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Objective: To investigate the association between maternal pre-pregnancy body mass index (BMI) and the risk for gestational diabetes mellitus (GDM) in women with twin pregnancy in South Korea. Materials and methods: We performed a single-center, retrospective cohort study involving 1028 women with twin pregnancy from January 2006 to December 2018 in South Korea. Pregnancies with monoamnionic twins, twin–twin transfusion syndrome, fetal death in utero before 24 weeks, pre-gestational diabetes mellitus, and unknown BMI or GDM status were excluded. Subjects were grouped into four groups based on pre-pregnancy BMI: underweight (

Objectives: Cerclage operation is one of the most common obstetric controversies. The aim of this study was to compare the perinatal outcomes and placental inflammation of cerclage performed adherent and non-adherent to international guidelines. Material and methods: This study included all consecutive women with singleton deliveries who underwent cerclage. According to the current American College of Obstetricians and Gynecologists (ACOG) guideline, we designated our study population into two groups: the adherent-to-guideline and non-adherent groups. Each group was categorized into two groups according to cervical length (CL) at the time of cerclage (

During placentation, cytotrophoblasts differentiate and fuse to form multinucleated cells (syncytiotrophoblasts) in a process that involves autophagy. Appropriate syncytial differentiation is essential for establishing a healthy pregnancy. In this study, we evaluated the effect of two chloroquine compounds, hydroxychloroquine (HCQ) and chloroquine (CQ), on syncytial differentiation and autophagy in cultured primary human trophoblasts (PHTs). PHT cells were isolated from the human term placenta. Bafilomycin, a well-known autophagy inhibitor, was used as a positive control. Biochemical and morphological differentiation was assessed in syncytiotrophoblasts, and autophagy-related proteins and genes were evaluated. Affymetrix Human Gene 2.0 ST Array profiling was used to identify genes affected by HCQ during syncytial differentiation. Chloroquine compounds lowered the production of beta-human chorionic gonadotropin (β-hCG) and the fusion index in PHTs. Syncytial differentiation in PHT was associated with the increased expression of ATG4C mRNA (autophagy-related gene), and this expression was affected by CQ but not by HCQ. Microarray analysis revealed that HCQ or CQ affected several genes (MMP15, GPC3, CXCL10, TET-1, and S100A7) during syncytial differentiation, which were different from that of the syncytial differentiation suppression (Ham’s/Waymouth media) or autophagy inhibition (bafilomycin treatment). Using Kyoto Encyclopedia of Genes and Genomes analysis we identified that HCQ might affect JAK2 signaling in the syncytial differentiation of PHT. In conclusion, chloroquine compounds could mitigate biochemical and morphological syncytial trophoblast differentiation in cultured PHT cells through the JAK signaling pathway rather than the inhibition of autophagic activity.

Objective: This study aimed to investigate the value of serum procalcitonin as an early predictor of antibiotic treatment response in the inpatient management of pelvic inflammatory disease (PID). Materials and methods: A prospective observational study was carried out at a university hospital. Patients admitted for pelvic inflammatory disease were classified into 2 groups: responders and non-responders. The primary outcome measure was the serum level of procalcitonin at the time of admission. The secondary outcome measures were other serum inflammatory markers including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count. Results: Baseline characteristics were similar between the groups. Serum level of procalcitonin at the time of admission did not differ between the groups (P = 0.564). However, the non-responders had more elevated CRP and ESR compared to the responders (P = 0.045 and P = 0.030, respectively). CRP showed the highest accuracy of 72.1% (95% confidence interval [CI], 59.2 to 82.9) in predicting antibiotics response, while procalcitonin showed the lowest accuracy of 49.1% (95% CI, 35.1 to 63.2). Conclusion: Compared with standard inflammatory markers such as CRP or ESR, procalcitonin had limited diagnostic value in predicting antibiotics response in patients admitted for PID. Therefore, procalcitonin measurement cannot be recommended as a laboratory test for patients with PID and the value of its routine use remains inconclusive.

Objectives: We assessed the usefulness of ultrasonography (USG) findings of adenomyosis during pregnancy in the prediction of subsequent preterm delivery. Materials and methods: We included consecutive pregnant women who underwent first trimester ultrasonography in our institution, confirmed as having adenomyosis and subsequently delivered in our institution from January 2006 to April 2018. The subjects were classified into two groups: preterm delivery group and term delivery group. Information of maximal uterine wall thickness measured at first trimester and second trimester, maternal characteristics, pregnancy outcomes, and neonatal outcomes were reviewed and compared between preterm and term delivery group. Results: A total of 57 pregnancies were included in this study, and 14 women (24.5%) delivered before 37 weeks of pregnancy. The women from the preterm delivery group had a significantly thicker uterine wall during the second trimester of pregnancy compared to the women from the term delivery group (4.49 ± 1.62 cm vs. 3.05 ± 1.6 cm, p = 0.004). From the first trimester to the second trimester of pregnancy, uterine wall thickness showed a significantly smaller decrease in the preterm delivery group than the term delivery group (−0.42 ± 0.93 cm vs. −1.04 ± 0.89 cm, p = 0.02). By receiver operating characteristics (ROC) curve analysis, uterine wall thickness greater than 4.6 cm in the second trimester of pregnancy showed 57.1% sensitivity, 86.1% specificity, 57.1% positive predictive value (PPV) and 86.1% negative predictive value (NPV) for subsequent preterm delivery (area under curve = 0.758). Conclusions: Uterine wall thickness measurement in second trimester can help to identify preterm delivery in pregnant women with adenomyosis. Keywords: Adenomyosis, Preterm delivery, Ultrasonography

Objective: The purpose of this study is to investigate the factors associated with successful amniopatch treatment in patients with iatrogenic preterm premature rupture of membranes (iPPROM) or spontaneous PPROM (sPPROM) before 23 weeks' gestation. Materials and methods: This cohort study included 28 women who received amniopatch treatment due to iPPROM or sPPROM at 15–23 weeks' gestation. Patients' clinical characteristics before performing the amniopatch, factors associated with the procedure, pregnancy and neonatal outcomes were compared between the iPPROM and sPPROM groups, and also between the successful and failed groups. Results: The amniopatch was successful in 6 of 28 patients (21.4%) with a success rate of 36.4% (4/11) and 11.8% (2/17) in the iPPROM group and sPPROM group (P = 0.174), respectively. The success group had a longer PPROM-to-delivery interval, fewer cases of clinical chorioamnionitis, larger birth weight, and lower neonatal intensive care unit admission rate than the failed group. The success rate of amniopatch procedure was proportional to maximal vertical pocket prior to procedure, which showed statistically significant association (adjusted odds ratio: 3.62, 95% confidence interval: 1.16–11.31, P = 0.027). Conclusion: The amniopatch treatment success rate was higher in the iPPROM group than the sPPROM group, but was not statistically significant. The neonatal outcome was more favorable when the amniopatch was successful. However, the only predictive factor associated with successful amniopatch was a larger amniotic fluid volume before the procedure.