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Objective The air pollution on pregnancy outcome (APPO) study is a prospective hospital-based cohort study designed to investigate the maternal and fetal effects of a particulate matter with an aerodynamic below 10 μm (PM10) and PM2.5 (below 2.5 μm) exposure. This study aims to analyze a relationship between particulate matter and adverse pregnancy outcomes and to find related biomarkers and develop management guidelines.Methods About 1,200 pregnant women are recruited for 3 years (from January 2021 to December 2023) from seven university hospitals to investigate the effects of particulate matter on pregnancy complications and adverse pregnancy outcomes. We collect biological samples by 5 mL of maternal venous blood and 15 mL of urine in each trimester of pregnancy, and 5 mL of umbilical cord blood and 2×2×2 cm of placental tissue are collected after delivery. In addition, by applying PM10 and PM2.5 concentration values and time-activity patterns from the time weighted average model, the individual predicted exposure of air pollution for the pregnant women are obtained.Results The average exposure of PM10 and PM2.5 of the participants in the entire period of pregnancy, was exceeded the World Health Organization air quality guidelines (an annual level, PM10 >15 μg/m3, PM2.5 >5 μg/m3). Moreover, it was revealed that the PM concentration was increasing toward the 3rd trimester of pregnancy.Conclusion The APPO study will be able to identify the degree of exposure to air pollution in pregnant women and use it as basic data for estimating individual exposure to particulate matter. And the results of the APPO study will facilitate in the development of health management for pregnant women against air pollution.

To establish a new treatment option for cervico-isthmic pregnancy (CIP) other than termination by maintaining pregnancy from diagnosis to delivery.This retrospective observational study included women diagnosed with CIP at Dongsan Medical Center, Daegu, Korea, from January 2014 to December 2019. Eight patients were diagnosed with CIP using transvaginal ultrasound and met the following inclusion criteria: (1) preserved and closed cervical canal; and (2) more than half of the uterine cavity above the sac was not involved in sac implantation. Five of the eight mothers decided to maintain their pregnancy after an adequate explanation of the possible risks. The same sonographer assessed fetal and maternal status every 1-2 weeks. Intra- and postoperative indicators, delivery information, and neonatal outcomes were also recorded.The mean patient age was 36 years. In all cases, placenta accreta spectrum and placenta previa were detected using preoperative ultrasonography. A hysterectomy was performed in three cases, and all patients required intensive care unit (ICU) care. The mean operative time was 156 minutes. The rate of postpartum hemorrhage was 40%. Four viable fetuses were delivered. Birth preceding 34 weeks occurred in one patient, who required neonatal ICU hospitalization for 19 days.Conservative treatment with careful diagnosis, management, and sufficient consultation could be an alternative treatment option in women with CIP, particularly older mothers, those with subfertility, and those who expect to have limited future opportunities for a successful pregnancy. Therefore, CIP should be treated as a separate disease entity.

Background Ambient particulate matter (PM) is a trigger factor for metabolic dysfunction. This study aimed to evaluate the associations between PM exposure and metabolic dysfunction in pregnancy. Methods This prospective, multicentre, observational, cohort study was conducted from January 2021 to June 2022. A total of 333 women with singleton pregnancies were recruited. For individual measurement of PM2.5 levels, an AirguardK® was installed inside the participants’ houses. Time-activity logs were recorded to predict each participant’s personal exposure to PM2.5. The participants were divided into groups according to the concentration of PM2.5 calculated by a time-weighted average model. We used the Student t-test and chi-squared test (or Fisher’s exact test) to evaluate changes in metabolic compound levels, blood pressure (BP), glucose intolerance, and lipid profiles, including serum triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratios. Logistic and linear regression models were used to analyse the association between PM2.5 exposure and metabolic dysfunction, using odds ratios (ORs) and 95% confidence intervals (CIs). Results PM2.5 exposure during pregnancy worsened metabolic dysfunction. Third trimester BP was elevated in those participants exposed to higher levels of PM2.5 (p 2.5, regardless of the PM2.5 cut-off level (PM2.5 ≥10 µg/m3, 7.91 % vs. 16.09 %, p 2.5 ≥25 µg/m3, 7.91 % vs. 26.67 %, p 2.5 was ≥10 µg/m3 (75.3 % vs. 83.0 %, p 2.5 ≥25 µg/m3 group (p=0.0171). We found an increased risk of elevated BP (adjusted OR [aOR]: 2.228, 95% CI: 1.115–4.449) and GDM (aOR 2.263, 95% CI 1.106–5.039) in the third trimester after adjusting for confounders. Conclusion Exposure to PM2.5 worsens metabolic dysfunction in pregnancy. Further studies are required to investigate the mechanisms by which ambient PM affects metabolic dysfunction in pregnancy.

