Iron Deficiency Anemia in Pregnancy

Iron deficiency anemia (IDA) is the most common hematologic abnormality, which is a reduction in the concentration of erythrocytes or hemoglobin in the blood in pregnancy because Iron requirements increase during pregnancy. Since a failure to maintain sufficient levels of iron may result in adverse maternal-fetal consequences, active counseling and support from medical staff are necessary. Regarding the points to note during treatment, this document is to provide a brief overview of the IDA and medical management during pregnancy.

Effects of corticotropin-releasing hormone on the expression of adenosine triphosphate-sensitive potassium channels (Kir6.1/SUR2B) in human term pregnant myometrium

OBJECTIVE: Corticotropin-releasing hormone (CRH) is a crucial regulator of human pregnancy and parturition. Adenosine triphosphate (ATP)-sensitive potassium (KATP) channels are important for regulating myometrial quiescence during pregnancy. We investigated regulatory effects of different concentrations of CRH on KATP channel expression in human myometrial smooth muscle cells (HSMCs) in in vitro conditions. METHODS: After treating HSMCs with different concentrations of CRH (1, 10, 102, 103, 104 pmol/L), mRNA and protein expression of KATP channel subunits (Kir6.1 and SUR2B) was analyzed by reverse transcription-polymerase chain reaction and western blot. We investigated which CRH receptor was involved in the reaction and measured the effects of CRH on intracellular Ca2+ concentration when oxytocin was administered in HSMCs using Fluo-8 AM ester. RESULTS: When HSMCs were treated with low (1 pmol/L) and high (103, 104 pmol/L) CRH concentrations, KATP channel expression significantly increased and decreased, respectively. SUR2B mRNA expression at low and high CRH concentrations was significantly antagonized by antalarmin (CRH receptor-1 antagonist) and astressin 2b (CRH receptor-2 antagonist), respectively; however, Kir6.1 mRNA expression was not affected. After oxytocin treatment, the intracellular Ca2+ concentration in CRH-treated HSMCs was significantly lowered in low concentration of CRH (1 pmol/L), but not in high concentration of CRH (103 pmol/L), compared to control. CONCLUSION: Our data demonstrated the regulatory effect was different when HSMCs were treated with low (early pregnancy-like) and high (labor-like) CRH concentrations and the KATP channel expression showed significant increase and decrease. This could cause inhibition and activation, respectively, of uterine muscle contraction, demonstrating opposite dual actions of CRH.

Postoperative outcomes of natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy and conventional laparoscopic-assisted vaginal hysterectomy: a comparative study

OBJECTIVE: The present study aimed to determine the differences in outcomes between natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy (NAVH) and conventional laparoscopy-assisted vaginal hysterectomy (LAVH). METHODS: We retrospectively reviewed the charts of patients who between July 2012 and September 2015, were diagnosed as having benign uterine disease such as uterine myoma, endometriosis, or adenomyosis and managed via NAVH or LAVH in a single-center (Eulji University Hospital). Data such as age, body weight, height, parity, operation time, intra/post-operative complications, and uterus weight were obtained from the clinical charts. NAVH and LAVH recipients were matched 1:3 in terms of baseline characteristics, and the 2 groups were compared regarding surgical outcomes. RESULTS: Of the 160 patients with benign uterine disease included in the present study. Forty received NAVH and remaining 120 received LAVH. There were significant differences between the groups regarding operation time and hemoglobin change. Notably, although the operation time was shorter for LAVH, hemoglobin change was lower for NAVH. Additionally, although maximum hospitalization duration was shorter for LAVH, the average length of hospitalization was similar between NAVH and LAVH. There were no significant differences between the groups in terms of other variables. CONCLUSION: NAVH may become a new alternative surgical method of choice for hysterectomy, as it represents a clinically feasible and safe approach; moreover is superior to LAVH in terms of bleeding loss.

