Transvaginal Ultrasonographic Assessment of Cervical Length for Prediction of Preterm Delivery within 7 Days in Patients with Preterm Labor / 대한주산의학회잡지

PURPOSE: To investigate the usefulness of transvaginal ultrasonographic measurement of cervical length in patients with preterm labor for prediction of preterm delivery within 7 days. METHODS: Cervical length was measured by transvaginal ultrasound in 140 women with singleton pregnancies presenting with preterm labor and intact membranes from 24(+0) to 33(+6) weeks of gestation. Other potential predictive factors, such as Bishop score, previous history of preterm delivery, and parity were assessed. RESULTS: The mean gestational age at presentation was 30.5+/-14.7 (range, 24.0 to 33.6) weeks and the mean cervical length was 29.0+/-0.9 (range, 31.0 to 52.1) mm. Delivery within 7 days occurred in 7.9% (11/140). Receiver-operating characteristics (ROC) curves established a cervical length of 25 mm as the most relevant cut off level for prediction of delivery within 7 days. Interval between admission and delivery was significantly short when ultrasonographic cervical length was less than or equal to 25 mm. Logistic regression analysis demonstrated that the significant independent risk factors were cervical length < or =25 mm (OR: 24.64, 95% Cl: 2.97~204.20, P=0.003). CONCLUSION: Ultrasonographic cervical length measurement is a useful tool for prediction of progression to preterm delivery within 7 days with patients with preterm labor.

A case of primary transitional cell carcinoma of the ovary / 대한산부인과학회지

Primary ovarian transitional cell carcinoma (TCC) is extremely rare type of tumor and resembles transitional cell carcinoma of the bladder. Primary ovarian TCC has been classified as a different subtype from malignant Brenner tumor for it's histologic and clinical characteristics. It usually presents at an advanced stage .Though more aggressive than malignant Brenner tumor, it shows more favorable prognosis because of better response to the chemotherapy than other epithelial ovarian carcinomas. We experienced a case of primary ovarian transitional cell carcinoma in a premenopausal woman who underwent staging operation and chemotherapeutic treatment, and herein report the case with a brief review of related literatures.

Clinical study on obstetric variables affecting perinatal mortality in placental abruption / 대한산부인과학회지

OBJECTIVE: To evaluate obstetric variables in the placental abruption that affect on perinatal mortality. METHODS: We reviewed clinical data of all singleton deliveries complicated with placental abruption between January 2000 and December 2007, in Department of Ob. & Gyn., Sanggye Paik Hospital. RESULTS: Placental abruption complicated 54 cases (0.55%) of all deliveries (n=9,903) from January 2000 to December 2007. The peak age was 26-30 years (42.1%). The most common symptom was vaginal bleeding (57.4%) and intrauterine fetal death had already occurred in 9.3%. Perinatal mortality rate was 13.0% and there was no maternal death. 38.9% of placental abruption occurred between 33 to 36weeks of gestational age. 38.9% of placental abruption was diagnosed before delivery with ultrasonography and 9.3% was chronic placental abruption. 33.3% of placental abruption was associated with preeclampsia, and then associated with PPROM (24.1%), uterine myoma (3.7%), chronic hypertension (1.9%) and smoking (1.9%). When the hypertensive disorders were associated, fetal distress rate was higher than normotensive pregnancy (63.2% vs 20.0%, P-value: 0.005). Mean gestational age (days) (194+/-32.8 vs 248.12+/-28.0, P-value<0.001) and the severity of placental abruption (P-value: 0.005) affect perinatal mortality in placental abruption. The most common complication of placental abruption was DIC (16 cases, 29.6%), followed by Couvelaire uterus (4 cases, 7.4%) and uterine rupture (1 case, 1.9%). CONCLUSION: Obstetric variables that affect perinatal mortality were gestational age at the diagnosis and the severity of placental abruption.

Normalization of serum SCC-Ag by surgical removal of maxillary inverted papilloma during follow-up of cervical carcinoma: a case report / 부인종양

Squamous cell carcinoma antigen (SCC-Ag) is a well-established tumor marker for monitoring recurrence of squamous cell carcinoma of the cervix. However, serum levels of SCC-Ag could be elevated by some benign conditions not to speak of squamous cell malignancies other than cervical carcinoma. Sinonasal inverted papilloma is one of benign tumor which may elevate serum SCC-Ag level. We experienced a case of cervical carcinoma patient whose serum level of SCC-Ag was not normalized in spite of combination chemotherapy until surgical removal of maxillary inverted papilloma detected by PET/CT.

