A case of neonatal lupus syndrome with congenital complete heart block / 대한산부인과학회잡지

The neonatal lupus syndrome is characterized by skin lesions, hepatic and hematologic abnormalities and congenital heart block. Congenital heart block which is believed to be caused by transplacental passage of the anti-Ro (SSA)/La (SSB) antibodies from mother to infant, is known to occur in 1 in 20,000 live births. In contrast to other manifestation of neonatal lupus syndrome, which usually subside within 6 months after birth, congenital heart block is a permanent and potentially fatal complication. We experienced a case of neonatal lupus syndorme with congenital complete heart block in a newborn of asyptomatic mother with anti-Ro (SSA)/ La (SSB) antibodies.

Proper Time of Delivery to Decrease Minor Perinatal Morbiditles / 대한산부인과학회잡지

OBJECTIVE: Much emphasis has been placed on the morbidity and mortality of infants delivered before 32 weeks of gestation, including intraventricular hemorrhage and respiratory distress. The incidence of these complications and their association with long-term sequelae are well defined. This information is important, especially when decisions regarding delivery have to be made. Although delivery at >32 weeks of gestation may be considered free of serious sequelae of prematurity, morbidities are still associated with delivery between 32 and 36 weeks of gestation. The purpose of this study is to determine the incidence of minor morbidities associated with premature delivery between 32 and 36 weeks of gestation. We tried to find out the proper time to decrease the minor perinatal morbidities and the adverse effect of tocolytic treatment. METHOD: The study population is consisted of infants delivered between 20 and 36 weeks of gestation at Kang Nam St. Mary's hospital from 1995 to 1999. Maternal and neonatal charts were abstracted for maternal past history, pregnancy complications and neonatal demographics comparing complications present at each gestational week. Mann-Whitney test and x2 test were used to assess statistical significance. RESULTS: There was no significant difference of delivery time due to maternal age and parity. There was increased risk of low Apgar score and low birth weight before 34 weeks of gestation. Neonatal death was significantly high before 32 weeks of gestation. Neonatal death, sepsis, intraventricular hemorrhage, respiratory distress, ventilatory equipment use was significantly high before 32-33 weeks of gestation. Hypothermia, feeding difficulty, jaundice, NICU admission was significantly high before 30, 32, 35, 35 weeks of gestation. So it is approved that minor perinatal morbidity was decreased after 34-35 weeks of gestation. CONCLUSION: Major morbidity was significantly high before 32-33 weeks of gestation and Minor morbidity was significantly high before 34 weeks of gestation. Therefore considering of minor and major morbidity, it is reasonable to postpone the preterm delivery until 34 weeks of gestation.

Tumor necrosis factor - a ( TNF - a ) , Vascular cell adhesion molecule - 1 ( VCAM - 1 ) and Lipid peroxide in Maternal plasma of Uncomplicated Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of study was to assess in a longitudinal study of maternal plasma concentrations of Tumor necrosis factor-alpha(TNF-alpha), Vascular cell adhesion molecule-1(VCAM-1), Lipid peroxide (malonaldehyde, MDA) in uncomplicated pregnancy. METHODS: Blood was collected from healthy women at 4 to 41 weeks' gestation and non-pregnant women. Plasma samples were measured by immunoassay for TNF-alpha, VACM-1 and by colorimetric assay for lipid peroxide, and data were statistically analyzed. RESULTS: Plasma concentration of TNF-alpha was not significantly elevated during first trimester compared with non-pregnant women, but significantly elevated during second and third trimester compared with non-pregnant women. Plasma concentration of VCAM-1 was significantly elevated during first trimester compared with non-pregnant women. Plasma concentration of lipid peroxide was not significantly elevated during pregnancy compared with non-pregnant women. CONCLUSION: The plasma concentration of TNF-alpha and VCAM-1 were significantly higher than that of non-pregnant state during second and third trimester in case of TNF-alpha, and during first trimester in case of VCAM-1. But the plasma concentration of lipid peroxide during pregnancy was not significantly different from that of non-pregnant, and the plasma concentration was kept up constant levels during gestation. These were seems to be meant that abnormal pregnancy would be happened if the level is above or below the measured level.

Comparison of Distribution of Fibronectin and Fibrinogen in Placenta between Normotensive and Preeclamptic Pregnancies / 대한산부인과학회잡지

In order to find out the distribution of fibronectin and fibrinogen in placenta among pregnancy induced hypertensive (PIH) patients, 6 normotensive pregnancies and 17 PIH patients were chosen. The placentas were obtained right after delivery and soaked in the 10% formalin solution. The score was measured in terms of the positiveness of the stain in immunohistochemical stain by using I antibody with the rabbit antihuman fibronectin and the rabbit anti-human fibrinogen. Comparison between two groups are as following: 1.The placenta of PIH patients showed significantly reduced positiveness of fibronectin in their fetal villous vessels and villous stroma. 2. In the PIH patients, the positiveness was reduced in the group giving the birth to intrauterine fetal growth retardation compared to giving birth to normal baby. 3. In both normotensive and PIH patients, the villous basement membrane did not show the staining response to fibronectin, while showing heavy staining response to fibrinogen. 4. The positiveness of fibrinogen in fetal vessels, villous basement membrane, intervillous space and stroma were almost same in both normotensive and PIH patients. From above results, we can conclude that there is abnormality in the distribution of fibronectin especially in the fetal vessels and the villous stroma of placenta among PIH patients. The cause of this result needs further study.

Effect of Epidermal Growth Factor on The Production of Cortisor, Thyroxine, and Prolactin in Fetal Rabbits / 대한산부인과학회잡지

Respiratory distress syndrome (RDS) is a major cause of death in premature neonates, and it is caused by the failure of morphological and biochemical lung maturation (synthesis and secretion of lung surfactant). It is known that cortisol, thyroxine, prolactin, epidermal growth factor (EGF), and estrogen accelerate the lung maturation. Cortisol and thyroxine are currently used in the antenatal treatment for the prevention of RDS in premature neonates. In order to evaluate the effect of EGF on the levels of cortsol, thyroxine, and prolactin, this study was undertaken. Phosphate buffered saline (PBS) with and without EGF was directly injected into the 25 days gestational fetus in uterus. Blood was collected for the measurement of cortisol, thyroxine, and prolactin one day or two days after the injection. Body weights and lung weights were also measured. The results were as follows: 1. There was no significant difference in body weights and lung weights between PBS-treated group(control group) and EGF-treated poup(experimental group), 24 hours and 48 hours after the injection. 2. 24 hours after the injection, the levels of cortisol were significantly inaeased in the EGF-treated group compared with those in the PBS-treated group. However 48 hours after the injection, there was no significant difference in the levels of cortisol between the two groups. The levels of thyroxine and prolactin in the EGF-treated group did not significantly differ from those in the PBS-treated group 24 hours and 48 hours after the injection. In conclusion, in vivo, the synthesis of cortisol may be affected by EGF treatment, which suggests that the action of EGF for lung maturation may be partially mediated by the increased endogenous levels of cortisol.