Objective This study aimed 1) to investigate the clinical characteristics of amniotic fluid embolism (AFE) cases clinically diagnosed by maternal fetal medicine (MFM) specialists in Korea, 2) to check the disagreement with 4 recently proposed criteria by the Society for Maternal-Fetal Medicine (SMFM) for research purpose, and 3) to compare maternal outcomes between cases satisfying all 4 criteria and cases with at least 1 missing criterion. Methods This study included 12 patients clinically diagnosed with AFE from 7 referral hospitals in Korea. We collected information, including maternal age, symptoms of AFE, the amount of transfusion, and maternal mortality. Results The median maternal age was 33 years (range, 28–40 years). Regarding symptoms, cardiovascular arrest, hypotension, respiratory compromise, clinical coagulopathy, and neurologic signs were observed in 41.7%, 83.3%, 83.3%, 100%, and 66.7% of the cases, respectively. Among the 12 cases, 5 women died and 2 suffered severe neurologic disability, showing an intact survival rate of 41.7%. Disagreement with all 4 criteria proposed by the SMFM was found in 66.7% of the cases, due to the lack of criteria for disseminated intravascular coagulation or strict onset time (

Background and Objective Obstetricians play a pivotal role in pregnancy and delivery. Also, they frequently encounter common comorbidity, such as pregnancy-related depression. We investigated the depression and sleep status of obstetricians in South Korea. Methods This is a questionnaire-based cross-sectional survey, carried out from December 2019 to January 2020. We asked board-certificated obstetricians to complete a series of questionnaires, including demographic information, the Beck Depression Inventory-2 (K-BDI), Pittsburgh sleep quality index (K-PSQI), insomnia severity index, Epworth Sleepiness Scale, and an acronym Snoring, Tiredness, Observed apneas, and high blood Pressure (STOP). Results A total of 107 obstetricians completed the questionnaires. Their mean age was 50.60 ± 7.83 years, and 83 (77.6%) were male. The average years after the board certification was 17.80 ± 7.62 years. They worked 68.90 ± 19.61 hours a week, and slept for 7 hours (06:59:20.75 ± 01:08:21.63), approximately. The number of duty days and deliveries in the last month were 6.44 ± 4.35 and 28.95 ± 25.16 per month, respectively. Forty-five (42.1%) obstetricians had poor sleep quality, 22 (20.6%) had suspicious insomnia, and 45 (42.1%) had significant depression. In multiple regression analyses, K-PSQI (standardized β = 0.492, p < 0.001) and the number of deliveries in the last month (standardized β = 0.453, p < 0.001) showed significant influence upon K-BDI. Conclusions The risk of depression increased by 8.8% as another monthly delivery was performed. A point increase in K-PSQI increased the risk of depression by 49.6%. The worse the sleep quality, and the more frequent the deliveries, the more depressed the obstetrician was.

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is affiliated with the β-coronavirus subgroup, which includes SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), but is far more infectious than the 2. Because it is potentially life-threatening to infants and pregnant women with weak immune systems, clinical manifestations and vertical transmission of COVID-19 are matters of interest. Staff of the obstetrics department of university hospitals in Daegu and of the Daegu metropolitan government designated Daegu Fatima Hospital for the delivery of pregnant women with suspected and confirmed SARS-CoV-2 infection. Thirteen pregnant women with laboratory-confirmed COVID-19 were identified. Among them was a 28-year-old pregnant woman who had recovered from COVID-19 and had given birth to a healthy girl at 38 weeks of gestational age. We present our uncommon experience with a brief review of literatures.

Background: The prevalence of sleep disorders increases as pregnancy progresses, which affects the health of pregnant women, fetal health, and the outcomes of pregnancy. The aim of this study is to evaluate the quality of sleep and life in pregnant women in Korea.Methods: This study is a prospective cross-sectional, case-control study of pregnant women and age-matched controls. From July to September 2019, all participants completed Korean-language versions of the sleep questionnaires including Pittsburgh sleep quality index (K-PSQI), Insomnia severity index, Epworth sleepiness scale, Back’s depression inventory-2(K-BDI), STOP (Snoring, Tiredness, Observed apneas, and high blood Pressure), and short-form 36 (K-SF-36).Results: A total of 422 participants consisted of 385 pregnant women and 137 controls. Second and third trimester were 200 and 185, respectively. K-PSQI scores were higher in pregnant women compared with the controls (7.87±3.49 and 8.50±3.55 vs. 5.79±2.76, p

