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Abstract Background This study aimed to compare obstetric outcomes in Korean women with and without future cardiovascular disease (CVD) within 10 years after pregnancy, and assessed whether pregnancy complications are independent risk factors, and whether the combination of pregnancy complications has an additive function for risk factors for CVD. Methods This was a nationwide population-based study combining the database of the Korea National Health Insurance claims and National Health Screening Programs to assess preeclampsia, low birth weight (LBW), and preterm delivery as risk factors for CVD. Cox proportional hazards models was used to evaluate the risk of total CVD, ischemic heart disease (IHD), and stroke after the pregnancy complications, with adjustment for potential confounding variables. Results Women with CVD were likely to have a higher prevalence of pregnancy complications than women without CVD. The risk of total CVD was associated with preeclampsia (adjusted hazard ratio (HR), 1.60 [95% confidence interval (CI) 1.50–1.72]), LBW (1.20 [1.12–1.28]), and preterm delivery (1.32 [1.22–1.42]), after adjustment for confounders, including cardiovascular risk factors before pregnancy. The risk estimates of pregnancy complications for IHD were higher than those for stroke. In this study, the risk of total CVD was higher in the combined presence of preeclampsia and preterm delivery (2.23 [1.57–3.17] or all three complications (2.06 [1.76–2.40]), relative to no complications. The highest HR was noted in the risk of all pregnancy complications for IHD (2.39 [1.98–2.89]). Conclusion Preeclampsia, preterm delivery, and LBW were independently associated with CVD in young Korean women. In addition, the combination of pregnancy complications had less-than-additive effects on CVD incidence.

Objective To evaluate the clinical significance of soft markers for aneuploidy screening in Korean women. Methods We retrospectively reviewed the medical records of 5,428 singleton pregnant women who underwent sonography during the second trimester at seven institutions in South Korea. We evaluated the prevalence of the following soft markers: intracardiac echogenic focus, choroid plexus cysts, pyelectasis, echogenic bowel, and mild ventriculomegaly. We developed best-fitted regression equations for the fetal femur and humerus length using our data and defined a short femur and humerus as both long bones below the fifth centile. The results of genetic testing and postnatal outcomes were investigated in patients who had been diagnosed with aforementioned soft markers. Results The median maternal age of our study population was 33 years, and the median gestational age at the time of ultrasonographic examination was 21 weeks. We detected soft markers in 10.0% (n=540) of fetuses: 9.3% (n=504) were isolated cases and 0.7% (n=36) of cases had two or more markers. We identified only two aneuploides (trisomy 18, 46,XX,t[8;10][q22.1;p13]), of which one was clinically significant. We presented the neonatal outcomes of the fetuses with the respective soft markers. Preterm delivery, low birth weight, and small-for-gestational-age (SGA) were significantly more common in women with a shortened fetal femur (P

Objective: This study aimed to evaluate whether state and trait anxiety among pregnant women were associated with fetoplacental Doppler findings, abnormal placental pathology, and placental angiogenic factors. Materials and methods: A total of 102 pregnant women at 32–35 gestational weeks were recruited and examined prospectively. State and trait anxiety were measured using the State-Trait Anxiety Inventory. Using Doppler ultrasound, pulsatility index (PI) of the umbilical artery (UA), middle cerebral artery (MCA), and uterine artery (UtA) and cerebroplacental ratio (CPR) were determined. Doppler parameters were converted into multiples of the median (MoM). Abnormal placental pathology was classified into 2 groups: vascular underperfusion (VU) and histological chorioamnionitis (HCA). Immunohistochemical analysis was performed to examine placental cells staining positive for placental growth factor (PLGF) and hypoxia-inducible factor-1-α (HIF-1α), which are markers for angiogenesis and hypoxic status, respectively. Results: Women with high state anxiety scores had low MCA-PI MoM and CPR MoM, while those with high trait anxiety scores had low MCA-PI MoM. VU was associated with a higher incidence of high trait anxiety scores, and HCA was associated with a higher incidence of high state and trait anxiety scores. Regression analysis showed a relationship between maternal state anxiety on MCA-PI MoM and HCA after controlling for covariates. Maternal trait anxiety exhibited relationships with VU and HCA after adjustment. Conclusion: Our results demonstrated that maternal anxiety is associated with altered fetal cerebral blood flow and abnormal placental pathology but is not associated with uteroplacental insufficiency and placental angiogenic factors.

