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Purpose: The purpose of this study was to suggest the importance of natural childbirth by investigating the results of midwife-led perinatal periods and whether they were positive experiences for both individual women and their families.Methods: This retrospective study aimed to confirm the perinatal outcomes of midwife-attended vaginal births. Among 1,127 women who gave midwife-led birth in Gyeonggi-do, Seoul between January 1, 2019 and December 31, 2021, data were collected for 829 women. Records were excluded that were missing necessary data. Data on childbirth were analyzed using frequency, percentage, mean, standard deviation, and the chi-square test.Results: Among the mothers who underwent natural childbirth, 549 (66.2%) were multiparous. In addition, all 829 patients (100%) breast-fed their infants. First-degree perineal lacerations occurred in 29.2% of patients, and second-degree lacerations occurred in 48%. Non–high-risk subjects made up 56.0% of the study sample. The average bleeding amount was 281.44±4.50, and the average 1-minute Apgar score for infants was 8.25±0.02.Conclusion: Compared to childbirth in a hospital, natural childbirth was associated with a lower risk of birth canal laceration, postpartum bleeding, and Cesarean section. In addition, the health statuses of the newborns were confirmed to be good . Based on the results of this study, there is a need for a strategy in which midwife-led natural childbirth is integrated into the local medical system, as well as a need to raise women's awareness of natural childbirth and positively influence the experience.

Transforming growth factor beta (TGF-beta) exerts an inhibitory effect on the growth of most epithelial cell types, and the loss of responsiveness to this growth inhibition has been implicated in the development of a variety of human cancers. The genetic alteration of TGF-beta receptors is known to play a critical role in this escape from growth regulation. We asked whether there is a correlation between TGF-beta sensitivity and the genetic status of TGF-beta type I and type II receptors (RI and RII, respectively) in human cervical carcinoma cell lines. Among 8 cell lines examined, 3 (ME-180, C-33A and HeLaS3) showed resistance to TGF-beta and 3 (SiHa, CaSki and HeLa229) showed minimal response to the growth inhibitory effect of TGF-beta; the other cell lines (HeLa and HT-3) were sensitive. Northern blot analysis revealed that the RII mRNA was not expressed in 2 TGF-beta-resistant cell lines (ME-180 and C-33A) but was expressed in the other cell lines. Southern blot analysis of RI and RII revealed a homozygous deletion of the entire TGF-beta RII gene in the cell line ME-180. We then asked whether the other TGF-beta-resistant or refractory cell lines had microsatellite instability and/or poly-adenine tract mutations of RII. We also checked for point mutations in the individual exons of the entire RII using polymerase chain reaction-single-strand conformational polymorphism (PCR-SSCP). Although C-33A exhibited poly-adenine microsatellite instability, its RII gene showed no signs of mutation. The molecular integrity of the TGF-beta, receptors in all cell lines, except ME-180 and C-33A, could be confirmed by examining the distinct transcriptional induction of plasminogen activator inhibitor-1 (PAI-1), p21(WAF1/CIP1) and, in some cases, the accompanying downregulation of c-myc in response to TGF-beta. Our observations, taken together, indicate that inactivation of the RII contributes to the resistance to TGF-beta of some cervical carcinoma cell lines. Loss of or attenuated sensitivity to TGF-beta growth inhibition in other cells may be attributed to the disruption of distal components in the TGF-beta signal pathway, but not to the receptor system.

A 2.5-kilobase cDNA clone that encodes a 371-amino acid novel transcription factor was isolated from a human placenta cDNA library using a yeast one-hybrid system. The novel ets-related transcription factor (ERT) showed a homology with the ETS DNA-binding domain. Using constructs of the transforming growth factor-beta (TGF-beta) type II receptor (RII) promoter linked to the luciferase gene, we have demonstrated that ERT activates transcription of the TGF-beta RII gene through the 5'-TTTCCTGTTTCC-3' response element spanning nucleotides +13 to +24 and multiple additional ETS binding sites between -1816 and -82 of the TGF-beta RII promoter. A specific interaction between ERT and the ETS binding sites was also demonstrated using an electrophoretic mobility shift assay. Deletion mapping of ERT protein suggests that the transactivation domain resides in the amino terminus while the DNA-binding domain is localized to the carboxyl-terminal region. Our results suggest that ERT might be a major transcription factor involved in the transcriptional regulation of the TGF-beta RII gene.