Background We investigated whether leptin during the third trimester was associated with fetal growth compared to IGF-1. Methods One hundred five appropriate-for-gestational-age (AGA) infants born at ≥28 weeks’ gestation were enrolled. Cord blood leptin and insulin like growth factor 1 (IGF-1) were collected simultaneously during delivery. Enrolled infants were stratified into three groups according to GA as follows: 28 to Results Sixty-eight infants out of 105 infants were preterm (32.5 ± 2.5 weeks), and 37 infants were term (37.8 ± 1.2 weeks). BW, BL, HC, and BMI were higher with increasing gestational age among the three gestational age-specific groups. With regard to hormones, leptin and IGF-1 were higher with increasing gestational age. Log cord serum leptin was independently associated with BW and BL in multivariable linear regression analysis, after adjustment for confounding factors including gestational age, delivery mode, multiple pregnancy, pregnancy induced hypertension, gestational diabetes mellitus, infant’s BMI, and log cord blood IGF-1 levels. Conclusions During the third trimester, cord serum leptin was independently associated with fetal growth.

Prenatal and perinatal infections and inflammation appear to associated with the development of retinopathy of prematurity (ROP). In this study, we evaluated whether inflammatory mediators in amniotic fluid (AF) retrieved during cesarean delivery influence the development of ROP in very low birth weight (VLBW) infants. This retrospective study included 16 and 32 VLBW infants who did and did not develop any stage of ROP, respectively. Each infant with ROP was matched with 2 infants without ROP based on days of ventilation care, gestational age, and birth weight. AF was obtained during cesarean delivery, and the levels of intra-amniotic inflammatory mediators such as interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10, matrix metalloproteinase (MMP)-2, MMP-8, MMP-9, and tumor necrosis factor (TNF)-α were measured using a Human Magnetic Luminex assay (RD Systems, Minneapolis, MN). The differences in the levels of inflammatory mediators according to the presence or absence of ROP were compared. In patients who developed ROP, the level of MMP-2 in the AF was significantly increased (P = .011), whereas the levels of IL-10 and TNF-α were significantly decreased (P = .028 and .046, respectively) compared with those in infants who did not develop ROP. The levels of the other mediators were not significantly different between the 2 groups. Multivariate regression analysis showed that MMP-2 was a risk factor for the development of ROP (odds ratio, 2.445; 95% confidence interval, 1.170-5.106; P = .017). The concentration of MMP-2 in AF is an independent factor in the development of ROP. Further studies are needed to determine whether the levels of inflammatory mediators in AF affect the ROP severity.

Background: A causative role between cervical ureaplasma colonization and adverse outcomes during pregnancy has remained controversial. We investigated whether cervical ureaplasma colonization affects the biochemically or histologically intraamniotic inflammation in preterm birth.Methods: Amniotic fluid was retrieved during delivery. Various chorioamnionitis-related cytokines (interleukin (IL)-1β, -6, -8, -10, and tumor necrosis factor-α) and regulators (matrix metalloproteins (MMP)-8 and MMP-9) were measured with Human Magnetic Luminex screening assay. We tested cervical swab specimens using real-time polymerase chain reaction assays for the detection of ureaplasma spp. colonization. Considering the clinical situation that causes intraamniotic infection, we arbitrarily divided into three categories of preterm labor with intact membrane, preterm premature rupture of membrane (PPROM), and control group with no exposure to preterm labor or preterm premature rupture of membrane.Results: The incidence of cervical ureaplasma colonization was 49.3% (136/276). The incidence of histologic chorioamnionitis was 27.5% (76/200). All differences in cytokines and regulators according to histologic chorioamnionitis were significant. Of the 153 cases that experienced preterm labor with intact membrane, IL-10, MMP-8, and MMP-9 levels in the ureaplasma positive group were significantly higher than those of the ureaplasma negative group. According to logistic regression analysis adjusted to preterm labor with intact membrane, PPROM, and gestational age at delivery, cervical ureaplasma colonization was an independent risk factor of histologic chorioamnionitis (odd ratio: 2.622, 95% confidence interval: 1.443-4.766).Conclusions: Cervical ureaplasma colonization augments biochemically intraamniotic inflammation in preterm labor with intact membrane, and was an independent risk factor of histologic chorioamnionitis.