The offspring of mothers with gestational diabetes mellitus (GDM) are at a higher risk for metabolic dysregulation and neurodevelopmental impairment. Evidence suggests that serotonin, which is present in both the placenta and the brain, programs the development and growth of the fetal brain. In the current study, we tested the hypothesis that GDM affects the methylation of the serotonin transporter gene (SLC6A4) and serotonin receptor gene (HTR2A) in the placenta. Ninety pregnant women were included in this study. Thirty mothers were diagnosed with GDM, and sixty mothers served as controls in a 1:2 ratio. Ten CpG sites within the promoter regions of SLC6A4 and HTR2A were analyzed using pyrosequencing. The relative expression of genes involved in DNA methylation was evaluated using real-time PCR. The average DNA methylation of placental SLC6A4 was higher in the GDM group than in the control group (2.29 vs. 1.16%, p < 0.001). However, the average DNA methylation level of HTR2A did not differ between the two groups. SLC6A4 methylation showed a positive correlation with maternal plasma glucose level and neonatal birth weight percentile and a negative correlation with the neonatal head circumference percentile. This finding suggests that epigenetic modification of the placental serotonin system may affect placental adaptation to a harmful maternal environment, thereby influencing the long-term outcome in the offspring.

Background: Immigrants face various problems in accessing healthcare because of lacking medical insurance. This study retrospectively evaluated the effect of insurance on the prenatal care and the obstetric outcomes of immigrants in South Korea. The main objective was to compare the obstetric complications between uninsured and insured immigrants, and the secondary objective was to compare the prenatal care and maternal nutrition during pregnancy. Methods: Using data from the hospital records, we compared the perinatal outcomes of insured and uninsured women who delivered at Buchoen St. Mary’s Hospital between 2010 and 2020, including the sociodemographic data, prenatal care, obstetric outcomes, and maternal nutrition. The association between insurance status and the various perinatal outcomes of immigrants was assessed using multivariate logistic regression, adjusting for potential confounding variables. Results: In total, 320 immigrant women were included, and 52 (16%) were uninsured. Uninsured immigrants had fewer numbers and a later initiation of prenatal care visits (7.75 ± 4.44 vs. 12.45 ± 3.75, p < 0.001; 1st trimester: 36.5% vs. 66.8%, p < 0.001, respectively), and a lower percentage of an adequate Kessner index score (26.9% vs. 63.8%; p < 0.001, respectively) than insured immigrants. The obstetric complications and maternal nutrition did not significantly vary. After adjusting for the confounding factors, the uninsured immigrants had a higher odds ratio of less-than-adequate prenatal care (adjusted odds ratio (OR) = 5.18; 95% confidence interval: 2.54–10.53; p < 0.001). Conclusions: Uninsured immigrants had inadequate prenatal care compared to insured immigrants, but this did not result in adverse obstetric and maternal outcomes.

Objective: To investigate which ultrasound findings or serum biomarkers, including insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 1 and 3 (IGFBP-1 and IGFBP-3, respectively), in the first and early second trimesters are the best predictors for preterm delivery. Materials and Methods: This was a case–control study conducted between March 2011 and March 2013 with women presenting for routine antenatal care at 11–18 weeks. We collected serum samples from pregnant women and stored them at −80°C. All patients underwent cervical length (CL) measurement at 18–21 weeks. We retrieved frozen samples for analysis from women with subsequent preterm and term delivery. Prediction models were developed using multivariate stepwise logistic regression. Receiver-operating characteristics curves were used to determine the most useful cutoff point. Results: Of the 72 women recruited, 24 women underwent spontaneous preterm delivery, and 48 women with term delivery were randomly selected as the control group, in a 1:2 ratio. The maternal serum concentration of IGFBP-3 and CL were significantly associated with preterm birth. Conclusion: Among the various known ultrasound findings and serum biomarkers in the early midtrimester, only CL and IGFBP-3 are independent predictors for preterm delivery in asymptomatic women.

