Prepregnancy Glucose Levels Within Normal Range and Its Impact on Obstetric Complications in Subsequent Pregnancy: A Population Cohort Study

Background@#We sought to identify the influence of prepregnancy glucose levels on obstetric complications in subsequent pregnancy. @*Methods@#Women in Republic of Korea who had given birth between January 1st, 2007 and December 31st, 2010 were enrolled. The database of the Health Insurance Review and Assessment Service and data from a national health screening program for infants and children were used. Subjects were divided into seven groups according to their fasting glucose levels. @*Results@#59,619 women were included for analysis, and 10.4%, 13.7%, 19.1%, 21.5%, 16.0%, 11.6%, and 7.5% women had glucose levels of 100 mg/dL. Each 5 mg/dL increase in prepregnancy fasting glucose levels was associated with increased risk of gestational diabetes and macrosomia in subsequent pregnancy. Adjusted risk ratio for gestational diabetes per standard deviation prepregnancy glucose > 100 mg/dL was 2.015 (95% confidence interval, 1.649–2.462) and for macrosomia an adjusted risk ratio 1.389 (95% confidence interval, 1.147–1.682). @*Conclusion@#Higher prepregnancy glucose level within normal range was related to gestational diabetes and macrosomia in following pregnancy. Our results may aid in the identification of women at future risk of obstetric complications and may guide to stratify women into normal and intensified care.Tweetable abstractHigher prepregnancy glucose in normal range is associated with gestational diabetes and macrosomia.

Applications of artificial intelligence in obstetrics

Artificial intelligence, which has been applied as an innovative technology in multiple fields of healthcare, analyzes large amounts of data to assist in disease prediction, prevention, and diagnosis, as well as in patient monitoring. In obstetrics, artificial intelligence has been actively applied and integrated into our daily medical practice. This review provides an overview of artificial intelligence systems currently used for obstetric diagnostic purposes, such as fetal cardiotocography, ultrasonography, and magnetic resonance imaging, and demonstrates how these methods have been developed and clinically applied.

Secular trends in cesarean sections and risk factors in South Korea (2006–2015)

Objective@#This study aimed to investigate trends in the rate of cesarean sections (CSs) in South Korea from 2006 to 2015 and identify the risk factors associated with these changes. @*Methods@#Using the National Health Insurance Corporation dataset, all women who gave birth between 2006 and 2015 were included in the study. We investigated 1) the mode of delivery, 2) the complication rates during pregnancy (i.e., preeclampsia and placenta previa), and 3) pre-pregnancy factors (body mass index, hypertension [HTN], diabetes mellitus [DM], and other pre-existing medical conditions), and their trends during the study period. @*Results@#Over 10 years, the rate of CS increased from 36.3% in 2006 to 40.6% in 2015 (P<0.01). The rate of CS increased in primiparous women, women with multiple pregnancy, and women with preeclampsia. Maternal age and the incidence of placenta previa also increased. In contrast, the rate of vacuum deliveries and vaginal birth after CS decreased during the study period. The rate of women with pre-pregnancy obesity and DM increased, but the rate of women with pre-pregnancy HTN decreased. @*Conclusion@#The rate of CS in South Korea increased from 2006 to 2015. This trend may reflect changes in the rate of different risk factors. Identifying the causes of the increasing CS trend observed in this study will allow clinicians to monitor these factors and possibly reduce the rate of CS.

Secular trends in cesarean sections and risk factors in South Korea (2006–2015)