Identification of biomarker for ovarian cancer by serum proteomic analysis using SELDI-ToF-MS / 부인종양

OBJECTIVE: SELDI-ToF-MS is an affinity-based mass spectrometric method. This study was performed to determine feasibility of serum proteomic pattern analysis using SELDI-ToF-MS for the detection of ovarian cancer. METHODS: Forty-three epithelial ovarian cancer patients and seventy-seven controls were included in the study from October 2003 to March 2005 in Sanggye Paik Hospital. Potential tumor biomarkers in sixty serum samples were screened, including twenty-one ovarian cancers and thirty-nine controls. Proteomic pattern was analyzed by SELDI-ToF-MS and optimal discriminating m/z value with proper cutoff of log-normalized intensity was determined by decision tree analysis (Phase I). Another sixty serum samples were obtained from twenty-two ovarian cancers and thirty-eight controls. Through analysis using SELDI-ToF-MS, the performance of diagnosing ovarian cancer was determined by applying previously adopted cutoff log-normalized intensity of m/z value determined in Phase I experiment (Phase II). RESULTS: A biomarker of 3501.23 kDa was selected based on the collective contribution to the optimal separation between ovarian cancers and controls. Sensitivity of 90.9% and specificity of 84.2% was achieved by SELDI-ToF-MS in Phase II experiment. Age, stage, and histologic type did not affect performance of SELDI-ToF-MS for diagnosing ovarian cancer. CONCLUSION: Serum proteomic analysis by biochip and mass spectrometry is a feasible method in diagnosing ovarian cancer.

Identification of biomarker for ovarian cancer by serum proteomic analysis using SELDI-ToF-MS / 부인종양

OBJECTIVE: SELDI-ToF-MS is an affinity-based mass spectrometric method. This study was performed to determine feasibility of serum proteomic pattern analysis using SELDI-ToF-MS for the detection of ovarian cancer. METHODS: Forty-three epithelial ovarian cancer patients and seventy-seven controls were included in the study from October 2003 to March 2005 in Sanggye Paik Hospital. Potential tumor biomarkers in sixty serum samples were screened, including twenty-one ovarian cancers and thirty-nine controls. Proteomic pattern was analyzed by SELDI-ToF-MS and optimal discriminating m/z value with proper cutoff of log-normalized intensity was determined by decision tree analysis (Phase I). Another sixty serum samples were obtained from twenty-two ovarian cancers and thirty-eight controls. Through analysis using SELDI-ToF-MS, the performance of diagnosing ovarian cancer was determined by applying previously adopted cutoff log-normalized intensity of m/z value determined in Phase I experiment (Phase II). RESULTS: A biomarker of 3501.23 kDa was selected based on the collective contribution to the optimal separation between ovarian cancers and controls. Sensitivity of 90.9% and specificity of 84.2% was achieved by SELDI-ToF-MS in Phase II experiment. Age, stage, and histologic type did not affect performance of SELDI-ToF-MS for diagnosing ovarian cancer. CONCLUSION: Serum proteomic analysis by biochip and mass spectrometry is a feasible method in diagnosing ovarian cancer.

Correlation between Ultrasonographic Findings of Endometrioma and Endometriosis Stage and Recurrence / 대한산부인과학회지

OBJECTIVE: This study was performed to evaluate of correlation between ultrasonographic findings of endometrosis and endometriosis stage and recurrence. METHODS: We reviewed medical records of fifty-nine patients who admitted the department of Obstetrics and Gynecology of Sanggye Paik Hospital from April 1998 to June 2004 and were surgically confirmed endometriosis stage 3-4. GnRH agonist was injected every 4 weeks after the first injection following initial operation and a total of six doses were injected to a patient. We performed ultrasonographic examination of pre- and post-operation at an interval of 3 or 6 months. The endometriotic ultrasonographic findings were classified into three group; low-level internal echo (LIE), LIE and septation, LIE and hyperechoic wall foci. The correlation between ultrasonographic finding of endometrioma and endometriosis stage and recurrence were analyzed by Fisher's exact test and Pearson's chi-square test. RESULTS: The follow-up periods after operation were about 11.9 months. Typical ultrasonographic findings of endometrioma were observed on 50 of 59 patients, diagnostic performance of ultrasound in the detection of endometrioma had a 84.7% sensitivity in this study. In 50 cases, 48% (n=24) had a only low-level internal echoes, 32% (n=16) had a low-level internal echoes and multiple septation, 20% (n=10) had a low-level internal echoes and hyperechoic wall foci. The most common ultrasonographic findings were LIE (50%) in stage 3, LIE and septation (33.3%) in stage 4. During follow-up we observed ultrasonographic recurrence in 6 (10.2%) cases. There were no statistically significant correlation between ultrasonographic finding and endometriosis stage or recurrence. CONCLUSION: Ultrasound is a convenient and reliable method for diagnosis of endometrioma. But, it appears that ultrasonographic findings of endometrioma not correlate with endometriosis stage or recurrence. Further long term follow-up studies in large scale is needed for correlation between ultrasonographic findings of endometriosis and clinical significance.