Uterine rupture in pregnancies following myomectomy: A multicenter case series

OBJECTIVE: The purpose of this case series was to retrospectively examine records of cases with uterine rupture in pregnancies following myomectomy and to describe the clinical features and pregnancy outcomes. METHODS: This study was conducted as a multicenter case series. The patient databases at 7 tertiary hospitals were queried. Records of patients with a diagnosis of uterine rupture in the pregnancy following myomectomy between January 2012 and December 2014 were retrospectively collected. The uterine rupture cases enrolled in this study were defined as follows: through-and-through uterine rupture or tear of the uterine muscle and serosa, occurrence from 24+0 to 41+6 weeks' gestation, singleton pregnancy, and previous laparoscopic myomectomy (LSM) or laparotomic myomectomy (LTM) status. RESULTS: Fourteen pregnant women experienced uterine rupture during their pregnancy after LSM or LTM. Preterm delivery of less than 34 weeks' gestation occurred in 5 cases, while intrauterine fetal death occurred in 3, and 3 cases had fetal distress. Of the 14 uterine rupture cases, none occurred during labor. All mothers survived and had no sequelae, unlike the perinatal outcomes, although they were receiving blood transfusion or treatment for uterine artery embolization because of uterine atony or massive hemorrhage. CONCLUSION: In women of childbearing age who are scheduled to undergo LTM or LSM, the potential risk of uterine rupture on subsequent pregnancy should be explained before surgery. Pregnancy in women after myomectomy should be carefully observed, and they should be adequately counseled during this period.

A Case of Crohn's Disease Having Normal Delivery after Infliximab Treatment during Early Pregnancy / 대한소화기학회지

Infliximab is a chimeric IgG1 monoclonal antibody to tumor necrosis factor (TNF)-alpha used in the treatment of steroid refractory or dependent Crohn's disease (CD). Patients with active CD are more likely to experience stillbirth, preterm labor, or small for gestational aged babies. The safety of administering infliximab in pregnant patients is not well documented. A 25-year-old woman, who was diagnosed with small bowel CD three years ago, was admitted to our hospital due to the aggravation of abdominal pain. She had been treated with mesalazine, azathioprine and intermittent steroid for three years. After admission, she did not respond to steroid therapy, we decided to try infliximab. After the administration of infliximab, epigastric pain was relived and Crohn's disease activity index score decreased significantly. However after the fourth infusion of infliximab, the patient became aware that she was ten gestational weeks old pregnancy state After then, infliximab was stopped and maintained by mesalazine. The patient gave birth to a healthy baby via normal vaginal delivery without the recurrence of CD. This case suggests that infliximab administration is safe during the early period of pregnancy. Thus, we report this case with a review of literature.

Risk Factors for Group B Streptococcus Colonization Among Pregnant Women in Korea / 한국역학회지

OBJECTIVES: To identify obstetric and maternal factors related to Group B Streptococcus (GBS) colonization in pregnant women in Korea. METHODS: The study was conducted between the years 2006-2008 in four hospitals, Cheil and Eulji hospital in Seoul, and Motae and Eulji hospital in Daejeon. We recruited 2,644 pregnant women between 35 to 37 weeks of gestation who had visited for antenatal care. Participants completed a questionnaire, and urine, vaginal and rectal specimens were obtained and cultured using selective broth media. After delivery, medical records were reviewed. RESULTS: GBS colonization was significantly associated with hospital, age group, education, frequency of pregnancy, and premature rupture of membranes (PROM, more than 18 hours). After adjustment for other variables, Cheil hospital (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.20-3.52), and the first pregnancy (OR, 2.32; 95% CI, 1.12-4.81) remained significant. History of vaginitis showed marginal significance (OR, 1.50; 95% CI, 0.98-2.29). CONCLUSION: To prevent GBS infection of neonates, clinicians should be alert to the potentially higher risk of GBS colonization in pregnant women in their first pregnancy, and women with premature rupture of membranes (PROM) (18 hours+) or who have a history of vaginitis.

Changing Molecular Epidemiology of Group B Streptococcus in Korea

The prevalence of group B streptococcus (GBS) among pregnant women and disease burdens in neonates and adults are increasing in Korea. Colonizing isolates, collected by screening pregnant women (n=196), and clinical isolates collected from clinical patients throughout Korea (n=234), were serotyped and screened for antibiotic resistance. Serotype III (29.8%) and V (27.7%) predominated, followed by Ia (17.0%). Antibiotic resistance was higher among clinical than colonizing isolates for erythromycin (35.1% and 26.9%; P=0.10) and for clindamycin (49.4% and 42.1%; P=0.17). erm(B) occurred in 91.9% of erythromycin resistant isolates, and 84.0% of isolates resistant to clindamycin. Only five isolates (4.2%) resistant to erythromycin were susceptible to clindamycin; by contrast, and unique to Korea, 34% of isolates resistant to clindamycin were erythromycin susceptible. Among these 60 erythromycin-susceptible & clindamycin-resistant isolates, 88% was serotype III, and lnu(B) was found in 89% of strains. Four fifths of the serotype V isolates were resistant to both erythromycin and clindamycin. Further characterization of the genetic assembly of these resistance conferring genes, erm(B) and lnu(B), will be useful to establish the clonal lineages of multiple resistance genes carrying strains.