Objective@#This study aimed to investigate trends in the rate of cesarean sections (CSs) in South Korea from 2006 to 2015 and identify the risk factors associated with these changes. @*Methods@#Using the National Health Insurance Corporation dataset, all women who gave birth between 2006 and 2015 were included in the study. We investigated 1) the mode of delivery, 2) the complication rates during pregnancy (i.e., preeclampsia and placenta previa), and 3) pre-pregnancy factors (body mass index, hypertension [HTN], diabetes mellitus [DM], and other pre-existing medical conditions), and their trends during the study period. @*Results@#Over 10 years, the rate of CS increased from 36.3% in 2006 to 40.6% in 2015 (P<0.01). The rate of CS increased in primiparous women, women with multiple pregnancy, and women with preeclampsia. Maternal age and the incidence of placenta previa also increased. In contrast, the rate of vacuum deliveries and vaginal birth after CS decreased during the study period. The rate of women with pre-pregnancy obesity and DM increased, but the rate of women with pre-pregnancy HTN decreased. @*Conclusion@#The rate of CS in South Korea increased from 2006 to 2015. This trend may reflect changes in the rate of different risk factors. Identifying the causes of the increasing CS trend observed in this study will allow clinicians to monitor these factors and possibly reduce the rate of CS.

Governmental Policies for Overcoming Low Birth Rate by Country

The issue exerting the greatest influence in Korea is the low birth rate. It is important, therefore, to examine the countermeasures taken, and their effectiveness, by other countries suffering a declining birth rate and consequent aging population before Korea. Such countries can be categorized according to their cultural background: the UK, Continental Europe, Scandinavia, and Asia. In Continental European countries, such as Germany and France, the employment rate of women is relatively low, whereas it is relatively high in the UK and Scandinavian countries. In Asian countries, such as Japan and Singapore, despite many policies instituting the work-family balance, a childcare infrastructure, and child allowance, little is being achieved, due to the specific culture of Asia and the social rejection of various family forms. However, it should not be forgotten that those countries succeeding in increasing the birth rate have implemented continuous policies for decades.

Prediction of Gestational Age at Birth using an Artificial Neural Networks in Singleton Preterm Birth

PURPOSE: The objective of the present study was to predict the gestational age at preterm birth using artificial neural networks for singleton pregnancy. METHODS: Artificial neural networks (ANNs) were used as a tool for the prediction of gestational age at birth. ANNs trained using obstetrical data of 125 cases, including 56 preterm and 69 non-preterm deliveries. Using a 36-variable obstetrical input set, gestational weeks at delivery were predicted by 89 cases of training sets, 18 cases of validating sets, and 18 cases of testing sets (total: 125 cases). After training, we validated the model by another 12 cases containing data of preterm deliveries. RESULTS: To define the accuracy of the developed model, we confirmed the correlation coefficient (R) and mean square error of the model. For validating sets, the correlation coefficient was 0.839, but R of testing sets was 0.892, and R of total 125 cases was 0.959. The neural networks were well trained, and the model predictions were relatively good. Furthermore, the model was validated with another dataset of 12 cases, and the correlation coefficient was 0.709. The error days were 11.58±13.73. CONCLUSION: In the present study, we trained the ANNs and developed the predictive model for gestational age at delivery. Although the prediction for gestational age at birth in singleton preterm birth was feasible, further studies with larger data, including detailed risk variables of preterm birth and other obstetrical outcomes, are needed.

Tuberculous peritonitis in the first trimester of pregnancy

Tuberculous peritonitis in pregnancy is a rare form of extrapulmonary tuberculosis that is not easily diagnosed. The clinical presentations of tuberculous peritonitis are usually non-specific and mimic those of other diseases, such as ovarian malignancy or chronic liver disease, and this non-specificity can cause diagnostic delays and complications. The authors report the case of a 31-year-old primigravida woman who presented with uncontrolled fever, dyspnea, elevated liver enzymes, and mild abdominal distension at 13+2 weeks of gestation. At 14+2 weeks, a therapeutic abortion was conducted and tuberculous peritonitis was confirmed by laparoscopic excisional biopsy of peritoneal nodules and histopathologic examination. The patient recovered on antituberculosis therapy and abdomen and chest follow up radiographic findings have confirmed improvement.