PURPOSE:To evaluate whether serial change in cervical length (CL) over time can be a predictor for emergency cesarean section (CS) in patients with placenta previa. METHODS:This was a retrospective cohort study of patients with placenta previa between January 2010 and November 2014. All women were offered serial measurement of CL by transvaginal ultrasound at 19 to 23 weeks (CL1), 24 to 28 weeks (CL2), 29 to 31 weeks (CL3), and 32 to 34 weeks (CL4). We compared clinical characteristics, serial change in CL, and outcomes between the emergency CS group (case group) and elective CS group (control group). The predictive value of change in CL for emergency CS was evaluated. RESULTS:A total of 93 women were evaluated; 31 had emergency CS due to massive vaginal bleeding. CL tended to decrease with advancing gestational age in each group. Until 29-31 weeks, CL showed no significant differences between the two groups, but after that, CL in the emergency CS group decreased abruptly, even though CL in the elective CS group continued to gradually decrease. On multivariate analysis to determine risk factors, only admissions for bleeding (odds ratio, 34.710; 95% CI, 5.239-229.973) and change in CL (odds ratio, 3.522; 95% CI, 1.210-10.253) were significantly associated with emergency CS. Analysis of the receiver operating characteristic curve showed that change in CL could be the predictor of emergency CS (area under the curve 0.734, p < 0.001), with optimal cutoff for predicting emergency cesarean delivery of 6.0 mm. CONCLUSIONS:Previous admission for vaginal bleeding and change in CL are independent predictors of emergency CS in placenta previa. Women with change in CL more than 6 mm between the second and third trimester are at high risk of emergency CS in placenta previa. Single measurements of short CL at the second or third trimester do not seem to predict emergency CS.

Ureteral involvement by endometriosis is a rare and often silent disease but capable of producing significant morbidity and leading to hydronephrosis and to renal failure. Surgery is the treatment of choice to remove endometriotic lesions and relieve ureteral obstruction if the kidney is still functional or a nephrectomy is performed if there is a complete loss of renal function. We report a case of acute renal failure induced ureteral endometriosis managed with laparoscopic unilateral nephrectomy and endometrioma cystectomy. Differential diagnosis is important to confirm diagnosis for patients with ureteral obstruction presenting nonspecific symptoms.

PURPOSE: We sought to estimate the risks of adverse obstetric outcomes and disease outcomes associated with severe thrombocytopenia in pregnant women with aplastic anemia (AA). METHODS: In a retrospective study, we compared demographics, clinical characteristics, laboratory results, and outcomes between severe thrombocytopenia (ST) and non-severe thrombocytopenia (non-ST) groups comprising pregnant women with AA. RESULTS: Of 61 AA patients, 43 (70%) were diagnosed as AA before pregnancy and 18 (30%) were AA during pregnancy. The ST group exhibited lower gestational age at nadir of platelet count (26.0 versus 37.0 weeks, p

Purpose: To compare umbilical arterial gas parameters in the second twin of twin pregnancies according to the mode of deliveryMethods: We retrospectively analyzed the medical records of twin deliveries after 34 weeks of gestation for 3 years. Excluding the cases which underwent emergency cesarean delivery during trial of labor, a total of 79 twin gestations had umbilical arterial blood gas values available and were and divided into cesarean delivery group (N=40) and vaginal delivery group (N=39). The mean differences of umbilical arterial blood parameters and the Apgar score between the first and second twin in each pregnancy were compared according the mode of delivery.Results: The differences of umbilical arterial gas parameters between twin siblings showed no significant difference according to the mode of delivery. With regard to the 1 minute and 5 minute Apgar scores, the differences between twin siblings are significantly increased in vaginal delivery group compared to cesarean delivery group (p=0.048, and p=0.038, respectively). In comparing the 28 cases delivered vaginally with an inter-twin delivery interval < 10 minutes and 40 cases delivered by cesarean section, no significant differences were observed in the umbilical arterial gas parameters and Apgar scores.Conclusion: The inter-twin umbilical arterial blood gas parameters according to the mode of delivery showed no difference. For twin deliveries, it is relatively safe to plan for a vaginal delivery, but an effort should be made to reduce the inter-twin delivery interval time.

This was a prospective, cohort study in Korean pregnant and postpartum women, to estimate the prevalence and patterns of sleep disturbances. The survey was composed of the following validated sleep questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Women's Health Initiative Insomnia Rating Scale, Berlin Questionnaire for sleep disordered breathing, the international restless leg syndrome (IRLS) Study Group criteria, and the Johns Hopkins Telephone Diagnostic Interview Form (JHTDIF) for RLS. Statistical analyses were performed using SPSS version 18.0. Six hundred eighty-nine women completed sleep surveys. The overall percentage of women with very poor sleep quality (a PSQI score greater than 10), clinically significant insomnia (a total score of 9 or more), excessive daytime sleepiness (a total ESS score of 10 or more), short sleep duration (less than 7 hours per night) were 80.7%, 50.5%, 34.0% and 29.5%, respectively, and all of three parameters became increased as pregnancy progressed and after delivery ( p = 0.002, 0.001, and 0.001, respectively). The overall positive rates in Berlin and RLS questionnaires were 25.4% and 19.4%. In conclusion, sleep disturbances are prevalent among Korean pregnant and postpartum women, and increase significantly as pregnancy progresses and after delivery. [ABSTRACT FROM AUTHOR]