Angiographic findings and effect of superselective embolization for early and late postpartum bleeding / 대한산부인과학회지

OBJECTIVE: Treatment of postpartum bleeding with uterine artery embolization has been well-described so far. However, angiographic differences between early and late postpartum bleeding has not been elucidated. The purpose of this study was to evaluate angiographic differences between early and late postpartum bleeding and therapeutic effect of superselective embolization. METHODS: Medical records and angiographic images of 12 patients (7 early and 5 late) with postpartum bleeding were evaluated. Timing of bleeding, mode of delivery, angiographic findings and treatment outcome were primary variables evaluated. RESULTS: Among 12 patients, 11 patients had been successfully treated with superselective embolization. One patient with amniotic fluid embolism and disseminated intravascular coagulation had expired. Among the early postpartum bleeding, uterine atony was found in every patients except post-cesarean hysterectomy cases. Pseudoaneurysm of uterine artery was found in all patients with late postpartum bleeding. CONCLUSION: Superselective embolization is an effective method to control postpartum bleeding. Pseudoaneurysm of uterine artery is a main cause of late postpartum bleeding.

Who is more appropriate to do metabolic control of pregnancy complicated by diabetes?: Comparison of internist and obstetrician / 대한산부인과학회지

OBJECTIVE: To compared obstetric outcomes of pregnancies complicated by diabetes according to the managing department and to consider role of obstetrician and endocrinologist METHODS: A retrospective analysis of 72 pregnant women managed for diabetes during March 2004 to December 2006 was performed. Eighteen women had been managed by obstetricians (Group I) while 54 women had been managed by endocrinologists of internal medicine (Group II) during their pregnancies at Eulji Hospital. None of these patients had multiple pregnancies, abnormal karyotype, or other medical disorders other than diabetes. Pregnancy outcomes were compared between two groups. RESULTS: No difference was found with regard to the age, parity, BMI (body mass index), weight gain during the pregnancy, and the gestational weeks of delivery. There was also no difference in the blood glucose levels after 100 gm OGTT (oral glucose tolerance test) and HbA1C levels in two groups. The neonatal birth weight of group I (2.89+/-0.21 kg) was significantly lower than that of group II (3.38+/-0.08 kg, P=0.040). The 1 min APGAR score, which was corrected by weight through ANCOVA test, was also significantly lower in group I (7.11+/-0.51 vs 8.11+/-0.19, P=0.028). But There was no difference in 5 min APGAR score. The incidence of birth weight over 3.8kg was significantly higher in group II [37/54 (68.5%) vs 1/17 (5.6%), P=0.030]. Neonatal hypoglycemia was also higher in group II (37.0% vs 11.1%, P=0.043). Other neonatal and maternal complications associated with diabetes were not significantly different between two groups. CONCLUSIONS: In medical point of view, obstetrician can effectively manage diabetes during pregnancy as good as internist. Besides, the management by obstetricians may be more economic, less annoying, and can induce more compliance and motivation of the patients.

A comparison of the effect of Anastrozole and Clomiphene citrate in anovulatory patients / 대한산부인과학회지

OBJECTIVE: To compare the clinical effectiveness of Anastrozole in ovulation induction with that of clomiphene citrate. METHODS: Sixty anovulatory women were randomly divided into 4 groups (1 mg, 2 mg and 4 mg of Anastrozole groups and Clomiphene citrate group). The ovulation induction was tried with 3 dosages of Anastrozole or 100 mg of Clomiphene citrate for 5 days. The serum level of estradiol, testosterone, FSH and LH were serially monitored (on 3rd, 5th and 8th days of treatment). Serum estradiol level at the time of hCG injection was also measured. Ovulation rate, number of dominant follicles, endometrial thickness, and pregnancy rate were measured and compared across the study groups. RESULTS: There was no statistically significant difference in estradiol, testosterone, or LH level between women treated with Anastrozole and Clomiphene citrate. In patients treated with 4 mg of Anastrozole, serum FSH level was higher than that of the women treated with Clomiphene citrate (P<0.05). Endometrial thickness was greater in patients treated with Anastrozole than women treated with Clomiphene citrate (P<0.05). Number of dominant follicles in patients treated with Clomiphene (1.56) was slightly greater than in women treated with Anastrozole (1.0-1.1), but there was no statistically significant difference. CONCLUSION: Anastrozole had similar clinical effectiveness in ovulation induction when compared to Clomiphene citrate. At 1 mg or 2 mg of Anastrozole, ovulatory rate remained below the effectiveness of Clomiphene citrate, therefore considering the expensive cost of Anastrozole, it should not be considered as first-line medication for ovulation induction but reserved for those who have certain conditions such as thin endometrium and polycystic ovarian syndrome.

