyoma treatment are shifting to the methods of the saving uterus. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the existence of the freshman effect in patients who underwent gynecologic surgery at a teaching hospital by comparing surgical outcomes and morbidity rates between the first academic quarter and other quarters.Methods: All data were collected prospectively. Between January 2015 and March 2018, patients who underwent gynecologic surgeries during the first academic quarter (March, April, and May in Korea) were retrospectively compared with patients who underwent gynecologic surgeries during other academic quarters (June through February). The primary outcome measure was the incidence of operative complication. Secondary outcomes were the operative time, operative blood loss, and length of hospital stay.Results: Among 1241 patients who underwent gynecologic surgery during the study period of 39 months, 1136 patients were analyzed for this study and divided into groups according to the first academic quarter (n = 335) and other academic quarters (n = 801). The baseline characteristics were not different between the groups. No significant difference in operative complications was found between the first and other academic quarters (1.5% versus 3.0%; P = 0.143). Moreover, there was no significant difference in operative time, operative blood loss, and length of hospital stay between the groups.Conclusions: This study did not demonstrate the existence of a "freshman effect", i.e., an increase in morbidity, at a Korean teaching hospital providing gynecologic surgical care. Patients undergoing gynecologic surgery can be reassured of their safety during the first academic quarter. [ABSTRACT FROM AUTHOR]

Objectives: The present study aimed to analyze the clinicopathologic features and treatment of uSTUMP in a single institution. In addition, we described the obstetric outcomes after uterine-preserving surgery for uSTUMP.Methods and Materials: A retrospective chart review was performed of patients diagnosed with uSTUMP between January 2000 and February 2018 at the Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center. We obtained data on the patients' demographics, treatment, therapeutic results, time to recurrence, disease-free and overall survival, and subsequent obstetric outcomes. The central pathology reviews were carried out by two pathologists specializing in gynecologic oncology.Result: A total of 19 patients diagnosed with uSTUMP were identified and included in the study. The mean age at diagnosis was 41 years (range 28-49 years). Frozen sections were performed in 11 patients including five patients during surgery. Nine of the 19 patients (47.4%) were treated by hysterectomy and 10 patients were initially treated by myomectomy. The mean follow-up period was 47 months (range 6-209 months). Two patients (10.5%; 2/19) experienced recurrence. Although not defined as recurrence in the present study criteria, one patient had a secondary diagnosis of atypical leiomyoma one year after the initial diagnosis of uSTUMP. Seven patients requested uterine-preserving treatment, five of whom wanted to become pregnant. Three of them (3/5; 60%) successfully delivered live birth to full term by Cesarean section without complications such as abortion, preterm delivery or uterine rupture, and tumor recurrence.Conclusions: The present study describes the clinicopathologic data of uSTUMP patients. Our results suggest a uSTUMP recurrence of 10.5%, comparable to previous reports. Although there is a possibility of malignant recurrence, fertility-preserving management is worth attempting because of relatively low affected age with careful close follow-up. [ABSTRACT FROM AUTHOR]