The objective of this study is to describe the clinical outcomes of patients treated for cervical pregnancy with or without methotrexate (MTX) and to evaluate the effects of MTX in the treatment of cervical pregnancy. Between January 1993 and February 2000, 31 patients were diagnosed with cervical pregnancy. Twenty-two patients were treated with MTX chemotherapy and nine patients were treated with surgical procedures without MTX treatment. In the non-MTX treatment group, three patients underwent total abdominal hysterectomy, five required adjuvant procedures to control the bleeding during dilatation and curettage (D&C) and only one patient was treated with a simple D&C. In the MTX treatment group, fourteen (63.6%) patients were treated with only MTX and eight (36.4%) cases underwent concomitant procedures (simple curettage, curettage and Foley catheter tamponade, cervical cerclage, ligation of the descending branches of uterine arteries, or ligation of hypogastric arteries). The uterus was preserved in all cases and three women delivered healthy babies in their subsequent pregnancy. In conclusion, early diagnosis, appropriate MTX regimen in combination of necessary adjuvant conservative procedures could contribute to successful treatment with preservation of the uterus and future reproductive ability.

This study was performed to evaluate the treatment results, prognostic factors and complication rates in patients with locally advanced cancer of uterine cervix after radiotherapy with high-dose rate (HDR) brachytherapy.One hundred and twenty patients with a locally advanced (stages IIB approximately IVA according to FIGO classification) carcinoma of the uterine cervix were treated with radiotherapy at the Department of Radiation Oncology, Samsung Medical Center between September 1994 and December 2001. The median age of the patients was 61 years (range 29 to 81). Sixty-one, 56 and 3 patients had FIGO stage IIB, III, and IV diseases, respectively. All patients were given external beam radiotherapy over the whole pelvis (median 50.4 Gy) and HDR intracavitary brachytherapy, with a median of 4 Gy per fraction, to point A. Twenty-one patients received chemotherapy, of which 13 and 21 received neoadjuvant chemotherapy and concurrent chemotherapy, respectively, during the first and fourth weeks of external beam radiotherapy. The chemotherapy was not randomly assigned and the median follow-up time was 28.5 months (range: 6 approximately 100 months).The three- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 64.4 and 57.0%, and 63.7 and 60.2%, respectively. The 5-year OS and DFS rates of the patients at stages IIB, III and IV were 60.2, 57.9 and 33.3%, and 57.4, 65.4 and 33.3%, respectively. Univariate analysis indicated that the FIGO stage, overall treatment time (OTT) and treatment response were significant variables for the OS (p=0.035, p=0.0649 and p=0.0009) and of the DFS (p=0.0009, p=0.0359 and p=0.0363). Multivariate analysis showed that the treatment response was the only significant variable for the OS (p=0.0018) and OTT for the DFS (p=0.0360). The overall incidence of late complications in the rectum and bladder were 11.7 and 6.7%, respectively. In addition, insufficiency fractures were observed in 7 patients (5.8%).The results of this study suggest that radical radiotherapy with HDR brachytherapy was appropriate for the treatment of locally advanced uterine cervix cancer. Also, the response after treatment and OTT are significant prognostic factors.

Study Objective To report our experience with radical laparoscopic-assisted vaginal hysterectomy (LAVH) with bilateral pelvic and/or paraaortic lymphadenectomy. Design Retrospective review (Canadian Task Force classification III). Setting University-affiliated hospital. Patients Fifty-two women with invasive carcinoma of the cervix, stage Ib1, smaller than 3 cm. Intervention Radical LAVH with pelvic and/or paraaortic lymphadenectomy. Measurements and Main Results Total operating time ranged from 230 to 650 minutes (mean 380 min). Major surgical complications were two cases of ureter injury, two cases of ureteral stricture, and one case of hematoma at the cannula site. Two cases were converted to laparotomy due to incomplete hemostasis of the uterine artery and obturator vein. The mean hemoglobin decrement was 1.7 g/dl the day after operation. Thirty patients received blood transfusion (mean 1.8 pints). Average numbers of pelvic and paraaortic lymph nodes removed were 27.7 (range 9–63) and 22.1 (range 6–52), respectively. After surgery, patients passed gas in 2.2 days and self-voided in 18.4 days on average. One woman had pelvic recurrence at 26 months after surgery. One died from brain metastasis 10 months after surgery. Conclusion This technique is feasible for treatment of early cervical carcinoma. An experienced surgeon could shorten operating time and reduce complications.