Complete androgen insensitivity syndrome due to androgen receptor gene mutation in the amino acid position 607 which bilateral testes situated in the normal ovary sites / 대한산부인과학회지

Androgen insensitivity syndrome (AIS) is a disorder of male sexual differentiation caused by mutations within the androgen receptor gene, represents a variety of phenotypes from females with 46,XY karyotype over individuals with ambiguous genitalia to infertile males. Single base mutations resulting in amino acid substitution represent the most common mutations of the androgen receptor (AR) gene and are associated with complete AIS. The location of the gonads can be variable including, the intra-abdominal cavity, the labioscrotal folds, and the inguinal regions. Testicular descent is a two-stage process comprising transabdominal and transinguinal phases. The first phase is not controlled by androgen and may be regulated by mullerian inhibiting substance, by contrast the second phase is androgen dependent. Recently we have identified a point mutation CGA to TGA at position 607 of exon 3 in complete AIS patient, so we report it with brief review of literatures.

Clinical characteristics and pregnancy outcomes of hyperemesis gravidarum / 대한산부인과학회지

OBJECTIVE: It is controversial that hyperemesis gravidarum has adverse effect on pregnancy. The purpose of this study is to evaluate clinical characteristics and pregnancy outcomes in women with hyperemesis gravidarum. METHODS: We identified 52 women who was treated as inpatients for hyperemesis gravidarum and had delivered babies between Jan. 2001 and Oct. 2004. The control group was 123 women who had not suffered from hyperemesis gravidarum. We performed a retrospective analysis of obstetric and pediatric medical records. We analyzed the data using student's t-test and Chi-square test and p-value<0.05 was considered as statistically significant. RESULTS: The average height (162.5+/-0.6 vs. 160.6+/-0.4 cm, Mean+/-SE) was significantly higher in hyperemesis group. The average pre-pregnancy BMI (20.2+/-0.3 vs. 21.0+/-0.2 kg/m2) and maternal age (29.8+/-0.5 vs. 31.2+/-0.3 years) were significantly lower in hyperemesis group. The average weight loss was 2.6 kg and the average hospital stay was 5.4 days. The average concentration of serum electrolytes were within normal limits. The hematocrit (35.4+/-0.4 vs. 34.3+/-0.2%) and unconjugated estriol (1.336+/-0.055 vs. 1.126+/-0.034 MoM) were significantly higher in hyperemesis group. Vaginal bleeding during the first trimester was more common in hyperemesis group (16.4 vs. 4.7%). Pregnancy outcomes between hyperemesis and control group were similar in average gestational age, average birth weight, average Apgar scores, sex ratio, congenital malformation and neonatal morbidity. CONCLUSION: Pregnant women with hyperemesis had significant differences in some demographic characteristics, hematocrit, unconjugated estriol and vaginal bleeding during the first trimester, but had similar pregnancy outcomes.

The differences of mid-trimester triple marker levels according to the occurrence time and severity of preeclampsia / 대한산부인과학회지