Purpose: To investigate cytokine- and oxidation-related genes for preeclampsia using DNA microarray analysis. Methods: Placentas were collected from 13 normal pregnancies and 13 patients with preeclampsia. Gene expression was studied using DNA microarray. Among significantly expressed genes, we focused on genes associated with cytokines and oxidation, and the results were confirmed using quantitative real time-polymerase chain reaction (QRT-PCR). Results: 415 genes out of 30,940 genes were altered by ≥2-fold in the microarray analysis. 121 up-regulated genes and 294 down-regulated genes were found to be in preeclamptic placenta. Six cytokine-related genes and 5 oxidation-related genes were found from among the 121 up-regulated genes. The cytokine-related genes studied included oncostatin M (OSM), fms-related tyrosine kinase (FLT1) and vascular endothelial growth factor A (VEGFA), and the oxidation-related genes studied included spermine oxidase (SMOX), l cytochrome P450, family 26, subfamily A, polypeptide 1 (CYP26A1), acetate dehydrogenase A (LDHA). These six genes were also significantly higher in placentas from patients with preeclampsia than in those from women with normal pregnancies. The placental tissue of patients with preeclampsia showed significantly higher mRNA expression of these six genes than the normal group, using QRT-PCR. Conclusion: DNA microarray analysis is one of the great methods for simultaneously detecting the functionally associated genes of preeclampsia. The cytokine-related genes such as OSM, FLT1 and VEGFA, and the oxidation-related genes such as LDHA, CYP26A1 and SMOX might prove to be the starting point in the elucidation of the pathogenesis of preeclampsia. [ABSTRACT FROM AUTHOR]

Tuberculous peritonitis in pregnancy is one of the least common forms of extrapulmonary tuberculosis in pregnancy. The case is described herein of a 23-year-old primigravida woman with primary tuberculous peritonitis in pregnancy at 24 weeks’ gestation. Excisional biopsy taken from the peritoneum during laparotomy resulted in the histopathologic diagnosis of tuberculous peritonitis. The patient made a good physical recovery after being placed on antituberculous chemotherapy and gave birth to a healthy male neonate of 2.5 kg at 37 weeks’ gestation by vaginal delivery. [ABSTRACT FROM AUTHOR]

Human transforming growth factor-beta1 (TGFB1) is a family of polypeptides that regulate cell growth, cell differentiation, and cell function as a multifunctional regulator of cellular activity. TGFB1 is produced by osteoblasts and stored in substantial amounts in the bone matrix, which is an important regulator of both skeletal development and homeostasis of bone metabolism. In the present study, we identified four new polymorphisms in TGFB1 and examined whether these polymorphisms are risk factors for osteoporosis. We have sequenced all exons including in the promoter region up to –1,800bp to identify additional genetic polymorphisms in TGFB1. Four novel polymorphisms were newly identified: one in 5' region (g.14129555underscore;14129557dupAGG), one in promoter region (g.14128838C>T), and two in intron (g.14106505G>A and g.14106215G>A). Two known SNPs (g.14128554C>T and g.14127139T>C) were also confirmed. The frequencies of each SNP were 0.479 (g.14129555underscore;14129557dupAGG), 0.007 (g.14128838C>T), 0.478 (g.14128554C>T), 0.476 (g.14127139T>C), 0.016 (g.14106505G>A), and 0.004 (g.14106215G>A) in the Korean population (n=1,885), respectively. Haplotypes and their frequencies were estimated by EM algorithm, and linkage disequilibrium coefficients (∣D'∣ and r2) between polymorphism pairs were calculated. We analyzed genetic associations of TGFB1 polymorphisms and haplotypes with spinal bone mineral density (BMD) value of 433 postmenopausal Korean women. By statistical analysis, we could not find any associations with spinal BMD. The information from this study of the critical TGFB1 would be useful for genetic studies of other diseases. © 2003 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Human transforming growth factor?beta1 (TGFB1) is a family of polypeptides that regulate cell growth, cell differentiation, and cell function as a multifunctional regulator of cellular activity. TGFB1 is produced by osteoblasts and stored in substantial amounts in the bone matrix, which is an important regulator of both skeletal development and homeostasis of bone metabolism. In the present study, we identified four new polymorphisms in TGFB1 and examined whether these polymorphisms are risk factors for osteoporosis. We have sequenced all exons including in the promoter region up to –1,800bp to identify additional genetic polymorphisms in TGFB1. Four novel polymorphisms were newly identified: one in 5' region (g.14129555underscore;14129557dupAGG), one in promoter region (g.14128838C>T), and two in intron (g.14106505G>A and g.14106215G>A). Two known SNPs (g.14128554C>T and g.14127139T>C) were also confirmed. The frequencies of each SNP were 0.479 (g.14129555underscore;14129557dupAGG), 0.007 (g.14128838C>T), 0.478 (g.14128554C>T), 0.476 (g.14127139T>C), 0.016 (g.14106505G>A), and 0.004 (g.14106215G>A) in the Korean population (n=1,885), respectively. Haplotypes and their frequencies were estimated by EM algorithm, and linkage disequilibrium coefficients (?D'? and r2) between polymorphism pairs were calculated. We analyzed genetic associations of TGFB1 polymorphisms and haplotypes with spinal bone mineral density (BMD) value of 433 postmenopausal Korean women. By statistical analysis, we could not find any associations with spinal BMD. The information from this study of the critical TGFB1 would be useful for genetic studies of other diseases. © 2003 Wiley?Liss, Inc. [ABSTRACT FROM AUTHOR]