Epidemiologic Analysis of Sexual Assault Victims in Northeast Area of Seoul / 대한산부인과학회지

OBJECTIVE: To analyse sexual assault cases epidemiologically. METHODS: We evaluated 129 female patients who visited the female sexual assault center in northeast area of Seoul with a complaint of sexual assault. After patient's consent was obtained, history taking and physical examination was performed. Photographic record was obtained on appropriate sites. We reviewed their medical and standardized rape records and photographs retrospectively. Descriptive statistics was performed with medico-legal parameters. RESULTS: Of 129 sexual assault victims, 44.2% were under 19 years of age. Spring was relatively vulnerable season for sexual assaults, vulnerable time was between 12 to 18 o'clock for victims younger than 14 years and between 0 to 6 o'clock for victims older than 13 years. Most frequent place was hotel for adolescent victims and was victim's house for other age groups. Sixty seven percent of assailants were strangers to the victims. Genital trauma was more frequent in victims younger than 20 years and alcohol use was more prevalent among adolescent victims. 82.2% of victims visited hospital within 24 hours and 91.4% of victims has destroyed potential physical evidences by bathing, douching, tooth brushing, changing clothes, defecation or urination. Follow up rates are low: 28.7% in obstetrics and gynecology clinic, 5.4% in psychiatric clinic. CONCLUSION: This study provide more accurate information about epidemiology of sexual assaults.

Epidemiologic Analysis of Sexual Assault Victims in Northeast Area of Seoul / 대한산부인과학회지

OBJECTIVE: To analyse sexual assault cases epidemiologically. METHODS: We evaluated 129 female patients who visited the female sexual assault center in northeast area of Seoul with a complaint of sexual assault. After patient's consent was obtained, history taking and physical examination was performed. Photographic record was obtained on appropriate sites. We reviewed their medical and standardized rape records and photographs retrospectively. Descriptive statistics was performed with medico-legal parameters. RESULTS: Of 129 sexual assault victims, 44.2% were under 19 years of age. Spring was relatively vulnerable season for sexual assaults, vulnerable time was between 12 to 18 o'clock for victims younger than 14 years and between 0 to 6 o'clock for victims older than 13 years. Most frequent place was hotel for adolescent victims and was victim's house for other age groups. Sixty seven percent of assailants were strangers to the victims. Genital trauma was more frequent in victims younger than 20 years and alcohol use was more prevalent among adolescent victims. 82.2% of victims visited hospital within 24 hours and 91.4% of victims has destroyed potential physical evidences by bathing, douching, tooth brushing, changing clothes, defecation or urination. Follow up rates are low: 28.7% in obstetrics and gynecology clinic, 5.4% in psychiatric clinic. CONCLUSION: This study provide more accurate information about epidemiology of sexual assaults.