Total laparoscopic hysterectomy via suture and ligation technique

OBJECTIVE: The term 'total laparoscopic hysterectomy (TLH) with classical suture method' refers to a surgical procedure performed using only sutures and ligations with intracorporeal or extracorporeal ties, without using any laser or electronic cauterization devices during laparoscopic surgery as in total abdominal hysterectomy. However, the method is not as widely used as electric coagulation equipment for TLH because further advances in technology and surgical technique are required and operative time can take longer. In the current study, we evaluated the benefits of the classical suture method for TLH. METHODS: This study retrospectively reviewed patients who received TLH using the classical suture method from August 2005 to April 2014. The patients' baseline characteristics were analyzed, including age, parity, cause of operation, medical and surgical history. Surgical outcomes analyzed included the weight of the uterus, operative time, complications, changes in hemoglobin level, blood transfusion requirements, and postoperative hospital stay. RESULTS: Of 746 patients who underwent TLH with the classical suture method, mean operation time was 96.9 minutes. Mean average decline in hemoglobin was 1.6 g/dL and transfusion rate was 6.2%. Urinary tract injuries were reported in 8 patients. Urinary tract injuries comprised 6 cases of bladder injury and 3 cases of ureter injury. There were no cases of vaginal stump infection, hematoma, bowel injury or abdominal wound complication. All cases involving complications occurred before 2010. CONCLUSION: The classical suture method for TLH presents tolerable levels of complications and blood loss. Advanced surgical skill is expected to decrease operation time and complications.

The Proteomic Analysis of Human Placenta with Pre-eclampsia and Normal Pregnancy

Preeclampsia is one of the most important and complexed disorders for women's health. Searching for novel proteins as biomarkers to reveal pathogenesis, proteomic approaches using 2DE has become a valuable tool to understanding of preeclampsia. To analyze the proteomic profiling of preclamptic placenta compared to that of normal pregnancy for better understanding of pathogenesis in preeclampsia, placentas from each group were handled by use of proteomics approach using 2DE combined with MALDI-TOF-MS. The 20 spots of showing differences were analysed and identified. Among differentially expressed protein spots Hsp 27 and Hsp 70 were selected for validation using Western blot analysis. In preeclamptic placenta 9 differentially expressed proteins were down-regulated with Hsp 70, serum albumin crystal structure chain A, lamin B2, cytokeratin 18, actin cytoplasmic, alpha fibrinogen precursor, septin 2, dihydrolipoamide branched chain transacylase E2 and firbrinogen beta chain. The 11 up-regulated proteins were fibrinogen gamma, cardiac muscle alpha actin proprotein, cytokeratin 8, calumenin, fibrinogen fragment D, F-actin capping protein alpha-1 subunit, Hsp 27, Hsp 40, annexin A4, enoyl-CoA delta isomerase and programmed cell death protein 6. The western blot analysis for validation also showed significant up-regulation of Hsp 27 and down-regulation of Hsp 70 in the placental tissues with preeclmaptic pregnancies. This proteomic profiling of placenta using 2DE in preeclampsia successfully identifies various proteins involved in apoptosis, mitochondrial dysfunction, as well as three Hsps with altered expression, which might play a important role for the understanding of pathogenesis in preeclampsia.

Carpal Tunnel Syndrome Associated with Tophaceous Deposition in Flexor Digitorum Tendons

Carpal tunnel syndrome is the most common peripheral entrapment neuropathy. We report on the first Korean case of carpal tunnel syndrome induced by tophaceous deposition in flexor digitorum tendons of a patient with chronic gout. A 63-year-old male suffered from numbness, decreased sensation over both median nerve distribution, and weakness of thenar muscle for 3 years. Physical examinations revealed positive Tinel's sign and Phalen's test and thenar qjmuscle atrophy was found on both hands. In nerve conduction study, there was no action potential of the sensory and motor of the bilateral median nerve. Ultrasonography showed increased cross-sectional area of median nerve due to tophaceous deposition in flexor digitorum tendons in the carpal tunnel. Dual-energy computed tomography showed diffuse multifocal green color coding tophaceous deposition within the carpal tunnel. His neuropathic symptoms improved after injection of triamcinolone into the carpal tunnel and administration of oral medication including non-steroidal anti-inflammatory drugs and colchicine.