This study was performed to investigate the association between hair mineral levels and nutrient intakes, age, and BMI in female adults who visited a woman's clinic located in Seoul. Dietary intakes were assessed by food frequency questionnaire and mineral levels were measured in collected hairs, and the relationship between these was examined. The average daily nutrient intakes of subjects were compared to those of the KDRIs, and the energy intake status was fair. The average intake of calcium in women of 50 years and over was 91.35% of KDRIs and the potassium intake was greatly below the recommended levels in all age groups. In the average hair mineral contents in subjects, calcium and copper exceeded far more than the reference range while selenium was very low with 85.19% of subjects being lower than the reference value. In addition, the concentrations of sodium, potassium, iron, and manganese in the hair were below the reference ranges in over 15% of subjects. The concentrations of sodium, chromium, sulfur, and cadmium in the hair showed positive correlations (P < 0.05) with age, but the hair zinc level showed a negative correlation (P < 0.05) with age. The concentrations of sodium, potassium, chromium, and cadmium in the hair showed positive correlations (P < 0.05) with BMI. Some mineral levels in subjects of this study showed significant correlations with nutrient intakes, but it seems that the hair mineral content is not directly influenced by each mineral intake. As described above, some hair mineral levels in female adults deviated from the normal range, and it is considered that nutritional intervention to control the imbalance of mineral nutrition is required. Also, as some correlations were shown between hair mineral levels and age, BMI, and nutrient intakes, the possibility of utilizing hair mineral analysis for specific purposes in the future is suggested.

The purpose of this study was to investigate the implications of dietary intake and the level of plasma antioxidant, lipid peroxidation, and antioxidant capacity in Korean women with cervical intraepithelial neoplasia (CIN). From October 2002 to March 2003, 58 patients diagnosed with CIN (confirmed with colposcopy directed biopsy) and 86 patients without any cervical disease as control group were enrolled in the study at the Department of Gynecology cancer center at Samsung Cheil Hospital. The intake of antioxidant vitamins in both groups exceeded the amount recommended by the Korea RDA, 7th edition. The plasma concentration of Vitamin C was significantly lower in the CIN group (0.36 mg/dL) than in the control group (0.48 mg/dL) (p

Objective : To report our experiences in laparoscopic assisted surgical staging (LASS) to manage the patients with endometrial cancer. Methods : From June 1997 to June 2003, we performed LASS in 31 patients with clinical stage I adenocarcinoma of the endometrium. We performed laparoscopic assisted vaginal hysterectomy (LAVH) with bilateral salpingo-oophorectomy (BSO) and intraoperative frozen-section (IFS) diagnosis. The depth of myometrial invasion, tumor differentiation, histologic types, cervical invasion, and adnexal involvement were determined by IFS diagnosis. Laparoscopic pelvic and/or para-aortic lymphadenectomies were performed based on the pathologically confirmed risk factors for nodal metastasis. Results : Fifteen patients only underwent LAVH with BSO and peritoneal washing cytology because they were identified by IFS diagnosis as low risk group for nodal metastasis. Sixteen patients had LAVH with BSO, peritoneal washing cytology and pelvic and/or para-aortic lymphadenectomies because they were identified as intermediate or high risk group. There were 15 patients with stage IA, 8 patients with stage IB, 1 patient with stage IC, 1 patient with stage IIA, 2 patients with stage IIB, 2 patients with stage IIIA and 2 patients with stage IIIB. Total length of the operation time ranged from 60 minutes to 280 minutes and the mean was 138 minutes. The mean hemoglobin decrement after the surgery was 1.3 gm/dL. One received blood transfusion. The average number of pelvic and para-aortic lymph nodes removed were 24.4 and 11.6, respectively. After the surgery, the patients passed gas after an average of 1.5 days and urinated after an average of 2.1 days. No one had serious complications after LASS. Conclusion : Based on our experiences, LASS might be an alternative to the traditional surgical approach in patients with early-stage endometrial carcinoma.

Objective : To evaluate the clinicopathologic characteristics of primary clear cell carcinoma of the ovary. Methods : From February, 1993 to February, 2003, thirty patients with clear cell carcinoma of the ovary were identified, who were treated in the department of obstetrics and gynecology, Samsung Cheil Hospital and Women's Healthcare Center. The clinicopatholgic characteristics of the patients were retrospectively evaluated for age, chief complaint, preoperative CA-125 level, FIGO stage, maximal tumor diameter, association with endometriosis, management, and survival. Results : Clear cell ovarian carcinoma accounts for 5.2% of all cases of ovarian cancer at this center. Mean age was 44.6 years (26-62 years). Most patients presented with a large pelvic mass ranging from 7 to 30 cm in maximal diameter and seventeen (71%) of twenty-four patients had elevated serum level of preoperative CA-125. Associated pelvic endometriosis was 60% (18/30). Tumors were 73.3% (22/30) stage I, 10% (3/30) stage II, 13.3% (4/30) stage III and 3.3% (1/30) stage IV. Except for two patients who wanted to preserve fertility, all patients underwent total hysterectomy and bilateral salpingo-oophorectomy, omentectomy, peritoneal washing cytology and with or without pelvic and paraaortic lymph node dissection. All patient except one stage Ia received postoperative chemotherapy. With a median follow-up of 38.7 months (3-116 months), 96% (24/25) of stage I/II patients are alive, while 40% (2/5) of stage III/IV patients are alive. Conclusion : Clear cell carcinoma of the ovary demonstrates a characteristic clinical behavior. Several factors may be associated with the survival rate in the ovarian clear cell carcinoma that are FIGO stage, associated pelvic endometriosis, spontaneous capsular rupture and presence of ascites.