Background: The purpose of this research is to discover whether measurement of cervical length and cervical volume at term is helpful in predicting the onset of labor in VBAC candidates.Methods: Transvaginal sonographic evaluations of the cervixes of pregnant women who desired to undergo VBAC were performed between 36 - 40 weeks gestation. Clinical information such as labor onset time, gestational age at delivery and delivery mode was gathered from medical records.Results: A total of 514 pregnant women participated in this study. Cervical length was significantly longer in the group that delivered 7 days or more after measurement than in the group that delivered within 7 days of measurement (43±0.77 cm vs. 2.99±0.72 cm, p< 0.001). Cervical volume was significantly larger in the group that delivered at and after 7 days than in the group that delivered within 7 days (29.21±11.62 cm3 vs. 34.07±13.41 cm3, p=0.014). The cervical length ROC curve was significantly more predictive than the cervical volume ROC curve (AUC: 0.711 vs 0.594, p= 0.001). There were no significant differences between the combined cervical length/volume ROC curve and the cervical length ROC curve alone (p= 0.565). The AUC of the cervical length ROC curve to predict postterm pregnancy was 0.729.Conclusion: Measuring cervical length is helpful in predicting the onset of spontaneous labor within 7 days and posterm delivery in VBAC candidates.

An amniocele is a herniation of the amniotic sac through a uterine defect. Uterine rupture during pregnancy may develop as a result of a pre-existing injury, uterine anomaly, or unscarred uterus. A 30-year-old patient, with a history of 2 vaginal deliveries, presented an amniocele complicated by left fundal perforation and was evaluated with 3-dimensional ultrasound at 23 weeks. Because of worsening lower abdominal pain and vaginal bleeding, she underwent exploratory laparotomy. Herein, we report a uterine rupture with amniocele.

Background: We would like to find out that whether the patient's parity, previous delivery mode and previous labor could influence cervical parameters. Cervical length, volume and width were measured using two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound on normal pregnant women.Method: This study was conducted between January 2009 and December 2010 in singleton pregnant women who were admitted for routine antenatal care at hospitals in affiliation with the Catholic University, Seoul, Korea. The study group was classified by parity (nullipara and multipara) and previous delivery mode (cesarean section group and vaginal delivery group). The previous cesarean section group was divided by elective group who did not undergo labor and labor group who underwent labor. Cervical parameters such as cervical length, volume and width were measured using 2D and 3D ultrasound examinations in the first and second trimesters and the results were analyzed between those groups mentioned above.Results: One hundred and twenty-one pregnant women in their 1st trimester and 233 pregnant women in their 2nd trimester (a total of 354) were enrolled in this study. Cervical parameters were not statistically significant from parity, nor previous delivery mode and previous labor in 1st trimester. Cervical volumes were not statistically significant from nullipara and elective cesarean section groups (35.96±9.81 vs. 34.73±9.75 cm3), but the nullipara groups were significantly lowered in the vaginal group (35.96±9.81 vs. 43.10±11.87 cm3) in 2nd trimester. For the nullipara group, cervical widths were not statistically significant in the elective cesarean section group but these were significantly lower than labor and previous vaginal group in the 2nd trimester.Conclusion: The cervical volume and width have an influence on parity, previous delivery mode and labor in the 2nd trimester.