Integrated Care Center for High Risk Pregnancy and Neonate: An Analysis of Process and Problems in Obstetrics / 대한주산의학회잡지

The medical environment of obstetric field has been deteriorated seriously, which is caused by sharply declined birth rates and several other causes in Korea. Inversely, the prevalence of high risk pregnancy is continuously going to explode, and human resources and facilities in delivery unit are still in shortage. It is greatly needed to be reinforced, but rather diminished substantively. Finally, maternal death rate of Korea has been extremely increased. It is time that the policies for treatment of high risk maternity in national level, no more leave the situation unchanged. The integrated care system which treats high risk maternity and neonate sequentially is very important in their disease characteristics. It is sure that the integrated management of high risk pregnancy and neonate can make an important role in the improvement of perinatal and maternal death rate and maternal-neonatal health care. Therefore, Ministry of Health and Welfare made a policy that establishes 'Integrated Care Center for High Risk Pregnancy and Neonate' for high risk maternity and neonate. It is supposed to start from four centers as a demonstration project in 2014, and will finally establish 17 centers in 11 broad territories of the country in 2017. It will accomplish a task of emergency center, and carry out treatment and emergency operation at all times. In addition, it will take the roll of emergency transfer system, data collection and analysis, and preventive management service through public education and relations. In the future, Integrated Care Center will play an important role in improving maternal health care as well as obstetric infrastructure.

Umbilical Artery Doppler Study as a Predictive Marker of Perinatal Outcome in Preterm Small for Gestational Age Infants

PURPOSE: To evaluate the merit of umbilical artery Doppler study as a predictive marker of perinatal outcome in preterm small for gestational age (SGA) infants. MATERIALS AND METHODS: A total of 218 patients at 27 - 36 weeks of gestational age (GA) who received antenatal umbilical artery Doppler velocimetry and delivered singleton infants with SGA. The ratio of peak-systolic to end-diastolic blood flow velocities (S/D) in the umbilical artery was measured in each patient. The patients were divided into 3 groups: the normal group with S/D ratios of less than 95th percentile (n = 134), elevated S/D ratio group of 95th or more percentile (n = 41), and those with absent/reversed end diastolic flow (n = 43). Maternal characteristics and neonatal outcomes of these groups were comparatively analyzed. RESULTS: The gestational age (GA) at the time of diagnosis of SGA, the mean GA at delivery, and the mean birth weight showed statistically significant difference among three groups (p < 0.001). Also, poor perinatal outcome was significantly increased in infants with abnormal S/D ratio (13.4% vs. 31.7% vs. 67.4%, p < 0.001). Multivariate logistic regression analysis revealed umbilical artery Doppler study as a significant independent factor for prediction of poor perinatal outcome (odds ratio: 3.7, 95% confidence interval 1.4 - 9.5, p = 0.007). CONCLUSION: Antenatal umbilical artery Doppler velocimetry is shown as a significantly efficient marker in predicting perinatal outcome in preterm SGA infants.

The efficacy of umbilical artery blood flow velocity waveform to predict the perinatal outcome of term pregnancies with small for gestational age / 대한산부인과학회지

OBJECTIVE: To investigate whether umbilical artery Doppler blood flow velocity waveform is effective in predicting perinatal outcome of term pregnancies with small for gestational age (SGA). METHODS: A total of 381 patients at 37~41 weeks of gestational age (GA) who received antenatal umbilical artery Doppler blood flow test and delivered singleton SGA infants. The ratio of peak-systolic to end-diastolic (S/D) blood flow velocities in the umbilical artery was measured in each patient. The patients were divided into a normal group (n=307) with a S/D ratio equal to or less than 3.0, and an abnormal group with a S/D ratio of greater than 3.0 (n=74). These groups were comparatively analysed with respect to maternal characteristics and neonatal outcomes. Results: There were no significant differences between the two groups in mean maternal age, gestational age at the time of delivery, and cesarean section rate due to fetal distress. There was significantly increased incidence of hypertensive disorders in pregnancy in the abnormal S/D ratio group. And the abnormal S/D ratio group showed lower neonatal birthweight, higher incidence of admission to neonatal intensive care unit (NICU), and longer stay in neonatal intensive care unit. According to linear regression, in pregnancies complicated by SGA, abnormal S/D ratio was still a risk factor for low birthweight even after controlling for the incidence of hypertension. Conclusion: In term pregnancies accompanied by SGA, abnormal umbilical artery S/D ratio is an independent predictor of neonatal birth weight, incidence of admission to NICU, and NICU stay.

