Detection of Adeno-associated Virus from Semen Suffering with Male Factor Infertility and Having Their Conception Partners with Recurrent Miscarriages

Adeno-associated virus (AAV) and human papillomavirus (HPV) DNAs were found in abnormal quality semen, early abortus and female genital tissues. It was suggested that they might cause male infertility and miscarriages. This study was performed to determine the detection rate of these viruses in the semen and to assess the relationship between the presence of virus and male factor infertility and recurrent miscarriages. Sixty-three of 99 recruited male were included in this study according to the completeness of follow-up and the sample availability. Fourteen male with normal reproductive capacity were allocated to control group, 15 male with abnormal results in semen analysis were grouped as male factor infertility (MF) group, and 34 male whose spouses have had history of repeated spontaneous abortions were designated as repeated miscarriage (RM) group. AAV and HPV were detected in semen by polymerase chain reaction. The detection rate of AAV in the MF infertility group and RM group was 60.0% and 50.0%, respectively, while 14.3% in the control group (p < 0.05). However, the differences in the detection rate of HPV were not statistically significant among groups. These results suggest that AAV could be related to repeated miscarriages and male infertility.

The effect of antenatal corticosteroid therapy on fetal growth / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to determine the effects of antenatal corticosteroid therapy on fetal growth. METHODS: We performed a retrospective analysis of 797 singleton-pregnant women with high risk of preterm delivery who admitted between 24 and 34 weeks' gestation. They were categorized into three groups; (1) no antenatal corticosteroid users (non-user group), (2) single course of corticosteroid users (single-course group), (3) multiple courses of corticosteroid users (multiple-course group). The birth weight, head circumference (HC), abdominal circumference (AC) and chest circumference (CC) of their neonates were measured. We surveyed if the neonates were small-for-gestational age (SGA) or not. RESULTS: According to antenatal corticosteroid use, 295 patients were included in the non-user group, 409 patients in the single-course group and 93 patients in the multiple-course group, respectively. The birth weight, HC, AC, CC and the rate of SGA of the neonates did not differ between any of the three groups. After adjusting the gestational age at delivery, the birth weight, HC, AC, CC and the rate of SGA of the neonates still showed no difference between any of the three groups. CONCLUSION: The antenatal corticosteroid administration to patients with risk of preterm delivery seems to have no effect on the birth weight and biometries of the neonates, and fetal growth does not seem to be associated with the number of courses of antenatal corticosteroid.

Pro-inflammatory cytokine-induced nuclear factor-kappa B activity in prelabor and in-labor myometrial cells at term gestation / 대한산부인과학회지

OBJECTIVE: The objectives of this study were to determine whether NF-kappa B-mediated pro-inflammatory cytokines signaling leads to COX-2 expression and PGE2 synthesis in human myometrial cells at term, and to compare cytokines-induced NF-kappa B activity and subsequent COX-2 expression and PGE2 synthesis between prelabor and in-labor myometrial cells. METHODS: Ten samples of human myometrium were obtained from 5 pregnant women with no labor and 5 in labor at term during cesarean section. Myometrial smooth muscle cells were harvested by cell culture and stimulated with TNF-alpha. PGE2 production and COX-2 expression were determined by ELISA and Western blotting analysis, respectively. NF-kappa B transcriptional activity was assessed by luciferase assay and by nuclear shifting using EMSA. RESULTS: Before the treatment of TNF-alpha, the levels of PGE2 production, COX-2 expression, and activity and nuclear shift of NF-kB in in-labor cells were higher than those in prelabor cells. By the stimulation of TNF-alpha, PGE2 output, COX-2 expression, and activity and nuclear shift of NF-kappa B increased in both of prelabor and in-labor cells. The increases of PGE2 production, COX-2 expression, and NF-kappa B activity were significantly greater in in-labor cells. CONCLUSION: Pro-inflammatory cytokines-induced COX-2 expression and subsequent PG synthesis, mediated by NF-kappa B, appears one of the important mechanisms of labor in term gestation.