This cross-sectional study analysed the characteristics of HSDD (hypoactive sexual desire disorder) in Korean women. Two hundred and seventeen women seen for sexual dysfunction were assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised (DMS IV-TR) and the Female Sexual Function Index (FSFI). A diagnosis of HSDD was more common in women in their 40 s (56%), who had previously undergone surgery for a feeling of 'wide vagina'. Both too much or too little sexual activity caused HSDD. Longer physical contact and sexual foreplay duration lessened the prevalence of HSDD. We concluded that special attention should be paid to women in their 40 s, particularly those with a history of vaginal surgery as they are at risk of HSDD. Potential treatment options should include couple counselling about the optimal frequency and duration of sexual activity, as well as treatment specific to the disorders identified by the FSFI. Impact statement What is already known on this subject: Many socio-medical factors affect the prevalence of HSDD (Hypoactive sexual desire disorder). Age, cultural factors, relationship status, education, religion, employment, mental distress, depression, medications, menopausal status, multiple psychiatric disorders and a variety of medical conditions impact on sexual function. What do the results of this study add: A history of wide vaginal surgery (perineoplasty, vaginal rogation rejuvenation, or anterior vaginal introitoplasty) affects the incidence of HSDD (and have not been evaluated before). Both too much or too little sexual activity were found to have caused HSDD. A longer physical contact and duration of sexual foreplay lessened the prevalence of HSDD. What are the implications of these findings for clinical practice and/or further research: We concluded that special attention should be paid to women in their 40 s; particularly those with a history of wide vaginal surgery, as they are at risk of HSDD. Potential treatment options should include couple counselling about the optimal frequency and duration of sexual activity, as well as treatment specific to the disorders identified by the FSFI. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to investigate the incidence of unexpected uterine malignancy (UUM) diagnosed after hysteroscopic surgery for presumed submucosal leiomyomas or endometrial polyps.Study Design: From the Korean national health insurance database between January 1, 2009 and December 31, 2015, we analyzed inpatient sample data that were extracted by a stratified random sampling (gender and age) method. We extracted women with or without UUM that was diagnosed after hysteroscopic surgery using diagnosis codes and procedure codes.Results: A total of 11,866 women who underwent hysteroscopic surgery were extracted from 4,476,495 women. The mean age of the patients who underwent hysteroscopic surgery was 37.8 ± 0.1 years. A hysteroscopic myomectomy or polypectomy was performed in 3498 and 8368 women, respectively. The incidence of UUM diagnosed after hysteroscopic myomectomy or polypectomy was 0.86% and 1.11%, respectively. The logistic regression analysis showed that the risk of UUM increased with age (Odds Ratio (OR), 1.61; 95% Confidence Interval (CI), 1.47-1.77; P < 0.001) and did not indicate hysteroscopic myomectomy or polypectomy (OR, 1.21; 95% CI, 0.93-1.55; P = 0.151).Conclusions: The incidence of UUM diagnosed after hysteroscopic myomectomy (0.86%) or polypectomy (1.11%) was higher than that of UUM diagnosed after hysterectomy (0.19%) or myomectomy (0.12%) for presumed benign leiomyoma. The incidence of UUM increased over the age of 50. [ABSTRACT FROM AUTHOR]

Controversy regarding psychological or psychiatric outcomes following hysterectomy still exists. The purpose of this study was to investigate the risk of postoperative psychiatric disorders in women with hysterectomy compared to that in women with uterus-conserving surgery for myomas by using population-based data from South Korea. This study was designed as a retrospective cohort study. We analyzed the National Health Insurance Service National Sample Cohort data including all administrative medical claims from 2002 to 2013. The study population, consisting of 9581 women, was defined as those diagnosed with uterine myoma who underwent medical procedures. The association between psychiatric and mood disorders and hysterectomy was assessed using Cox proportional hazard regression. During the study period, 1381 (14.4%) women experienced psychiatric disorders and 374 (3.9%) experienced mood disorders. The hazard ratio (HR) for psychiatric disorder was higher in women after hysterectomy than in women after uterus-conserving procedures (adjusted HR = 1.44; 95% CI = 1.27-1.64, p < 0.0001). In addition, the HR for mood disorders in women after hysterectomy was significantly higher than in women after uterus-conserving procedures (adjusted HR = 1.62; 95% CI = 1.26-2.08, p = 0.0002). Our study suggests that hysterectomy increased the risk of psychiatric disorders compared to uterus-conserving procedures in women with uterine myoma. Considering these findings, more focus on psychological responses in women following hysterectomy is needed, and appropriate psychosocial support or provisioning of information before or after procedures could reduce psychological distress. [ABSTRACT FROM AUTHOR]

Objective: In Korea, the Value Incentive Program (VIP) was first applied to selected clinical conditions in 2007 to evaluate the performance of medical institutes. We examined whether the condition-specific performance of the VIP resulted in measurable improvement in quality of care and in reduced medical costs.Design: Population-based retrospective observational study.Setting: We used two data set including the results of quality assessment and hospitalization data from National Health Claim data from 2011 to 2014.Participants: Participants who were admitted to the hospital for obstetrics and gynecology were included. A total of 535 289 hospitalizations were included in our analysis.Methods: We used a generalized estimating equation (GEE) model to identify associations between the quality assessment and length of stay (LOS). A GEE model based on a gamma distribution was used to evaluate medical cost. The Poisson regression analysis was used to evaluate readmission.Main Outcome Measures: The outcome variables included LOS, medical costs and readmission within 30 days.Results: Higher condition-specific performance by VIP participants was associated with shorter LOSs, decreases in medical cost, and lower within 30-day readmission rates for target and non-target surgeries. LOS and readmission within 30 days were different by change in quality assessment at each medical institute.Conclusions: Our findings contribute to the body of evidence used by policy-makers for expansion and development of the VIP. The study revealed the positive effects of quality assessment on quality of care. To reduce the between-institute quality gap, alternative strategies are needed for medical institutes that had low performance. [ABSTRACT FROM AUTHOR]