Background Fine particulate matter (PM2.5) can easily penetrate blood vessels and tissues through the human respiratory tract and cause various health problems. Some studies reported that particular matter (PM) exposure during pregnancy is associated with low birth weight or congenital cardiovascular anomalies. This study aimed to investigate the correlation between the degree of exposure to PM ≤ 2.5 μm (PM2.5) during pregnancy and congenital anomalies relevant to the field of pediatric surgery. Methods Mother-infant dyads with registered addresses in the Metropolitan City were selected during 3 years. The electronic medical records of mothers and neonates were retrospectively analyzed, with a focus on maternal age at delivery, date of delivery, gestation week, presence of diabetes mellitus (DM) or hypertension, parity, the residence of the mother and infant, infant sex, birth weight, Apgar score, and presence of congenital anomaly. The monthly PM2.5 concentration from the first month of pregnancy to the delivery was computed based on the mothers' residences. Results PM2.5 exposure concentration in the second trimester was higher in the congenital anomaly group than in the non-congenital anomaly group (24.82 ± 4.78 µg/m3, P = 0.023). PM2.5 exposure concentration did not affect the incidence of nervous, cardiovascular, and gastrointestinal anomalies. While statistically insignificant, the groups with nervous, cardiovascular, gastrointestinal, musculoskeletal, and other congenital anomalies were exposed to higher PM2.5 concentrations in the first trimester compared with their respective counterparts. The effect of PM2.5 concentration on the incidence of congenital anomalies was significant even after adjusting for the mother's age, presence of DM, hypertension, and parity. The incidence of congenital anomalies increased by 26.0% (95% confidence interval of 4.3% and 49.2%) per 7.23 µg/m3 elevation of PM2.5 interquartile range in the second trimester. Conclusions The congenital anomaly group was exposed to a higher PM2.5 concentration in the second trimester than the non-congenital anomaly group. The PM2.5 exposure concentration level in the first trimester tended to be higher in groups with anomalies than those without anomalies. This suggests that continuous exposure to a high PM2.5 concentration during pregnancy influences the incidence of neonatal anomalies in surgical respects., Graphical Abstract

This study aimed evaluate the feasibility of modified laparoscopic transabdominal cervicoisthmic cerclage (LTCC) and its impact on recurrent pregnancy loss (RPL) and is a retrospective observational cohort study of patients who underwent modified LTCC from 2003 to 2018 (n = 299). The surgery was performed at a mean gestational age of 12.5 weeks (range 10.5–17.5 weeks). Of the 299 patients, 190 were reported as having undergone abortion (one abortion: 91 (47.9%), two: 59 (31.1%), three or more: 40 (21.1%)) before the present pregnancy and prior to the surgery. The mean operation time was 47.4 min (range 15–100 min). We followed up with 205 of 299 patients and recorded their obstetric outcomes. There were 176 successful deliveries via cesarean section, and the fetal survival rate was 85.9% (176/205). The results of this study suggest that modified LTCC is a safe and feasible surgical option during pregnancy for patients with a history of RPL due to cervical factors.

This study aimed to evaluate the feasibility and safety of temporary transcatheter balloon occlusion of bilateral internal iliac arteries (TBOIIA) during cesarean section in a hybrid operating room (OR) for placenta previa (PP) with a high risk of massive hemorrhage. This retrospective study analyzed the medical records of 62 patients experiencing PP with a high risk of massive hemorrhage (mean age, 36.2 years; age range 28–45 years) who delivered a baby via planned cesarean section with TBOIIA in a hybrid OR between May 2019 and July 2021. Operation time, estimated blood loss (EBL), amount of intra- and postoperative blood transfusion, perioperative hemoglobin level, hospital stay after operation, balloon time, fluoroscopy time, radiation dose, rate of uterine artery embolization (UAE) and hysterectomy, and complication-related TBOIIA were assessed. The mean operation time was 122 min, and EBL was 1290 mL. Nine out of sixty-two patients (14.5%) received a blood transfusion. The mean hemoglobin levels before surgery, immediately after surgery and within 1 week after surgery were 11.3 g/dL, 10.4 g/dL and 9.2 g/dL, respectively. In terms of radiation dose, the mean dose area product (DAP) and cumulative air kerma were 0.017 Gy/cm2 and 0.023 Gy, respectively. Ten out of sixty-two patients (16.1%) underwent UAE postoperatively in the hybrid OR. One out of sixty-two patients had been diagnosed with placenta percreta with bladder invasion based on preoperative ultrasound, and thus underwent cesarean hysterectomy following TBOIIA and UAE. While intra-arterial balloon catheter placement for managing PP with a high risk of hemorrhage remains controversial, a planned cesarean section with TBOIIA in a hybrid OR is effective in eliminating the potential risk of intra-arterial balloon catheter displacement, thus reducing intraoperative blood loss, ensuring safe placental removal and conserving the uterus.