Effect of antioxidants on cyclooxygenase-2 expression, prostaglandin synthesis and nuclear factor Kappa-B activity in human myometrium / 대한산부인과학회지

OBJECTIVE: The oxidative stimuli activate NF-kappa B, which is a transcriptional factor inducing the expression of cyclooxygenase-2 (COX-2), an enzyme which involves in the rate-limiting step of prostaglandin (PG) synthesis. This study was performed to investigate whether vitamin C or caffeic acid phenethyl ester (CAPE) suppress COX-2 protein expression, PG synthesis, and NF-kappa B activity in human myometrium at term. METHODS: Human myometrial cells were cultured and stimulated with tumor necrosis factor-alpha (TNF-alpha), and also treated with TNF-alpha plus caffeic acid phenethyl ester, and TNF-alpha plus vitamin C. The expressions of COX-2 protein were assessed by western blot analyses. The activity of NF-kappa B was measured by luciferase assay. PGE2 production was determined by ELISA. RESULTS: The expression of COX-2 protein and the synthesis of PGE2 were promoted by TNF-alpha and peaked after 6 hours of exposure. CAPE and vitamin C significantly inhibited the TNF-alpha-dependent expression of COX-2 protein and the synthesis of PGE2. NF-kappa B activities were also suppressed by the addition of CAPE and vitamin C to TNF-alpha pre-stimulated cells. CONCLUSION: The antioxidants, CAPE and vitamin C, inhibited COX-2 expression, PGE2 synthesis and NF-kappa B activity in human myometrial cells. These results suggest that the antioxidant may play an inhibitory role in human labor.

The Benefits and Risks of Multiple Courses of Antenatal Corticosteroid Therapy in Patients with Preterm Premature Rupture of Membranes / 대한산부인과학회잡지

OBJECTIVE: This study was performed to determine the benefits and risks of multiple courses of corticosteroids in patients with preterm premature rupture of membranes (PPROM). METHODS: We retrospectively evaluated the pregnancy and neonatal outcomes for women of singleton pregnancy with PPROM admitted at 24-32 weeks of gestation. Patients were categorized into 3 groups according to antenatal corticosteroids exposure: (1) non-user group, (2) single-course group, (3) multiple-course group. Chi-square test, analysis of variances, Kruskal-Wallis test, and multiple logistic regression analysis were used for statistical analyses. RESULTS: A total of 170 patients were included, with 50 in non-use group, 76 in single-course group, and 44 in multiple-course group. Univariate analyses showed that clinical chorioamnionitis occurred in the highest incidence in multiple-course group (x2=6.20, p<0.05) and the decreased incidence of RDS in multiple-course group (x2=10.0, p<0.01). Multiple logistic regression analyses demonstrated that no significant association was found after adjustment of confounding variables (odds ratio=0.28, p=0.063) whereas multiple courses of corticosteroids were independently associated with clinical chorioamnionitis (odds ratio=13.15, p=0.025). CONCLUSION: Multiple courses of antenatal corticosteroids therapy did not reduce the incidence of RDS in neonates and were associated with increased risk of clinical chorioamnionitis in patients with PPROM.

A Multi-center Study for Birth Defect Monitoring Systems in Korea

The aim of this study was to establish a multi-center birth defects monitoring system to evaluate the prevalence and the serial occurrence of birth defects in Korea. Ten medical centers participated in this program. A trained nurse collected relevant records from delivery units and pediatric clinics in participating hospitals on a monthly basis. We observed 1,537 cases of birth defects among 86,622 deliveries, which included live births and stillbirths. The prevalence of birth defects was 1.8%, and the sex distribution of the birth defect cases was 55.2% male and 41.6% female. The highest proportion of birth defects was in the cardiovascular system (17.5%), followed by birth defects involving in the genitourinary system (15.6%). Chromosomal anomalies were detected 30.0 per 10,000 births. Of these chromosomal anomalies, Down syndrome was most frequently observed. This study led to an establishment of a multi-center active monitoring system for birth defects. To better understand the serial occurrence of birth defects in Korea, it is necessary to increase the number of participating hospitals and to launch on a nation-wide multi-center study.