The efficacy of umbilical artery blood flow velocity waveform to predict the perinatal outcome of term pregnancies with small for gestational age / 대한산부인과학회지

OBJECTIVE: To investigate whether umbilical artery Doppler blood flow velocity waveform is effective in predicting perinatal outcome of term pregnancies with small for gestational age (SGA). METHODS: A total of 381 patients at 37~41 weeks of gestational age (GA) who received antenatal umbilical artery Doppler blood flow test and delivered singleton SGA infants. The ratio of peak-systolic to end-diastolic (S/D) blood flow velocities in the umbilical artery was measured in each patient. The patients were divided into a normal group (n=307) with a S/D ratio equal to or less than 3.0, and an abnormal group with a S/D ratio of greater than 3.0 (n=74). These groups were comparatively analysed with respect to maternal characteristics and neonatal outcomes. Results: There were no significant differences between the two groups in mean maternal age, gestational age at the time of delivery, and cesarean section rate due to fetal distress. There was significantly increased incidence of hypertensive disorders in pregnancy in the abnormal S/D ratio group. And the abnormal S/D ratio group showed lower neonatal birthweight, higher incidence of admission to neonatal intensive care unit (NICU), and longer stay in neonatal intensive care unit. According to linear regression, in pregnancies complicated by SGA, abnormal S/D ratio was still a risk factor for low birthweight even after controlling for the incidence of hypertension. Conclusion: In term pregnancies accompanied by SGA, abnormal umbilical artery S/D ratio is an independent predictor of neonatal birth weight, incidence of admission to NICU, and NICU stay.

Prognostic factors in recurrent cervical cancer patients with pulmonary metastasis / 대한산부인과학회지

OBJECTIVE: To characterize prognostic factors in patients with pulmonary metastasis in recurrent cervical cancer. METHODS: The records of 2,042 patients treated for cervical cancer from 1994 to 2004 at two institutions were retrospectively reviewed. Twenty-five (1.04%) patients had pulmonary lesions consistent with metastatic cervical cancer. The data were analyzed retrospectively and reviewed for patient characteristics. RESULTS: Patients were treated with chemotherapy, radiotherapy only, chemoradiotherapy, surgery, and conservative treatment. There were no significant differences in survival rates between each treatment method (p=0.3410). Mean survival after treatment of pulmonary metestasis was 23 months. Histologic type, lymph node metastasis, other organ metastasis, and pretreatment SCC level were not significant prognostic factors, but FIGO stage (p=0.039) and disease-free interval (p=0.033) were significant factors. CONCLUSION: This study revealed that FIGO stage and disease-free interval were independent prognostic factors of pulmonary metestasis in recurrent cervical cancer.

Simplified prognostic factor scoring system in patients with lymph node-negative stage IB-IIA cervical cancer / 대한산부인과학회지