Clinical characteristics and prognosis of peripartum cardiomyopathy / 대한산부인과학회지

OBJECTIVE: To examine clinical characteristics and risk factors and to assess prognosis of peripartum cardiomyopathy (PPCM). METHODS: We retrospectively reviewed the medical records of 10 patients with confirmed PPCM by clinical symptoms and echocardiography, who delivered between January 1995 and December 2005 at our Hospital. Clinical and serial echocardiographic data of these patients were collected. RESULTS: Mean maternal age at the time of diagnosis was 28.8+/-3.2 years and the mean gestational age was 37(+3)+/-4 weeks. Common associated conditions were nulliparity (90%), cesarean delivery (70%), anemia (70%), preeclampsia (60%), transfusion before diagnosis (40%), twin pregnancy (30%). At the time of diagnosis, the mean left ventricular ejection fraction (EF) was 42.84+/-9.69%, fractional shortening (FS) was 23.41+/-5.49%, and left ventricular end diastolic dimension (LVEDD) was 5.58+/-0.55 cm/m2. Normalization of left ventricular function occurred in 8 patients (80%). After recovery of the left ventricular function, mean EF was 61.41+/-4.21%, FS was 34.08+/-3.26%, and LVEDD was 4.68+/-0.76 cm/m2. Incidence of PPCM was 1 in 2455 pregnancies, and maternal mortality was 12.5% in 10 months follow-up. CONCLUSION: The risk of PPCM may increase in puerperal women with rapid dramatic hemodynamic change. Echocardiography may provide significant prognostic information.

Study for umbilical cord plasma leptin in gestational diabetes and normal pregnancy / 대한산부인과학회지

OBJECTIVE: To compare umbilical cord plasma leptin level between infants of mothers with gestational diabetes and infants of control subjects and to evaluate the regulation of leptin in GDM. METHODS: Leptin concentrations were measured in cord blood at birth using a specific radioimmunoassay employing human recombinant leptin (Human Leptin RIA kit; Linco Research, Inc. USA). We compared cord plasma leptin level between gestational diabetes (n=18 women) and control pregnancies (n=21 women). RESULTS: Maternal weight, fetal birth weight, Ponderal index and placental weight were significant variables among the demographic variables. There was statistical difference in cord plasma leptin level between infants of mothers with gestational diabetes and infants of control subjects (Control subjects: 4.8 [3.7-7.9]ng/mL, GDM women: 8.0 [6.6-11.9]ng/mL, P=0.022). There was also statistical difference in the ratio between cord plasma leptin level and birth weight (Control subjects: 0.001 [0.001-0.002]ng/mL/gm, GDM women: 0.002 [0.002-0.003]ng/mL/gm (P=0.022)), and between cord plasma leptin level and Ponderal index (Control subjects: 0.280 [0.217-0.579], GDM women: 0.605 [0.452-1.005], (P=0.008)). There was no difference in gender. CONCLUSION: We found significant difference in umbilical cord plasma leptin level and adjusted leptin level for fetal birth weight, Ponderal index and placental weight between infants of mothers with gestational diabetes and infants of control subjects. It is suggested that umbilical cord plasma leptin is produced by fetal fat tissue, but it is more complicatedly regulated by placenta and other factors in gestational diabetes.

Factor V Leiden mutation in Korean women with pregnancy-induced hypertension / 대한산부인과학회지

OBJECTIVE: The purposes of this study was to evaluate the frequency of Leiden mutation (missense mutation in the factor V gene at exon 10, 1691 CGA to CAA) in Korean women with well characterized pregnancy-induced hypertension (PIH) compared with normotensive gravid women. METHODS: Genomic DNA from 121 PIH cases and 98 normotensive pregnant control cases were used for polymerase chain reaction (PCR). To genotype Leiden mutation (missense mutation in the factor V gene, exon 10 (1691 G to A)), primers (5'-TGC CCA GTG CTT AAC AAG ACC A-3', 5'-TGT TAT CAC ACT GGT GCT AA-3') were employed to make 267 base pair (bp) PCR product. There was an initial denaturation at 94 degrees C 5 min, followed by 30 cycles of one minute at 94 degrees C, one minute at 55 degrees C, and one minute at 72 degrees C. A 267 bp PCR product was further digested with Mnl I for 2 hour at 37 degrees C and analysed through 12% polyacrylamide gel electrophoresis to determine genotype. Allele 1691G yielded 37 bp, 67 bp, 163 bp fragment and allele 1691A yielded 67 bp, 200 bp fragment. RESULTS: We examined the genotypes of factor V of 121 Korean women with pregnant induced hypertension and 98 normal pregnant women. None of the 219 Korean women carried the factor V Leiden mutation. CONCLUSION: The factor V Leiden mutation is absent and not a common cause of PIH in Korean women.