A Case of Delayed Delivery of Second Twin / 대한산부인과학회잡지

With the introduction of assisted reproductive technologies, the incidence of multifetal pregnancies has significantly increased. In vaginal delivery for multifetal pregnancy, the delivery of the second fetus usually follows the first in few minutes. However in rare circumstances, the delivery is delayed for days due to disappearance of uterine contraction after delivery of the first fetus. Successful prolongation of the interdelivery time may improve the neonatal outcomes of the remaining fetus (es), particularly in the cases of extremely premature gestation. We present a case of a delayed delivery of second twin with an interval of 48 days.

Management of Hepatitis B Antigen-Positive Pregnant Women / 대한주산의학회잡지

No abstract available.

The Relationship of the Results of 50-g Screening Test and Gestational Diabetes / 대한산부인과학회잡지

OBJECTIVE: To evaluate the relationship between results of 50-g one-hour glucose screening test (50 GTT) and gestational diabetes and to find cut-off result value of 50 g GTT which can diagnosis the gestational diabetes without other confirmative tests. METHODS: Retrospective study were performed from 1353 pregnant women between 24-28 weeks of gestation, whose results of 50 gGTT were the same or above 140 mg/dl. The diagnosis of gestational diabetes was determined by 100-g 3-hour oral glucose tolerance test (100 gGTT) result. RESULTS: From 1998 to 2002, One hundred twenty-six pregnant women were diagnosed as gestational diabetes among 1353 pregnant women performed 100 gGTT. We couldn't decide any diagnostic cutoff value to gestational diabetes. There was a correlation between the results of 50 gGTT and the incidence of gestational diabetes (p<0.0001). Twenty-one (63.64%) patients among 33 patients whose 50-g screening test result

The Comparison of Severity according to Preceding Causes of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants

PURPOSE: This report attempts to reveal the incidence and prevalence of bronchopulmonary dysplasia (BPD) and compare the severity according to preceding causes of BPD in very low birth weight (VLBW) infants. METHOD: Retrospective study was done on 293 VLBW infants who were born and admitted to neonatal intensive care unit in Samsung medical center between October, 1995 and December, 2001. Classical BPD was defined as oxygen dependency at 36 week's postmenstrual age (PMA). Ogawa BPD was defined as oxygen dependency at 28 days after birth, with respiratory distress symptoms and the change on chest X-ray finding. This classification further classified as BPD into 5 subtypes by the presence of respiratory distress syndrome (RDS), pathologic chorioamnionitis and the type of chest X-ray finding. BPD by Jobe and Bancalari was defined as oxygen dependency at 28 days after birth and classified as 3 subtypes (severe, moderate, mild) by the severity of oxygen dependency. Comparisons were made among classifications. RESULTS: Classical BPD infants were 56 (19.1%), Ogawa BPD infants were 76 (25.9 %), BPD by Jobe and Bancalari infants were 124 (42.3%). In Ogawa classification, Infants with RDS and the change on chest X-ray were 58 infants (76.4%). There was no statistical difference of mortality between each type of Ogawa BPD. In classification by Jobe and Bancalari, 35 infants (28.2%) belonged to severe BPD and 75 infants (60.5%) belonged to mild BPD. The mortality was highest in severe BPD infants but there was no statistical difference after correction by birth weight. There was no statistical correlation between Ogawa classification and classification by Jobe and Bancalari. CONCLUSION: There was no statistical difference in mortality or severity between each subtype of classifications according to the severity or preceding cause of BPD in very low birth weight infants.