OBJECTIVE: The aim of this study is to apply a prognostic factor scoring system in patients with lymph node-negative stage IB - IIA cervical cancer. METHODS: One hundred and ninety-one stage IB - IIA cervical cancer patients were enrolled in this retrospective study from 1994 to 2005 in our gynecologic department. All patients were treated by radical abdominal hysterectomy with lymph node dissection, and there were no patients with involvement of lymph nodes or parametrial invasion. Statistical analysis comprised of clinical characteristics, pathology result, post-operative adjuvant therapy, and recurrence rate. RESULTS: Among the 191 patients, recurrence occurred in 9 patients (4.7%), while no recurrence was observed in the remaining 182 patients (95.3%). No significant difference was found between the two study groups in terms of average age, weight, parity, FIGO stage, and postoperative adjuvant therapy. After univariate analysis, tumor size and deep stromal invasion were factors found to be statistically significant for risk of recurrence. Cell type, close surgical margin, lymphovascular permeation were not significant factors. Multivariate analysis demonstrated deep stromal invasion was the only significant prognostic factor (RR=11.7, p=0.028). The scoring system was applied to tumor size, close surgical margin, and deep stromal invasion, 1, 1, and 2 points given for each factor, respectively. Using the ROC curve, based on 2 points as the cut-off level, the recurrence rate was significantly higher (p<0.0025). CONCLUSION: Deep stromal invasion was the most important prognostic factor in patients with early stage cervical cancer in the absence of lymph node metastasis. Herein, the scoring system may be applied to predict disease outcome.

Neoadjuvant chemotherapy in cervical carcinoma during pregnancy: Case report / 부인종양

When the cervical cancer is diagnosed in early stage during pregnancy, the treatment can be postponed for fetal viability. This case presents a patient diagnosed as cervical cancer stage Ib1 during her pregnancy. The patient had 2 cycles of neoadjuvant chemotherapy (Paclitaxel-cisplatin) formerly and cesarean section was done at 33rd weeks of intrauterine pregnancy, then radical abdominal hysterectomy with bilateral pelvic lymph node dissection and paraaortic lymph node biopsy was immediately performed right after the delivery. For the baby born, there was neither complication nor congenital anomaly but mild bilateral ventriculomegaly seen on brain CT taken on 3 days after birth. This case offers a better chance for both mother and fetus while conserving fetal viability and managing the early cervical cancer during pregnancy through close follow up.

The Role of NF-kappaB in the TNFalpha-induced Hyperplasia of Synoviocytes Isolated from Patients with Rheumatoid Arthritis / 대한면역학회지

No abstract available.

A case of Behcet's disease with superior and inferior vena caval occlusion

Behcet's disease is a chronic multisystemic disorder involving many organs and characterized by recurrent oral and genital ulcers and relapsing iritis. A case of BD with large vein thrombosis involving superior and inferior vena cava is presented. Large vein thrombosis in BD is not commonly developed and most commonly observed in the inferior or superior vena cava. A review of the literature emphasizes the rarity of the combined superior and inferior vena caval occlusion. Existence of extensive large vein occlusion in BD is associated with limited therapy and poor prognosis.

Association Between Autoantibodies and Neuropsychiatric Manifestations in Patients with Systemic Lupus Erythiematosus / 대한류마티스학회지

OBJECTIVE: To explore the association between neruopsychiatric manifestations and auto-antibodies in patients with neruopsychiatric lupus. METHODS: 233 patients with systemic lupus erythematosus (SLE) who were admitted or visited Kangnam St. Mary's Hospital from January 1993 to March 1996 were included in this study. The medical records of this group were reviewed in detail according to a predefined protocol with special emphasis upon any neruopsychiatric manifestations of the illness. RESULTS: 1) Among patients with SLE, 45(20.1%) had neruopsychiatric manifestations during the course of the disease. 2) The positivity of anticardiolipin antibody and antiribosomal P antibody is more frequent in neruopsychiatric group than that of non-neruopsychiatric lupus(56.3% vs. 22.9%, 44.1% vs. 21.5%, respectively, p<0.05). 3) The frequency of anticardiolipin antibody and lupus anticoagulant is more frequent in thrombotic group than that of non-thrombotic group(69.2% vs. 26.3%, 50.0% vs. 12.1%, respectively, p<0.05). CONCLUSIONS: Our findings suggest that investigation of the autoantibodies such as anticardiolipin antibody, antiribosomal P antibody, and lupus anticoagulant may be useful for early detection and management of SLE patients who have neruopsychiatric manifestations.