Background In accordance with the guidelines for the expectant management of women exposed to previable preterm premature rupture of membrane, we compared neonatal outcomes according to the latent period from membrane rupture to delivery among extremely preterm infants exposed to maternal preterm premature rupture of membrane using the Korean Neonatal Network database. Methods Of the 3,305 extremely preterm infants born at 23–27 weeks' gestation between 2014 and 2017 who were registered in the Korean Neonatal Network, 1,464 infants were born to pregnant women who were exposed to preterm premature rupture of membrane. The short latency group was defined as infants born with a latent period between membrane rupture and delivery < 7 days (n = 450), whereas the prolonged latency group was defined as infants born with a latent period of ≥ 7 days (n = 434). Using well-established risk factors for adverse short-term outcomes, multivariate logistic regression analysis was performed to assess a prolonged latent period in preterm premature rupture of membrane as an independent risk factor for neonatal outcomes in extremely preterm infants exposed to preterm premature rupture of membrane. Results The mean gestational age at membrane rupture in the prolonged latency group was significantly lower than that in the short latency group (22.7 ± 2.5 vs. 25.4 ± 1.3 weeks, P < 0.001). Nevertheless, the mean gestational age at delivery and birth weight were not significantly different between the two groups. The incidence of oligohydramnios and histologic chorioamnionitis in the prolonged latency group was significantly higher than that in the short latency group (38.7 [155/401] vs. 26.1 [105/403], 69.8 [270/384] vs. 61.0 [242/397], respectively, P < 0.05). The survival rate in the prolonged latency group did not differ from that in the short latency group (71.2 [309/434] vs. 73.3 [330/450], P = 0.478). Although the prolonged latency group was not associated with mortality during hospitalization in the multivariate logistic regression analysis, the prolonged latency group's early pulmonary hypertension and bronchopulmonary dysplasia rates were increased by 1.8 and 1.5 times, respectively. Conclusion A prolonged latent period of 7 days or more does not affect the survival rate but increases the risk of bronchopulmonary dysplasia occurrence among extremely preterm infants who are exposed to maternal preterm premature rupture of membrane., Graphical Abstract

Background Pregnancy in women with epilepsy (WWE) is known to have a higher risk for fetal development complications, which may include congenital malformations. Unfortunately, information pertaining to pregnancy in WWE is difficult to obtain because there are considerable ethical issues preventing these studies from being conducted on pregnant women. Therefore, this study investigated the pregnancies of Korean WWE in a tertiary epilepsy center to observe data resulting from the outcome of the pregnancies. Methods This was a retrospective study of 48 pregnant WWE who were treated at the regional tertiary epilepsy center. All records of hospital visits before and after the period of pregnancy were analyzed to obtain information about the seizures as well as pregnancy-related outcomes, including the status of the newborns' conditions. Results The subject group consisted of 31 (63.3%) with partial epilepsy, 6 (12.5%) with generalized epilepsy, and 11 (22.9%) with unclassified epilepsy. There were 27 subjects who took one antiepileptic drug (AED), and 12 who took two AEDs. The most commonly used drug was lamotrigine (29.8%). Of the 48 WWE involved in the study, 31 underwent caesarian sections and 17 opted for natural birth. Thirty-nine (81.3%) delivered at full-term, but 9 (18.7%) delivered at preterm. Compared to full-term infants, pre-mature infants showed lower birth weight, smaller head circumference, shorter height, and lower 1-minute Apgar scores, but seizure frequencies of the mothers did not differ. Conclusion In WWE, epilepsy classification, number of AEDs taken, and frequency of seizures are not significantly correlated with delivery and fetal condition. This data could be used as a clinical reference for physicians to provide useful information to WWE if they are concerned about their pregnancies., Graphical Abstract

The change in sleep patterns across the duration of pregnancy is an item of interest. The aim of this study is to provide data on pregnant women’s quality of sleep (QoS) and quality of life (QoL) to determine appropriate times to screen for potential problems. This is a multicenter, prospective, longitudinal observational study. Primigravidae, with no previous illness, completed questionnaires once a month. Strict exclusion criteria were applied in order to evaluate QoS and QoL in “normal” pregnant women. A total of 83 normal primigravidae completed this study. The mean age was 33.1 ± 4.0. During pregnancy, body mass index gradually increased, and QoS worsened to a significant degree between the fifth and ninth months (Pittsburgh Sleep Quality Index 6.8 ± 2.8 vs. 8.9 ± 3.6, p < 0.001). There was a statistically significant difference in QoL between the fifth and seventh months (Short Form-36 70.8 ± 18.3 vs. 67.3 ± 15.1, p = 0.009). There was no evidence of significant depression or suspicion of sleep-disordered breathing. Pregnant women in South Korea have gradual worsening of QoS which becomes clinically significant by full term. QoL changes significantly between the fifth and seventh months. The results of this observational study suggest that it would be fruitful to evaluate QoS and QoL in pregnant women between the second and third trimesters.