Performance of Risk Indices for Prediction of Osteoporosis in Post- and Perimenopausal women / 대한산부인과학회지

OBJECTIVE: To examine the ability of published osteoporosis risk indices for prediction of osteoporosis in post- and perimenopausal women. METHODS: Subjects included 1559 of post- and perimenopausal women, 45 year old and older, recruited from Menopause Clinic from January 2002 to June 2004. Their bone mineral density (BMD) of femur neck was determined by dual energy x-ray absorptiometry (DXA), and their historical and clinical risk factors were assessed. We employed the World Health Organization (WHO) diagnostic criteria of osteoporosis for calculating the T scores, using race/ethnic and gender-specific young adult mean values. We applied 6 published osteoporosis risk indices (OSTA, ORAI, SCORE, SOFSURF, ABONE, NOF practice guideline) to each subject. Also, the predictive abilities of risk indices were assessed using the area under receiver operating characteristic (ROC) curve. RESULTS: The prevalence of osteoporosis and osteopenia was 8.7% and 32.6% for femur neck, 16.0% and 30.1% for lumbar spine, respectively. The prevalence of osteoporosis for femur neck was increased dramatically in the coming decades (1.6% for fifties, 8.7% for sixties, 43.0% for seventies, 64.1% for over eighties). ROC curve for predicting osteoporosis according to femur neck by OSTA showed the area under the curve (AUC) of 0.920. Sensitivity, specificity, and positive predictive value (PPV) were 93.4%, 75.4%, 26.6%, respectively. AUC for ORAI, SCORE, SOFSURF, ABONE, and NOF practice guideline was 0.896, 0.916, 0.871, 0.846, and 0.856, respectively. CONCLUSION: Validated risk indices have varying complexity, but similar sensitivity, specificity, and PPV for identifying individuals who are likely to have osteoporosis. However, OSTA is the most excellent risk index and simple tool.

Second-line Chemotherapy with Paclitaxel and Carboplatin for Patients with Recurrent Ovarian Carcinoma / 대한산부인과학회잡지

OBJECTIVE: This study is to investigate the efficacy and toxicity of paclitaxel plus carboplatin used as a salvage therapy. METHODS: Between June 2000 and November 2003, 10 patients aged 43-74 (median 55.0) with recurrent ovarian carcinoma were given combination chemotherapy including paclitaxel and carboplatin. The subjects received initial chemotherapy with paclitaxel plus cisplatin/carboplatin. On recurrence, paclitaxel was administered intravenously at a dose of 175 mg/m2 with carboplatin by AUC 5 every 3 weeks. The median treatment cycle was 10 cycles (range, 1 to 15 cycles). Recurrence of ovarian carcinoma was determined by elevation of serum CA-125, or radiologic imaging. Responses and toxicities were evaluated according to Gynecologic Oncology Group criteria and Common Terminology Criteria for Adverse Events from NCI (National Cancer Institute). RESULTS: The overall clinical response rate was 60.0% (6/10). Better response was observed in patients who were sensitive with initial chemotherapy. Anemia was the most frequent complication. CONCLUSION: Paclitaxel and carboplatin has been shown to be a feasible agent in patients with recurrent ovarian cancer.

Evaluation of NeonatalImmature Reticulocyte Fraction in Small-for-gestational Age Infant in Umbilical Cord Blood / 대한산부인과학회잡지

OBJECTIVE: To evaluate the immature reticulocyte fraction (IRF) by automated calculator that have played a role of predicting marker for hematopoiesis induced by perinatal asphyxia. METHODS: Hospital charts of 40 neonates with diagnosis of small for gestational age (SGA: birth weight <10 percentile) and 47 babies of appropriate for gestational age (AGA) who were delivered vaginally between May 8, 2000 and March 2, 2002 at department of Obstetric and Gynecology, Sanggye Paik Hospital, Inje university. About 5 cc in cord blood was collected immediately after delivery, the calculation of nucleated RBC (N-RBC)/100WBC by macroscopic exam and the evaluation of reticulocyte maturation by automated reticulocyte calculator (Sysmex SE 9000, TOA Medical Electronics Co., Ltd, Kobe, Japan) were performed, and made a comparative study of apgar score. RESULTS: The comparison between AGA and SGA infants, the mean values of cord blood sampling parameter N-RBC (3.53 +/- 4.89 vs 7.92 +/- 10.06, P=0.016), middle fluorescence ratio reticulocyte (MFR) (0.21 +/- 0.02 vs 0.23 +/- 0.03, P<0.001), high fluorescence ratio reticulocyte (HFR) (0.08 +/- 0.03 vs 0.12 +/- 0.03, P<0.001), IRF (0.28 +/- 0.03 vs 0.35 +/- 0.05, P<0.001) were obtained. All of the parameters were significantly different between SGA infants and normal infants and IRF was more valuable marker than N-RBC in evaluation of hematopoietic activity in SGA infants (multiple logistic regression analysis: P value 0.282 vs <0.001). CONCLUSION: Immature reticulocyte fraction by automated calculator is more accurate and confident marker better than N-RBC/100WBC by manual countingin evaluation of the fetal hypoxic induced hematopoiesis.

