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子宮發育不全症에 對한 著者의 見解

The statistical study of hypoplasia on Korean Women By S, J, Kim(Director Prof. Shin Dept. of Gynecology & obstetrics) Summary and Conclusions

대한산부인과학회지 1958년 1권 1호 p.31 ~ 40
김석자 (  ) - 수도의과대학 산부인과학교실

Abstract


Total of 9, 091 out-patients visited our clinic between January, 1956 and August, 1957. Out of tis, there were 419 cases of uterine hypoplasia, all of whom were followed for more than 4 years. we divided into) 4 groupp, these cases according to the size of uterus. The normal size of the uterus of Korean women is the size of a chicken egg.
When the uterus is slightly smaller than normal, it is classified as slightly small, if it is the:size a small chcken -egg, it is classified as small and if it is smaller than a pigeon egg, it is classified as very small. the majority of the cases belong to slightly small and small groups (about 87%) and the cases which belong to very,, small comprise - the rest (about 130). The ratio of cases of uterine hypoplasia with the total number of out-patients is about one to twenty (4; 61+0.22%) and the majority of these cases (83. 7%) visised the out-patient clinic!, with the complaints of sterility´ and the rest with irregular menstruation. The uterine hypoplasia as the c~ I use of sterility (excluding 53 cases of obstruction of Fallopian tube) was found in 40.96f1.80% among 707 case . of sterility cases. There was no particular relationship between the menstrual pattern and the uterine hypo] b sia, although abnormal menstruation was found more freqently as the uterus became smaller. Obliteration of they Fallopian tuba complicated the uterine hypoplasia in 4.°65+1.62% of the cases.
Estrogen is commonly used in the treatment of uterine hypoplasia. However, large doses of estrogen disturb the menstrual cycle and,therefore, the author used 100,000 units within 10 days after each menstrual period. The change of the size of uterus following the use of estrogen are as follows. In 41.4%, the uterus increased in size during and immediately after the estrogen therapy and there were no changes in 58.6 ?0/ of the cases. among the former group, the uterus returns to its pretreatment size in 2 to 3months following .cessation of the.therapy. and it is the author´s opinion that this treatment should be repeated at 2 to 3 months, intervals.
The effect of the hormone on the increase in the size of uterus has a close relationship with the age of the patient. Thus, the younger the patient, the more evident is the influence of the hormone and after 30 years of age, the susceptibility of the uterus to hormone decreases rapidly.. Therefore, this hormone therapy should be started in relatively people.
Among the hormone treated cases, 1$. 4l3. 14% became pregnant and in non-treated cages this was 12 9±. 00. showing no material difference- In other words, the hormone therapy in- uterine hypoplasia´ dose not seemed to increase the possibility of pregnancy in a given patient.
Among the hormone treated cases, 18.4f3.14% became pregnant and in non-treated cases this was 12.9±3.01%. showing no material difference. In other word, the hormone therapy in uterine hypoplasia does not seemed to increase the possibility of pregnancy in a given patient.
The uterine - hypoplasia havjng no hormone therapy might keep the possibility of pregnancy but´ it effects tohave the longer sterile period than normal uterus. However, if the hormone , lierapy is indicated for the patient even more than 3 years sterile history, it may give higher possibility of pregnancy than untreated cases- C´osidering. the facts, that the younger the patient, the more the susceptability to estrogen and it requires often ,quite a long Period to obtain a satisfactory result, the uterine hypoplasia should be treated immediately whenever found withoutt delay.
Reviewing the pregnant cases among the uterine hypoplasia, we found there is a close relationship between the size of uterus and pregnancy rate. Thus the pregnancy rate in slightly small group is higher than in small group: The retroflexion of the uterus is another factor in sterility. According to the three months results of our basal. temperature curve study taken from 17 sterile cases who are free from complication, we observed 15 cases of nonovulation who mostly belong to the small group. Therefore, it may be considered that the non-ovulation may play the important role in the sterile condition due to uterine hypoplasia.
In summary, the factors that are involved ´in sterility in patients- with uterine hypoplasia are as follows;
1) Unovulatio
2) Size of uterus
3) Obstruction of Fallopian tube
4) The hormone. susceptibility of uterus and the age of patient
5) Abnormal position of the uterus.
Among this 1), 2), 4) are closely related with the hormone and, since uterine hypoplasia is a major factor in sterility, ´the hormone -therapy in those patients should be based on sound knowledge of endocrinology. Therefore, as stated_ in the- introduction, following examinations should be carried . out to determine these changes, in uterine hypoplasia cases.
1) The quantitative analysis of hormone in urine and blood
2)The -histological picture of uterine endometrium
3) The duality, oUthe cervical mucus
4) The basal body ´temperature curve.
And -finally, the changes in these facters following hormone therapy should be studied.

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