Antimicrobial resistance is currently becoming a global threat to human health. We performed a retrospective study on patients who underwent emergency cerclage between January 2016 and December 2018 at the Dongsan Medical Center. Cervical culture was first performed before surgery to confirm that there was no infection and was repeated on days 1, 4, and 7 after surgery. A total of 85 pregnant women underwent emergency cerclage. Among them, six patients had vancomycin-resistant enterococci (VRE) colonization in the cervix after cerclage, and 23 patients developed extended-spectrum β-lactamase (ESBL)-producing bacterial colonization in the cervix. The average gestational age at delivery was lower in the VRE group. Neonatal death was also significantly higher in the VRE group. The rate of occurrence of early-onset sepsis was also higher in the VRE group, and both VRE and ESBL-producing bacterial colonization cases in which early-onset sepsis occurred resulted in neonatal death. The prognosis of cervical VRE colonization after cervical surgery was poor, whereas the prognosis of ESBL-producing bacterial colonization in the cervix did not differ significantly from that of the control group. However, careful neonatal treatment is required considering that early-onset sepsis is fatal to the newborn.

There are reports that pregnant women infected with SARS-CoV-2 not only have increased morbidity but also increased complications and evidence of maternal and fetal vascular malperfusion on placental pathology. This was a retrospective study of pregnant women diagnosed with SARS-CoV-2 infection after March 2020. The results of reverse transcription polymerase chain reaction testing and IgM and IgG antibody testing of the amniotic fluid, cord blood, placenta, and maternal blood were confirmed at delivery. Placentas were evaluated histopathologically. The study included seven pregnant women diagnosed with SARS-CoV-2 infection during pregnancy at a mean gestational age of 14.5 weeks. Out of the seven women, five were infected during the first trimester. The mean gestational age at delivery was 38.4 weeks. The reverse transcription polymerase chain reaction results for maternal plasma, cord blood, placenta, and amniotic fluid were negative and IgG antibodies were detected in maternal plasma and cord blood. On placental pathology, maternal vascular malperfusion was found in only one case, fetal vascular malperfusion in four cases, and inflammatory changes were found in two cases. Pregnancy outcomes for women diagnosed with SARS-CoV-2 infection during early pregnancy are positive and it is likely that maternal antibodies are passed to the fetus, which results in a period of immunity.

This retrospective study aimed to evaluate the correlation between ophthalmologic factors and proteinuria in patients with pre-eclampsia using swept-source optical coherence tomography (OCT) and OCT angiography. In total, 61 pregnant patients diagnosed with pre-eclampsia were recruited during their hospital stay. The authors investigated the relationship between urine protein–creatinine ratio (PCR) and chorioretinal measurements including choroidal thickness (CT), choroidal vascularity index (CVI), foveal avascular zone (FAZ), vascular density (VD), ganglion cell layer+ (GCL+) and GCL++. The associations between mean arterial pressure (MAP) and ophthalmologic factors were also evaluated. Central subfield CT of the right eye (p = 0.031) and paracentral CT of both eyes were related to higher PCR (≥1.35 mg/mg). A significant association with PCR after logarithm transformation was noted (r = 0.284, p = 0.026). Retinal measurements (FAZ, VD, GCL+ and GCL++) and CVI were not related with PCR. There was a positive association between MAP and PCR after logarithm transformation (r = 0.296, p = 0.021); however, chorioretinal factors were not related with MAP. In pregnant women with pre-eclampsia, CT using OCT is a novel factor that is correlated with PCR. Ocular structural alteration in patients with pre-eclampsia may be one of systemic vascular changes caused by pre-eclampsia rather than hypertension.

PURPOSE To determine whether serum insulin and glucagon levels of umbilical cord blood correlate with subsequent postnatal hypoglycemia in appropriate for gestational age (AGA) - preterm infants at different gestational ages (GAs). METHODS The serum insulin and glucagon levels of umbilical cord blood were measured using magnetic bead based multiplex immunoassay in 69 AGA - premature infants, stratified according to GA: GA 23-30 weeks, early preterm (EP, n=31); GA 31-34 weeks, late preterm (LP, n=38). Postnatal hypoglycemia was defined as a capillary glucose level

Endometrial cancer is the third most common gynecologic cancer in the Korea and occurs mainly in menopausal women. Although it can develop in young premenopausal women cancer as well, an attack in the adolescent girl is very rare. A 13-year-old girl visited gynecology department with the complaint of abnormal uterine bleeding. An endometrial biopsy revealed FIGO (International Federation of Gynecology and Obstetrics) grade II endometrial adenocarcinoma. In the treatment of endometrial cancer, conservative management should be considered if the patient is nulliparous or wants the fertility preservation. Therefore, we decided to perform a hormonal therapy and a follow-up endometrial biopsy after progestin administration for eight months revealed no residual tumor. We report a case of endometrial cancer occurred in a 13-year-old girl with a brief review of the literature.