OBJECTIVE: To evaluate the differences of mid-trimester triple marker levels in patients with mild versus severe and early versus late onset preeclampsia. METHODS: From January 2000 to December 2004, a retrospective study of 65 women with preeclampsia for whom mid-trimester triple test data were available was made. None of these patients had diabetes, other medical disorders, multiple pregnancy, abnormal karyotype and malformations. Preeclampsia patients were grouped to "early onset" [<32 weeks of gestation (wks), n=17] and "late onset" (n=48), and also "mild" (who had delivered with no symptoms and lab findings of severe preeclampsia at term spontaneous labor or elective cesarean delivery, n=31) and "severe" (n=34). The levels of mid-trimester maternal serum alpha-fetoprotein (MSAFP), human chorionic gonadotropin (hCG) and unconjugate estriol (MSuE3) in patients with early and late onset, mild and severe were compared. RESULTS: The each groups of comparison did not differ significantly with regard to age, weight, parity. The mean MSuE3 [0.92+/-0.09 (MoM+/-SE)] in patients with early onset was significantly lower than in patients with late onset preeclampsia (1.24 MoM, SE 0.07). In the comparison according to severity, the mean MSuE3 was significantly lower (0.98 MoM, SE 0.06 vs 1.28 MoM, SE 0.10, p=0.016) and the mean hCG was significantly higher (1.46 MoM, SE 0.12 vs 1.12 MoM, SE 0.07, p=0.015) in patients with severe preeclampsia than in those had mild preeclampsia symptoms at term delivery. CONCLUSION: Lower levels of mid-trimester MSuE3 and higher levels of hCG were associated with the severe preeclampsia rather than mild. Especially, lower levels of mid-trimester MSuE3 was also associated with early onset preeclampsia.

Clinical characteristics and pregnancy outcomes of hyperemesis gravidarum / 대한산부인과학회지

OBJECTIVE: It is controversial that hyperemesis gravidarum has adverse effect on pregnancy. The purpose of this study is to evaluate clinical characteristics and pregnancy outcomes in women with hyperemesis gravidarum. METHODS: We identified 52 women who was treated as inpatients for hyperemesis gravidarum and had delivered babies between Jan. 2001 and Oct. 2004. The control group was 123 women who had not suffered from hyperemesis gravidarum. We performed a retrospective analysis of obstetric and pediatric medical records. We analyzed the data using student's t-test and Chi-square test and p-value<0.05 was considered as statistically significant. RESULTS: The average height (162.5+/-0.6 vs. 160.6+/-0.4 cm, Mean+/-SE) was significantly higher in hyperemesis group. The average pre-pregnancy BMI (20.2+/-0.3 vs. 21.0+/-0.2 kg/m2) and maternal age (29.8+/-0.5 vs. 31.2+/-0.3 years) were significantly lower in hyperemesis group. The average weight loss was 2.6 kg and the average hospital stay was 5.4 days. The average concentration of serum electrolytes were within normal limits. The hematocrit (35.4+/-0.4 vs. 34.3+/-0.2%) and unconjugated estriol (1.336+/-0.055 vs. 1.126+/-0.034 MoM) were significantly higher in hyperemesis group. Vaginal bleeding during the first trimester was more common in hyperemesis group (16.4 vs. 4.7%). Pregnancy outcomes between hyperemesis and control group were similar in average gestational age, average birth weight, average Apgar scores, sex ratio, congenital malformation and neonatal morbidity. CONCLUSION: Pregnant women with hyperemesis had significant differences in some demographic characteristics, hematocrit, unconjugated estriol and vaginal bleeding during the first trimester, but had similar pregnancy outcomes.

The differences of mid-trimester triple marker levels according to the occurrence time and severity of preeclampsia / 대한산부인과학회지

OBJECTIVE: To evaluate the differences of mid-trimester triple marker levels in patients with mild versus severe and early versus late onset preeclampsia. METHODS: From January 2000 to December 2004, a retrospective study of 65 women with preeclampsia for whom mid-trimester triple test data were available was made. None of these patients had diabetes, other medical disorders, multiple pregnancy, abnormal karyotype and malformations. Preeclampsia patients were grouped to "early onset" [<32 weeks of gestation (wks), n=17] and "late onset" (n=48), and also "mild" (who had delivered with no symptoms and lab findings of severe preeclampsia at term spontaneous labor or elective cesarean delivery, n=31) and "severe" (n=34). The levels of mid-trimester maternal serum alpha-fetoprotein (MSAFP), human chorionic gonadotropin (hCG) and unconjugate estriol (MSuE3) in patients with early and late onset, mild and severe were compared. RESULTS: The each groups of comparison did not differ significantly with regard to age, weight, parity. The mean MSuE3 [0.92+/-0.09 (MoM+/-SE)] in patients with early onset was significantly lower than in patients with late onset preeclampsia (1.24 MoM, SE 0.07). In the comparison according to severity, the mean MSuE3 was significantly lower (0.98 MoM, SE 0.06 vs 1.28 MoM, SE 0.10, p=0.016) and the mean hCG was significantly higher (1.46 MoM, SE 0.12 vs 1.12 MoM, SE 0.07, p=0.015) in patients with severe preeclampsia than in those had mild preeclampsia symptoms at term delivery. CONCLUSION: Lower levels of mid-trimester MSuE3 and higher levels of hCG were associated with the severe preeclampsia rather than mild. Especially, lower levels of mid-trimester MSuE3 was also associated with early onset preeclampsia.