A Study on the Incidence and Risk factors of Cystic Periventricular Leukomalacia in very Low Birth Weight Infants

PURPOSE: Our study was carried out to estimate the incidence of cystic periventricular leukomalacia (CPVL) and to identify the risk factors for CPVL. METHODS: The medical records and cranial ultrasound scan were reviewed for 321 infants weighing less than 1, 500 g who lived more than 28 days and admitted to the NICU at Samsung Medical Center from October 1995 to December 2001. A multiple logistic regression was performed to identify which factors were independently associated with CPVL. RESULT: CPVL developed in 19 (5.9%) infants of 1, 188+/-236 g birth weight and 28(+6)+/-2(+4) weeks gestational age. Incidence of CPVL according to birth weight and gestational age were as follows respectively: <750 g 5.3%, 750-999 g 5.5%, 1, 000-1, 249 g 3.9%, 1, 250-1, 499 g 7.9% and <25weeks 8.3%, 25-26weeks 6.7%, 27-28weeks 6.5%, 29-30weeks 2.7%, 31-32weeks 11.1%. The mean day of diagnosis of CPVL was 41+/-33 days. Univriate analysis indicate that two clinical variables, prolonged ventilator duration (CPVL: control, 35+/-64 days vs 17+/-26 days, P=0.0184) and severe intraventricular hemorrhage (IVH) (21% vs 2.7%, P=0.0324), were significant predictors of CPVL. The odds ratio estimate and 95% confidence limits are 1.012 and 1.003 to 1.022, respectively for prolonged ventilator duration; 2.6 and 1.044 to 6.602, respectively for severe IVH. CONCLUSIONS: These data suggest that prolonged ventilator duration and severe IVH increase the risk for development of CPVL.

Activation of Nuclear Factor Kappa B by Inducers in Gestational Tissues at Term / 대한산부인과학회잡지

OBJECTIVE: Nuclear factor kappa B (NF-kappa B) is a transcriptional factor in the expression of cyclooxygenase 2 (COX-2), the key enzyme in production of prostaglandins. The purpose of this study was to investigate the activation of NF-kappa B in human gestational tissues obtained from term pregnant women by various inducers. METHODS: Myometrium, chorion, and amnion were collected during cesarean section from term pregnant women not in labor. Cells from gestational tissues were isolated and cultured with Interleukin-1beta (IL-1beta), Tumor Necrosis Factor-alpha (TNF-alpha) or Lipopolysaccharide (LPS). The activation of NF-kappa B in cells of each tissues was measured by luciferase assay. RESULTS: Luciferase activity analysis showed significantly higher activity of NF-kappa B in myometrial cells treated with LPS, in chorion cells treated with IL-1beta and TNF-alpha, and in amnion cells treated with IL-1beta and LPS than control. CONCLUSION: In cells of gestational tissue at term pregnancy, the activation of NF-kappa B is cell-specific and various according to inducers.

The Value of Transvaginal Ultrasonographic Measurement of Cervical Length for Prediction of Preterm Delivery in Patients with Preterm Labor / 대한산부인과학회잡지

OBJECTIVE: The aim of this study is to evaluate the value of vaginal ultrasonographic cervical length in prediction of preterm delivery in patients with preterm labor. METHODS: One-hundred twenty-nine women in preterm labor at 24-34 weeks of gestation were studied retrospectively. Transvaginal ultrasonography for measurement of cervical length was performed at the time of admission. Receiver-operating characteristic (ROC) curve analysis, partial correlation coefficient, and multiple logistic regression analysis were used for statistical analysis. RESULTS: The mean gestational age at admission was 30.2 +/- 2.5 weeks and the mean gestational age at delivery was 35.7 +/- 3.9 weeks. The median admission-to-delivery interval was 864 hours (24-2616). ROC curve analysis showed a significant relationship between cervical length and preterm delivery (area under the curve=0.82, por=2.5 cm was significantly shorter than that in patients with cervical length >2.5 cm. CONCLUSION: Transvaginal ultrasonographic measurement of cervical length is a useful predictor of preterm delivery in patients with preterm labor and intact membranes.