We aimed to compare the effects of ramosetron and palonosetron in the prevention of postoperative nausea and vomiting (PONV) in patients that received opioid-based intravenous patient-controlled analgesia (IV-PCA) after gynecological laparoscopy. We reviewed the electronic medical records of 755 adults. Patients were classified into two groups, ramosetron (group R, n=589) versus palonosetron (group P, n=166). Based on their confounding factors, 152 subjects in each group were selected after the implementation of propensity score matching. The overall incidence of PONV at postoperative day (POD) 0 was lower in group R compared to group P (26.9% versus 36.8%; P=0.043). The severity of nausea was lower in group R than in group P on postoperative day (POD) 0 (P=0.012). Also, the complete responder proportion of patients was significantly higher in group R compared to that in group P on POD 0 (P=0.043). In conclusion, ramosetron showed a greater efficacy in the prevention of postoperative nausea at POD 0 compared to palonosetron in patients after gynecological laparoscopy. [ABSTRACT FROM AUTHOR]

Objective: A pulmonary recruitment maneuver (PRM) can effectively reduce post-laparoscopic shoulder pain (PLSP). However, a high-pressure PRM may cause pulmonary barotrauma. This study aimed to evaluate the efficacy and safety of a PRM using two different maximum inspiratory pressures (40 and 60cmH2O) for reducing PLSP.Study Design: Patients undergoing gynecologic laparoscopy were randomly allocated to a control group (n=30), a 40 cmH2O PRM group (n=30), and a 60 cmH2O PRM group (n=30). In the control group, residual carbon dioxide was removed by passive exsufflation through the port site. In the two intervention groups, the PRM consisting of five manual pulmonary inflations was performed at the end of surgery with a maximum pressure of 40 cmH2O or 60 cmH2O, respectively. Shoulder pain and wound pain were recorded using a visual analogue scale at 24 and 48h postoperatively.Results: Wound pain scores at 24 and 48h post-surgery were not different between the three groups. The PLSP scores in the two intervention groups were significantly lower than that seen in the control group at 24 and 48h postoperatively (P=0.006 and P<0.001, respectively). However, there were no statistically significant differences in the PLSP scores between the two intervention groups.Conclusion: A low-pressure PRM (40cmH2O) is as effective as a high-pressure PRM (60cmH2O) for removing residual gas from the peritoneal cavity. PRM using a maximal inspiratory pressure of 40cmH2O is safe and efficacious for the reduction of PLSP. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the cumulative recurrence rates of ovarian endometrioma among patients using a levonorgestrel-releasing intrauterine system (LNG-IUS) after conservative laparoscopic surgery.Methods: A retrospective review was conducted of premenopausal women who underwent conservative laparoscopic surgery for ovarian endometrioma and subsequent treatment with LNG-IUS at two gynecologic surgery centers in South Korea between January 1, 2007, and September 30, 2014. Eligible patients had no residual ovarian lesions before LNG-IUS insertion, underwent insertion within 12 months of primary surgery, and were followed up for at least 6 months afterwards. Recurrence was defined as a cystic mass (≥2 cm in diameter) detected by transvaginal ultrasonography.Results: Overall, 61 patients were included. The mean duration of follow-up was 42.9 ± 22.0 months (range 8-98). Recurrence of ovarian endometrioma was detected among 7 (11%) of the patients. On Kaplan-Meier analysis, the cumulative recurrence rates were 4.0%, 6.3%, and 25.5% at 24, 36, and 60 months after surgery, respectively. In multivariate analysis, nulliparity at surgery was the only risk factor for recurrence (hazard ratio 5.892, 95% confidence interval 1.139-30.484; P=0.034).Conclusion: Long-term maintenance therapy with LNG-IUS after conservative surgery might be a treatment option to consider to prevent ovarian endometrioma recurrence among premenopausal women. [ABSTRACT FROM AUTHOR]