Endocrine response to step-up microdose GnRH agonist / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the endocrine response to step-up microdose GnRH agonist. METHODS: Administration of triptorelin acetate was initiated from 2 mg and gradually increased to 50 mg during 6-day period to five normal menstruating women. Serum FSH, LH, and estradiol levels were serially measured for 6 days. The same set of experiment was duplicated after taking oral contraceptive for 3 weeks. Serum testosterone and progesterone levels were measured on day 1 and day 5 of experiment. RESULTS: The flare of gonadotropin continued for 6 days. When subjects were pretreated with oral contraceptive, serum FSH levels 4 hrs after GnRH agonist injection were 17.35+/-7.88 mIU/mL, 11.26+/-4.81 mIU/mL, and 9.60+/-4.08 mIU/mL for day 1, 2, and 3 respectively. The FSH levels were not statistically different when pretreatment with oral contraceptive was not applied. The level of serum LH was significantly lower in the cycle, which was pretreated by oral contraceptive (32.13+/-9.61 mIU/mL vs. 14.12+/-5.63 mIU/mL for day 1, 28.95+/-3.09 mIU/mL vs. 15.76+/-9.92 mIU/mL for day 2, and 24.45+/-2.52 mIU/mL vs. 16.86+/-8.56 mIU/mL for day 3). The sign of corpus luteum rescue was found in 2 out of 5 subjects only in non-treated cycle. CONCLUSION: Step-up microdose GnRH agonist protocol could induce persistent gonadotropin flare for 6 days and this regimen could be applied in controlled ovarian hyperstimulation especially for poor responders. The pretreatment with oral contraceptive is necessary to prevent supraphysiologic LH elevation and corpus luteum rescue.

A study for Pertinence in Emergent Cesarean Section / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to analyze the inclination, pertinence and influential factor in emergent cesarean section according to the assortment and analysis of the indication of emergent cesarean section. METHODS: The retrospective study was performed with the review of 360 emergent cesarean section cases from January 2003 to December 2003. RESULTS: The indication of cesarean section was followed by the order of progress failure (47.5%), previous cesarean section (19.2%), and fetal distress (15.8%). The improper operation of emergent cesarean section was done in fetal distress (28.1%), progress failure (8.6%), and induction failure (16.7%). The absence of acceleration with prolonged bradycardia was the most common (50.0%) type of fetal distress. The emergent cesarean section were done more commonly on Tuesday and Friday during weekdays and it was the peak time in a whole day of cesarean section from 11 o'clock to 12 o'clock and 16 o'clock to 17 o'clock. CONCLUSION: It was proved that twenty six (7.2%) cases of emergent cesarean section were done improperly. Now, work through the non-medical factors are considered more important to reduce improper section rate.

A Case of Miliary Tuberculosis During Pregnancy / 대한주산의학회잡지

Although miliary tuberculosis is uncommon during pregnancy. it is often associated with a maternal history of intravenous drug abuse, malignancy, alcoholism, or human immunodeficiency virus infection, and it is difficult to diagnose when associated with pregnancy. There is no solid evidence that pregnancy has an adverse effect on tuberculosis, thus routine therapeutic abortion is not indicated. If the early diagnosis and promptly adequate chemotherapy was done, the outcome of pregnancy in a women with miliary tuberculosis is likely to be good. Recently we have experienced a case of miliary tuberculosis at 20 weeks gestation without any risk factors of tuberculosis. So we report this case with a brief review of literature.

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.

A Case of Cloacal Anomaly with Multiple Associated Anomalies / 대한산부인과학회잡지

Cloacal anomaly is an extremely rare congenital malformation results from a failure in the development of the urorectal fold that separates the rectum from uterovaginal tract. It is characterized by the presence of a single duct where the gastrointestinal, genital and urinary tracts join. It presents with highly variable forms, which make it difficult to be diagnosed antenatally. We report a case of cloacal anomaly confirmed with autopsy, which was initially detected by the presence of a huge cystic fetal abdominal mass by ultrasound at a 22 weeks of gestation.