Ultrasound Evaluation of Normal and Abnormal Fetuses: Comparison of Conventional, Tissue Harmonic, and Pulse-Inversion Harmonic Imaging Techniques

OBJECTIVE: To determine the usefulness of tissue harmonic imaging (THI) and pulse-inversion harmonic imaging (PIHI) in the evaluation of normal and abnormal fetuses. MATERIALS AND METHODS: Forty-one pregnant women who bore a total of 31 normal and ten abnormal fetuses underwent conventional ultrasonography (CUS), and then THI and PIHI. US images of six organ systems, namely the brain, spine, heart, abdomen, extremities and face were compared between the three techniques in terms of overall conspicuity and the definition of borders and internal structures. RESULTS: For the brain, heart, abdomen and face, overall conspicuity at THI and PIHI was significantly better than at CUS (p < 0.05). There was, though, no significant difference between THI and PIHI. Affected organs in abnormal fetuses were more clearly depicted at THI and PIHI than at CUS. CONCLUSION: Both THI and PIHI appear to be superior to CUS for the evaluation of normal or abnormal structures, particularly the brain, heart, abdomen and face.

A Case of Emergent Cesarean Delivery followed by Graft Replacement of Hemiaortic Arch in a Patient with Ruptured Thoracic Aortic Aneurysm / 대한산부인과학회잡지

Aortic aneurysms are extremely uncommon in women under age 40 and are rarely encountered by obstetricians. Various physiologic changes of pregnancy appear to make pregnancy a risky situation of rupture of an aortic aneurysm and pregnancy is discouraged in women with an aortic aneurysm. Development of pregnancy induced hypertension in women with an aortic aneurysm is a profound problem and their treatment is not established. We report a case of emergent cesarean delivery followed by aortic aneurysm replacement surgery in a patient with thoracic aortic aneurysm which was accompanied by pregnancy induced hypertension.

Normal Size of Fetal Kidneys: Sonographic Measurements / 대한산부인과학회잡지

OBJECTIVE: To establish size ranges of normal fetal kidneys by ultrasonogram during pregnancy. METHODS: The A-P diameter and length of each of 450 kidneys in 225 consecutive fetuses between 19 and 41 weeks of gestation were measured on sonogram from March to August 2001 in Samsung Medical Center. Gestational ages were determined by last menstrual period and Crown-Rump Lengths of early stage of pregnancy. Abnormal fetuses, twins, offspring of diabetic mothers, and fetuses with renal pelvic dilatation of 5 mm or greater were excluded to avoid any questionable measurements. RESULTS: The results showed normal distribution and results were similar to previous reports. There was a strong correlation between fetal renal size and gestational age, but no significant difference between right and left renal sizes in fetuses. Average A-P diameter and renal lengths were significantly different when compared across the range of gestational ages (p<.001). CONCLUSION: As long as we know, this was the first report of size of the normal fetal kidney sonographically during pregnancy in Korea. We think that these results can be used to detect abnormality of fetal kidney and to estimate uncertain gestational age.

A Significance of Emergency Cerclage in Cervical Incompetence with Advanced Cervical Dilatation / 대한산부인과학회잡지

OBJECTIVE: To investigate the clinical significance of emergency cerclage on prologation of pregnancy and perinatal outcome in mid-trimester cervical incompetence with advanced cervical dilatation. METHODS: We analyzed the pregnancy outcome retrospectively by the medical record review for 16 patients who had emergency cervical cerclage placed from March 1995 to June 2001. And these data were compared with those of 48 patients who had elective cervical cerclage placed during the same period. RESULTS: The mean gestational age of the patients at emergency cerclage was 22.0+/-2.3 weeks. The mean cervical dilatation was 2.9+/-1.2 cm and mean effacement was 55.3+/-4.7%. The mean prolongation of pregnancy after cerclage was 63.1+/-54.7 days (median 61, range 2-152) and the mean duration of antepartum hospitalization was 10.1+/-12.6 days (2-52). After cerclage, preterm premature rupture of the membranes occurred in 5 cases (31%), clinical chorioamnionitis in 3 cases (19%), and preterm labor in 5 cases (31%). The mean gestational age at delivery was 31.1+/-7.1 weeks. Perinatal survival rate was 85% (17/20), and neonatal survival rate was 94% (17/18). CONCLUSION: It seems that emergency cerclage contribute to maintenance of pregnancy and improve perinatal outcome of fetuses in cervical incompetence with advanced cervical dilatation.