Objectives: Optimum selection criteria for secondary cytoreductive surgery (SCS) in recurrent ovarian cancer is often dependent on multiple confounding factors. This study aimed to evaluate the treatment outcomes of recurrent ovarian cancer and investigate the factors identifying patients who most likely benefit from the SCS. Methods: We retrospectively reviewed medical records of recurrent ovarian cancer patients from five referral hospitals in Korea from 2010 to 2020. Recurrent characteristics, following treatment methods and potential factors for survivals were evaluated between the chemotherapy and surgery groups. Results: A total of 670 patients with recurrent ovarian cancer were identified. The patient's median age was 55 years (24-83), and 88.1% of patients had initial stage III/IV disease. Of all patients, 215 (32.1%) received SCS for the disease recurrence. The median survival was 85 months (95% CI: 65.0-105.0) in the chemotherapy group, whereas the median survival time was not reached in the SCS group. Patients who received the SCS were more likely to be young and had no residual disease at primary surgery, platinum-sensitive recurrence, limited regional recurrence (LRR, ≤3 lesions or regional carcinomatosis) with a low rate of ascites (p<0.001, 0.001, 0.001, 0.001, 0.006, respectively). In multivariate cox analysis, residual disease at primary surgery, PFI, recurrent sites, ascites, and SCS were significant prognostic factors for survival. Meanwhile, predicting factor for complete resection after SCS was only recurrent sites (LRR, p<0.001). Conclusions: SCS resulted in significantly favorable survival outcomes in well-selected patients. Platinum-sensitive recurrence with limited regional diseases (< 3 regions or limited carcinomatosis without ascites) can be considered as optimum criteria for SCS in recurrent ovarian cancer. [ABSTRACT FROM AUTHOR]

Objectives: Despite an increasing number of reports on the adoption of the enhanced recovery after surgery program (ERAS) in gynecology in Western countries, there are very few reports on this topic in Korea. Distinct characteristics for infrastructure and insurance systems may attribute to the slow adoption of ERAS. The COVID-19 pandemic forced rearrangement of medical resources, especially in public hospitals dealing with the disease in the frontline. This study aimed to investigate how a public hospital deals with gynecologic surgeries in the circumstances of limited resources caused by the pandemic. Methods: As the COVID-19 developed as a pandemic, the Seoul Metropolitan Government Boramae Medical Center hospital evacuated several wards to admit patients severely suffering COVID-19 since March 2020. The bed count assigned for the obstetrics and gynecology (OBGY) department was forced to decrease from 28 beds to 16 beds (-42%). The availability of outpatient clinics and the surgical facility was not affected. In order to maintain surgical volume, we promptly adopted ERAS in the whole OBGY surgery. Early feeding and individualized discharge planning were applied for all inpatient surgical cases to cope with reduced inpatient volume. The number of surgeries and average hospital stay were compared before and after inpatient volume reduction. Results: There was a slight decrease in the number of total surgeries due to the reduction of Cesarean section cases (1335 in 2018, 1331 in 2019, 1279 in 2020). However, the number of surgeries for benign and malignant gynecologic diseases was not reduced (771 and 94 in 2019, 737 and 94 in 2020, respectively). The proportion of minimally invasive hysterectomy for benign diseases increased (58.8% in 2019, 72.2% in 2020, p=0.03). Single site laparoscopic surgery for the benign adnexal disease increased (40.8% in 2019, 56.1% in 2020, p<0.001). The hospital stay for cesarean section, abdominal hysterectomy, laparoscopic hysterectomy, oncologic staging surgery, laparoscopic adnexal surgery significantly decreased with an average difference of one day. The 90-days re-admission rate was not different between 2019 and 2020. Conclusions: COVID-19 pandemic-related medical resource shortage accelerated adaptation of ERAS in OBGY surgery. Repositioning the medical resources more efficiently is imperative as the COVID-19 pandemic gain momentum. [ABSTRACT FROM AUTHOR]

Objective: To compare surgical outcomes of laparoendoscopic single-site myomectomy (LESS-M) vs. conventional laparoscopic myomectomy (LM).Design: Multicenter, noninferiority, randomized, controlled trial.Setting: University hospitals.Patient(s): A total of 100 subjects with symptomatic uterine myomas were randomly assigned to either LESS-M or conventional LM. Surgical outcomes were comparatively assessed between the groups on the basis of the intention-to-treat principle.Intervention(s): Laparoscopic myomectomy.Main Outcome Measure(s): The time required for uterine defect suturing.Result(s): There were no differences in baseline demographics (age, body mass index, surgical indication, number of myomas, and size and location of the largest myoma) between the two groups. The suturing time (mean ± SD) was 21.9 ± 10.7 minutes (95% confidence interval 18.8-24.9 min) for the LESS-M group and 23.3 ± 12.4 minutes (95% confidence interval 19.8-26.9 min) for the conventional LM group, with no significant difference between the two groups. The other surgical outcomes, such as total operative time, operative blood loss, postoperative hemoglobin change, degree of surgical difficulty, postoperative pain scores, operative complication, and length of hospital stay, were similar between the two groups. Three subjects (6%) assigned to the LESS-M group underwent conventional LM because of difficulty in myoma enucleation and suturing, whereas no failure to intended procedure occurred in the conventional LM group (6% vs. 0).Conclusion(s): Laparoendoscopic single-site surgery is a feasible and safe treatment option for myomectomy that offers surgical outcomes comparable to those with conventional LM.Clinical Trial Registration Number: NCT01984632. [ABSTRACT FROM AUTHOR]