We introduce a case of triplet pregnancy with a complete hydatidiform mole coexisting two viable fetuses and important issues for prenatal care in both mothers and fetuses due to a significantly high risk for both mothers and fetuses. A 32-year-old patient conceived a triplet pregnancy after intrauterine insemination. At 14 weeks of gestation, ultrasonography revealed hydatidiform moles that were adjacent to two fetuses. Fetal karyotyping of the two fetuses showed normal results. The second baby developed fetal growth restriction at 24 weeks of gestation and preeclampsia developed at 29 weeks of gestation. At 31 weeks and one day of gestation, cesarean section was performed due to fetal distress of the second baby. Microscopically, the molar tissue was favorably diagnosed as complete hydatidiform mole. This is successful delivery report of a pregnant woman who had triplet pregnancy complicated with one complete hydatidiform mole coexisting two viable fetuses in Korea.

Nowadays, cameras embedded in smartphones can take high resolution photographs that can be used to analyze skin conditions without using specialized equipments. In shooting photographs with a smartphone, it is difficult to maintain a uniform shooting distance. Therefore, it is essential to adapt a skin analysis method to the shooting distance. In this paper, we focus on a pore detection algorithm that is adaptive to the camera distance. We develop a relationship model between the shooting distance and the appropriate size of the pore detection mask. In addition, we propose a method to estimate the normalized pore size (i. e. pore size at a standard shooting distance). We conducted experiments on skin images taken from different shooting distances. It was verified that the proposed method can achieve more accurate pore detection result, close to those from skin images taken at a standard shooting distance.

We report a case of de novo 7q interstitial deletion detected by conventional karyotyping and by microarray of amniotic fluid sampled during the prenatal period. A 32-year-old pregnant woman was evaluated at our hospital following detection of increased nuchal translucency at 12 weeks and 5 days of gestation. Conventional karyotyping revealed 46,XX,del(7)(q21q22) in 20 interphase mitotic cells, and high-resolution microarray revealed 12.8 Mb (90,625,014-103,430,901) deletion in the region 7q21.13q22.1. Both parents had normal karyotypes. After birth, the neonate displayed several anomalies, including palatine cleft, upslanted and wide palpebral fissure, low-set ears, micrognathia, microcephaly, ventriculomegaly, subglottic tracheal stenosis, hearing loss, and hand/foot deformities, including brachydactyly, polydactyly, and cutaneous syndactyly. This case study helps explain the phenotype-genotype relationship in patients with 7q21.13q22.1 deletion.

As the development of Doppler ultrasonography, many cases of uterine arteriovenous malformation (AVM) have beed diagnosed. But there is no case of cervical AVM in pregnant uterus. We present a 33-year-old pregnant woman who was diagnosed with AVM of the uterine cervix during the midtrimester. Color Doppler sonography and magnetic resonance image were used for diagnosis. We performed Cesarean section because of the risk of massive bleeding from the cervical AVM at 34 weeks' gestation. This is the first case of cervical AVM during pregnancy with a successful outcome and an uneventful postpartum course.

Benign metastasizing leiomyoma (BML) is a rare disease, which usually occurs in women with a history of a prior hysterectomy or myomectomy for benign uterine leiomyoma, and has the potential to metastasize to distant sites, such as the lung, lymph nodes, muscular tissue, heart, or retroperitoneum. These lesions are slow-growing, asymptomatic, and usually found incidentally. The prognosis of BML is also excellent. However, there has been debate on the origin and the correct classification of BML, and there are no guidelines for the treatment of BML. We report here on a rare case of BML in both the retroperitoneal cavity and lung in a 48-year-old woman with a history of hysterectomy due to histologically benign uterine leiomyoma. The patient underwent retroperitoneal mass excision and bilateral salpingo-oophorectomy, and then wedge biopsy of two pulmonary nodules was performed additionally 9 days later. Until now, there has been no sign of recurrence and the patient remains asymptomatic. To our knowledge, pulmonary BML is rare and the co-existence of the retroperitoneal metastases after previous hysterectomy is even rarer.