A Case of in-utero Vesicoamniotic Shunting and Postnatal Vesicostomy in Very Low Birth Weight Baby with Posterior Urethral Valve Syndrome

We present a case of in-utero vesicoamniotic shunting and postnatal vesicostomy in a very low birth weight baby with posterior urethral valve syndrome. He was diagnosed as posterior urethral valve at 24(+5) weeks' gestation. Because of severe hydronephrosis and oligohydroamnios, the shunt was established by basket-shaped catheter at 27(+0) weeks' gestation. After shunt, hydronephrosis improved. At 29(+4) weeks' gestation, the shunt catheter escaped from its position and severe urinary ascites and hydronephrosis developed. At 30 weeks' gestation, the baby was born and showed elevated BUN and creatinine. On the 10th day of birth, vesicostomy was done for urinary drainage. Thereafter, the baby has been followed up for 10 months and has had recurrent episodes of urinary infection. We report the case with a brief review of literature.

A case of antenatal periventricular leukomalacia in monochorionic twin pregnancy complicated with twin-to-twin transfusion syndrome / 대한산부인과학회잡지

Nearly 100% of monochorionic twin pregnancies have vascular anastomoses and a fourth of those has clinical features of twin-to-twin transfusion syndrome. Cerebral palsy, microcephaly, porencephaly, and multicystic periventricular leukomalacia are serious antenatal neurologic complications associated with vascular communications in monochorionic twin gestation. It is most likely that such neurological damage is caused by intrauterine cerebral ischemic necrosis. The intermittent blood flow reversal or sudden hypotension in one twin, or emboli of thromboplastic material originating in the dead fetus could cause in utero cerebral damage in the other twin. In this report, we present a case of antenatal periventricular leukomalacia in monochorionic twin pregnancy complicated with twin-to-twin transfusion syndrome.

The Association of Histologic Chorioamnionitis and Bronchopulmonary Dysplasia in Prematurity / 대한산부인과학회잡지

OBJECTIVE: Bronchopulmonary dysplasia (BPD) is one of the most frequent and clinically significant complications of prematurity and it has been widely accepted that immaturity, barotrauma, and oxygen toxicity are major factors in the etiology of BPD. However, recent studies showed that infection may also play a role in the pathogenesis of BPD and exposure to a prenatal inflammatory process may lead to lung injury and predispose to the subsequent development of BPD. The purpose of this study was to test the hypothesis that neonates with BPD had higher incidence of histologic chorioamnionitis than those in whom BPD does not develop. METHODS: A retrospective study was conducted to examine the relationship between histologic chorioamnionitis and the occurrence of BPD in neonate. We reviewed the hospital charts of 363 women and their neonates whose gestational age at birth were between 24 weeks and 35 weeks and recorded their pregnancy outcomes, the results of placental Biopsy, perinatal outcomes including the occurrence of BPD. RESULTS: 1. Neonates who developed BPD showed higher incidence of acute histologic chorioamnionitis. The relationship remained significant even after the adjustment for gestational age (odds ratio, 3.2: 95% confidence interval, 1.6-11.3: P<0.05). 2. Higher maternal serum CRP was also associated with increased incidence of histologic chorioamnionitis and BPD (P<0.05). 3. Neonates who developed BPD also had higher incidence of infectious morbidity such as early neonatal pneumonia and sepsis (P<0.05). CONCLUSION: These results suggest that histologic chorioamnionitis is closely related to the occurrence of BPD. This support the hypothesis that intrauterine infection may cause fetal lung injury and subsequent development of BPD.