Endometrial cancer is primarily associated with postmenopausal women. However, endometrial cancer associated with pregnancy is uncommon. Total abdominal hysterectomy and bilateral salpingoophorectomy are the primary operative procedures for endometrial cancer. The conservative treatment by progestin therapy could be considered to who wished to preserve the childbearing ability. We report a case about a 26-year-old women with focal well differentiated endometrial adenocarcinoma, and she was treated with progestin therapy (megesterol acetate) for 12 months. Thereafter, she was diagnosed with missed abortion and underwent a dilatation and curettage. Pathological examination of the tissue included chorionic villi and focal well differentiated endometrial adeocarcinoma. We hue experienced the coexistence of endometrial adenocarcinoma and pregnancy.

Loss of heterozygosity (LOH) at chromosome 3p frequently occurs in squamous cell carcinomas of the uterine cervix and indicates the probable sites of tumor suppressor genes that play a role in the development of this tumor. To study such recessive mutations involved in multistep cervical carcinoma, we separated tumors and normal DNA pairs from 43 invasive squamous cell carcinomas of the cervix on archived slides. We studied LOH using polymerase chain reaction (PCR) with 10 polymorphic DNA marker on the 3p12-26.1 region. HPV type 16 and 18 were preformed by PCR on tumor specimens. LOH at one or more loci was observed in 15 cases(35%). HPV DNA of any types was detected in 35 cases of all tumors (81%). HPV 16 was detected in 32 cases(74%) and HPV 18 in 9 cases (21%). In the 32 cases with positive HPV 16 infection, 9 (28%) had LOH, while in the 11 with negative HPV 16 infection, 6(55%) had LOH. Three cases in the 9 positive HPV 18 infection(33%) had LOH, while 12 in the 34 negative HPV 18 infection (35%) had LOH. Our results confirm that no relationship was found between 3p LOH and HPV.

c s c t u C I a r s c u o c b [ w q t h 5 o c a c Objectives. The aim of this study was to evaluate the efficacy of he follow-up methods and results of atypical glandular cells of ndetermined significance (AGUS) detected on cervicovaginal ap smears. Methods. From May 1991 to December 1996, we have perormed 407, 451 cervicovaginal Pap smears, of which 326 patients ere identified as AGUS. Of the 326 patients, 268 patients were ollowed by repeat Pap smears, colposcopy, cone biopsy, or endoetrial curettage. Results. The incidence of AGUS on Pap smears is approxiately 0.08%. The mean age of the patients was 43 years (range 2–79 years). The most common complaint was abnormal vaginal leeding. The gross findings of the cervix were normal to mild rosion. The following past histories of patients could affect the GUS results on Pap smear: 30 had cone biopsy, 21 had Pap mears on pregnancy and within 8 weeks after delivery or evacution, 3 were on hormonal replacement therapy, 2 had intrauterine evices for contraception, and 5 were undergoing follow-up after reatment of cervical cancer. The benign lesions detected during ollow-up periods were 6 microglandular hyperplasia of the cervix, atypical squamous metaplasia of the cervix, 2 cervical endomeriosis, 2 tubal metaplasia, 10 cervical myoma, 11 cervical polyps, endometrial polyps, 3 uterine myoma, 1 pelvic endometriosis, 1 varian endometriosis, and 4 uterine adenomyosis. The premaligant or malignant lesions of the cervix were 4 low-grade squamous ntraepithelial lesions, 24 high-grade squamous intraepithelial leions, 8 glandular atypia/dysplasia, 5 adenocarcinoma in situ, 3 icroinvasive adenocarcinoma, and 4 invasive adenocarcinoma. he neoplastic lesions of the uterus were 6 endometrial hyperplaia, 11 endometrial adenocarcinoma, 1 malignant mixed Mullerian umor, and 1 metastatic endometrial adenocarcinoma. Sixty-seven 25%) of 268 patients followed up were identified as having clincally significant lesions of the cervix or uterus. The detection rates f abnormal lesions were 3.1% with repeated Pap smears (3/98), 8.4% with colposcopic-directed biopsy (31/109), 63.6% with cone iopsy (35/55), and 29.7% with endometrial curettage (19/64). Conclusion. AGUS on Pap smears showed various benign and alignant lesions of the cervix or uterus. The clinicians must ommunicate with the pathologists regarding the patient’s clinical