In this paper we propose a novel method to measure the contrast reduction in a digital image, and its application on LCD backlight dimming. The contribution of this paper is twofold. First, we propose a new key concept, burstiness, in measuring the contrast reduction. Second, there has not been a backlight control method that quantifies the image quality degradation in terms of contrast reduction, and optimizes it with power consumption. By considering the spatial distribution characteristic of contrast reduced pixels, the proposed method effectively captures the contrast reduction. This leads to a gain in the power saving in the backlight dimming while visual perception quality is maintained.

We propose an image adaptive backlight dimming method that quantitatively measures the perceived image quality degradation in terms of brightness and contrast. Unlike conventional methods, the proposed adaptive dimming considers the spatial distribution characteristics of the clipped pixels via a new measure, clusterization, to effectively estimate the perceived contrast loss and prevent the clipping artifact (light saturation). The proposed adaptive dimming achieves an average 17.71% power reduction while keeping the image quality difference to a tolerably low amount, as shown by the subjective mean opinion score test results. Comparing the optimal backlight levels estimated by the proposed method with results from other methods, the proposed backlight dimming is closer to the ground truth backlight levels that are favored by human subjects.

rd trimester pregnancy, surgical management without delivery is very difficult and preterm birth is inevitable because of life-threatening complications not only for mother but fetus. We present a woman with 31 weeks and 3 days’ gestation and spontaneous hemoperitoneum that was treated by conservative management without preterm delivery successfully. A review of the literature was undertaken.

Interlabial mass in infant is not common. Because of similarity of symptoms and signs of those mass and less experience of gynecologist due to those rarity, differential diagnosis is not easy. In infant, there are fi ve common interlabial masses which are prolapsed ectopic ureterocele, urethral prolapse, paraurethral cyst, hydrocolpos and rhabdomyosarcoma. Ureterocele with duplex ureter might be diagnosed, however prolapsed ureterocele through urethra is extremely rare. We found 18 months old girl with interlabial mass and diagnosed as prolapsed ectopic ureterocele by ultrasonography, magnetic resonance imaging and voiding cystourethrography. We managed by endoscopic incision of ureterocele successfully. So we report this case with a brief review of associated literatures.

Most orbital tumors of infants include retinoblastoma, dermoid cyst (teratoma), optic nerve glioma and nevus, and hemangioendothelioma is found in rare cases. Hemangioendothelioma, the tumor of intermediate malignancy between angiosarcoma and hemangioma, is commonly recognized in soft tissue of extremities, skin, lung and liver with symptoms of ulceration and hepatomegaly in neonates and infants. However it seldom localizes in the orbit. Although there have been two case reports of orbital hemangioendothelioma in neonate and adult in Korea, there was no case report of prenatally diagnosed orbital hemangioendothelioma in fetus. We found hemangioma-like orbital tumor in a fetus at 36 weeks of gestation by prenatal ultrasonography and confirmed hemangioendothelioma by microscopic examination after birth. This is the first case of orbital hemangioendothelioma in fetus.

�Objective: This study was aimed to investigate endometrial histology and to find predictable clinical factors for endometrial disease (hyperpla sia or cancer) in women with polycystic ovary syndrome (PCOS). Methods: We investigated the endometrial histology and analyzed the relationship between endometrial histology and clinical parameters, such as LH, FSH, estradiol, testosterone, fasting and 2 hours postprandial glucose and insulin, insulin resistance, body mass index, endometrial thickness, menstrual status from 117 women with PCOS. Statistical analysis was performed with chi square and t-test, p-value < 0.05 was considered as statistically significant. And receiver operating characteristic curve was used to find predictable clinical factors for endometrial dis ease and to decide the cuff off values. Results: In 117 women with PCOS, endometrial histologic profiles are as follows: proliferative phase in 90 women (76.9%), endometrial hyper plasia in 25 women (21.4%), and endometrial cancer in 2 women (1.7%). Of 25 women with endometrial hyperplasia, simple hyperplasia without atypia, complex hyperplasia without atypia and complex hyperplasia with atypia were diagnosed in 15 (12.8%), 6 (5.1%), 4 (3.4%) women, respectively. Age and endometrial thickness were significantly related with endometrial disease, p = 0.013 and p = 0.001, respectively. At the cut off level of 25.5 years in age, sensitivity and specificity predicting for endometrial disease were 70.4% and 55.6%, respectively ( p = 0.023). At the cut off level of 8.5 mm in endometrial thickness, sensitivity and specificity were 77.8% and 56.7%, respectively ( p = 0.000). Conclusion: In women with PCOS, the incidence of endometrial hyperplasia and cancer were 21.4% and 1.7%. The age and endometrial thickness may be used as clinical determining factors for endometrial biopsy.