Gemcitabine as second-line chemotherapy in patients with recurrent epithelial ovarian cancer: Review of four cases / 대한산부인과학회잡지

Adjuvant multiagent chemotherapy with platinum and paclitaxel after optimal cytoreductive surgery decisively improved survival rates of patients with epithelial ovarian carcinoma. However, more than two- thirds of patients with advanced disease will encounter tumor progression, underlining the need for effective second-line strategies. Continued efforts to discover new active agents for the treatment of patients with ovarian carcinoma had identified gemcitabine. Four patients with epithelial ovarian carcinoma, who were treated in Inje University Sanggye Paik Hospital and recurred thereafter received gemcitabine 1,000 mg/m2 as a 30 min intravenous infusion on days 1, 8, and 15, which was repeated every 28 days. The disease progressed in two patients, while one showed stable disease and another reached complete response. One patient expired of disease two months after the completion of therapy. Grade 3 leukopenia was successfully managed using G-CSF. Regrowth of hair lost during previous chemotherapy occurred in all subjects. We report four cases of advanced recurrent ovarian carcinoma which were treated with gemcitabine.

A Case of Advanced Squamous Cell Carcinoma Arising in Mature Cystic Teratoma of the Ovary / 대한산부인과학회잡지

Mature cystic teratoma comprises approximately 10-20% of all ovarian neoplasms and malignant transformation from mature cystic teratoma is reported to be less than 2%. Squamous cell carcinoma is the most frequent malignancy (80%) arising in mature cystic teratoma followed by sarcoma (7-8%), adenocarcinoma (6-7%), carcinoid tumor, melanoma, choriocarcinoma (1-2%). Prognosis of squamous cell carcinoma in mature cystic teratoma is reported much poorer than that of epithelial ovarian cancer with the same stage. We experienced one case of squamous cell carcinoma arising in mature cystic teratoma.

Study on Umbilical Cord Plasma Leptin in Preeclamptic and Normal Pregnant Women / 대한산부인과학회잡지

OBJECTIVE: Leptin, the protein encoded by the Ob gene in the adipose cell, is produced by the placenta during pregnancy and materanal serum leptin is increased in preeclampsia. The objective of this study was to compare umbilical cord plasma leptin level between infants of mothers who experienced preeclampsia and infants of control subjects and to understand the physiology of leptin. METHODS: Leptin concentrations were measured in cord blood at birth using a specific radioimmunoassay employing human recombinant leptin (Human leptin RIA kit; Linco Research, Inc. U.S.A.). We compared cord plasma leptin between preeclamptic (n=17 women) and normal pregnancies (n=21 women). RESULTS: Gestational age is the only one significant variable among the demographic variables (P=0.011). There was no statistically significant difference in cord plasma leptin level between infants of mothers who experienced preeclampsia and infants of control subjects, but preeclampsia group had slightly lower leptin levels than control subjects (Control subjects: 4.8 [3.7-7.9] ng/ml, Preeclamptic women: 2.7 [2.3-6.8] ng/ml, P=0.142). There was also no difference in the leptin value adjusted for different gestational age, or ratio between cord plasma leptin level and gestational age (Control subjects: 0.017 [0.013-0.018], Preeclamptic women: 0.010 [0.008-0.025], P=0.131). CONCLUSION: We found no difference between umbilical cord plasma leptin in infants of mothers who had preeclampsia and umbilical cord plasma leptin in infants of control subjects, but insignificantly lower levels of umbilical cord plasma leptin in infants of mothers who had preeclampsia. It suggest that maternal serum concentration do not correlate with cord leptin concentration and dysregulation of leptin metabolism and/or function in the placenta may be implicated in the pathogenesis of preeclampsia.