Aims and objectives. The purpose of the study was to evaluate the effects of a structured educational programme on the patient-controlled analgesia device in terms of postoperative pain, dose of analgesics used, adverse reactions, patient knowledge and attitudes of patient-controlled analgesia and patient satisfaction with postoperative pain management among gynaecological patients in South Korea. Background. Patient-controlled intravenous analgesia has become the most common method to manage postoperative pain. Although the patient-controlled analgesia device can be very effective in managing pain, patients using external pump delivery have several problems because of their lack of knowledge of patient-controlled analgesia. To minimise these problems, nursing interventions that may decrease the number of problems should be developed and adopted into clinical practice. Design. A non-equivalent control group, non-synchronised design. Methods. The participants were 79 patients who had gynaecological surgery under general anaesthesia. Of the 79 patients, 39 were assigned to the experimental group and 40 to the control group. A day before surgery, 40 minutes of structured education on the patient-controlled analgesia device was provided individually to the patients in the experimental group using both a CD-ROM and brochure. Results. Pain level and adverse reactions were significantly lower in the experimental group than in the control group. Furthermore, the analgesic dose administered and the level of patient satisfaction with postoperative pain management increased significantly in the experimental group compared with the control group. Conclusion. A structured educational programme on the patient-controlled analgesia can be an effective nursing intervention for pain management in gynaecological patients. Relevance to clinical practice. Nurses caring for the patients who are using the patient-controlled analgesia should provide a structured educational programme to increase knowledge of pain management with patient-controlled analgesia, patient satisfaction with pain management, as well as more effective management of the pain and adverse reaction caused by patient-controlled analgesia. [ABSTRACT FROM AUTHOR]

Objective: To investigate pregnancy outcomes subsequent to ovarian pregnancy treated by surgery.Methods: A retrospective analysis was conducted of ovarian pregnancies that were treated by surgery at a hospital in Korea between January 1996 and December 2009.Results: Forty-nine women with ovarian pregnancies (1.6% of all ectopic pregnancies) were treated; 28 of these patients who were followed-up for more than a year were included in the study. The most common risk factor for ovarian pregnancy was endometriosis (42.9%). Accurate diagnosis of ovarian pregnancy was made preoperatively in 7 patients (25%). Of the 28 patients, 16 (57.1%) had subsequent pregnancies: 13 (46.4%) were intrauterine pregnancies and 3 (10.7%) were tubal pregnancies. However, no subsequent ovarian pregnancies occurred. In addition, only 1 patient had secondary infertility after surgery for ovarian pregnancy.Conclusions: After an ovarian pregnancy treated by surgery, the outcome of a subsequent pregnancy is reasonable; there is a high rate of successful subsequent pregnancy and a low rate of subsequent ectopic pregnancy or of infertility. [ABSTRACT FROM AUTHOR]

Background: Our objective was to evaluate risks of adverse obstetric outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy.Methods: We analyzed the national health insurance database, which covers almost the entire Korean population, between 2004 and 2015. The risks of adverse pregnancy outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy, compared to those in women without a diagnosed myoma, were analyzed in multivariate logistic regression analysis.Results: During the study period, 38,402 women with diagnosed myoma(s), 9890 women with a history of myomectomy, and 740,675 women without a diagnosed myoma gave birth. Women with a history of diagnosed myoma(s) and women with a history of myomectomy had significantly higher risks of cesarean section (aOR 1.13, 95% CI 1.1-1.16 and aOR 7.46, 95% CI 6.97-7.98, respectively) and placenta previa (aOR 1.41, 95% CI 1.29-1.54 and aOR 1.58, 95% CI 1.35-1.83, respectively), compared to women without a diagnosed myoma. And the risk of uterine rupture was significantly higher in women with previous myomectomy (aOR 12.78, 95% CI 6.5-25.13), compared to women without a diagnosed myoma, which was much increased (aOR 41.35, 95% CI 16.18-105.69) in nulliparous women. The incidence of uterine rupture was the highest at delivery within one year after myomectomy and decreased over time after myomectomy.Conclusions: Women with a history of myomectomy had significantly higher risks of cesarean section and placenta previa compared to women without a diagnosed myoma. [ABSTRACT FROM AUTHOR]