Analysis of A1166C Polymorphism in Type I Receptor for Angiotensin II Gene with Pregnancy Induced Hypertension(PIH) in Korean Women / 대한주산의학회잡지

BACKGROUND/AIM: Recent studies have suggested an association between genetic background of renin-angiotensin(RA) system and the pathogenesis of pregnancy induced hypertension(PIH). Even though various single nucleotide polymorphism(SNP) such as M235T, T174M polymorphism in angiotensinogen gene(AGT) and I/D polymorphism in angiotensin I-converting enzyme gene(ACE) have been studied extensively among essential hypertension and PIH in various population, its association was still inconclusive. Previous studies within Korean PIH patients also revealed that M235T or T174M single nucleotide polymorphism in AGT gene or I/D polymorphism in ACE gene were not linked tightly with PIH. However, recent studies on angiotensin II type I receptor(AT1) polymorphism A1166C with PIH in Polish or in Chinese suggested its possible correlations to a pathogenesis of PIH. Thus the aim of the present study was to determine the frequency of genotypes of A1166C mu-tation in women with PIH and to establish the role of this polymorphism on the susceptibility to the PIH development. PATIENTS AND METHODS: We have analysed 121 women with PIH and 98 healthy normotensive gravid women as a control. Genomic DNA was used for PCR. To genotype the A1166C polymorphism in angiotensin II receptor(AT1) gene, primers(sense 5'-CGA CTA CTG CTT AGC ATA-3', antisense 5'-GCA CCA TGT TTT GAG GTT-3') were employed to make 546bp PCR product. There was an initial denaturation at 94degrees C 5 minutes, followed by 30 cycles of one minute at 94degrees C, one minute at 58degrees C, and two minutes at 7degrees C. A 546bp PCR product was further digested with DdeI for 2 hour at 37degrees C and analysed through 2% agarose gel electrophoresis to determine genotype. Allele C1166 yielded 435bp, 111bp fragment and allele A1166 yielded intact 546 bp fragment RESULTS: We found that frequency of genotype A1166/C1166 and A1166/A1166 in PIH were 9.9% (12) and 90.1%(109), while in controls were 17.3%(17) and 82.7%(81). There was no statistical significance between development of PIH and A1166C polymorphism in type I receptor for Angiotensin II. Homozygous mutated genotype(C1166/C1166) was not detected in this study. CONCLUSION: Our results found no possible correlation of A1166C polymorphism in angiotensin II receptor(AT1) with PIH in Korean and found that allele C might behave as a protective factor rather than as a risk factor in the pathogenesis of PIH. We suggest a large-scale study to evaluate relevance to this polymorphism for PIH.

Effects of preeclampsia on labor induction with prostaglandin E2 and oxytocin / 대한산부인과학회잡지

OBJECTIVE: The purposes of this study were 1) to determine whether preeclampsia itself affects failure of labor induction with prostaglandin E2 and oxytocin and 2) to investigate risk factors for failed induction in women with preeclampsia. METHOD: Fifty preeclamptic women and 175 nonpreeclamptic women requiring labor induction were studied prospectively. Intravaginal prostaglandin (PG) E2 tablet (Dinoprostone, The Upjohn company, 3 mg) followed by a second dose if the cervix assessed 6 hours later was 5 or less of Bishop score, and oxytocin were used for labor induction. Women with rupture of membrane, spontaneous contraction resulting in cervical change or an initial cervical examination showing more than 2 cm dilatation and 50% effacement were excluded. Statistics were analyzed with 2 test, Student t test, and multiple logistic regression. RESULTS: 1) The women with preeclampsia had a significantly higher rate of failed induction than did those without preeclampsia [24% (2/50) versus 9% (16/175); p <0.05]. However, the women with preeclampsia had a higher rate of the use of magnesium sulfate, and were more likely to decrease gestational age at induction and increase maternal weight than those without preeclamp sia (p <0.0001, respectively). There were no significant differences in prevalence of nulliparity and low initial Bishop score (< or =3) between the women with and without preeclampsia. 2) Multiple logistic regression showed that preeclampsia itself was not associated with failed induction after correction of known confounding variables (odds ratio 0.22, 95% confidence interval 0.03-2). 3) In women with preeclampsia, the use of magnesium sulfate only was associated with increased risk of failed induction analyzed by multiple logistic regression(odds ratio 38.5, 95% confidence interval 1.6-897). Maternal weight with 70 kg or more was associated with increased risk of failed induction, but it is not statistically significant (p=0.055). CONCLUSIONS: 1) The risk of failed induction is increased in women with preeclampsia, but not by preeclampsia itself but by the use of magnesium sulfate, prematurity, and increased maternal weight secondary to preeclampsia. 2) The use of magnesium sulfate is independent risk factor for failed induction in women with preeclampsia.