Gene Expression Pattern of Human Chorion-Derived Mesenchymal Stem Cells during Adipogenic Differentiation

PURPOSE: The aim of this study was to identify the adipocyte-specific gene expression patterns in chorion-derived mesenchymal stem cells during adipogenic differentiation. MATERIALS AND METHODS: Chorionic cells were isolated from the third trimester chorions from human placenta at birth and identified morphologically and by fluorescence-activated cell sorting analysis. After inducing adipogenic differentiation for 28 days, cells at days 3, 10, 21 and 28 were analyzed by Oil red O staining and RNA extraction in order to assess the expression levels of adipocyte marker genes, including CCAAT-enhancer binding protein alpha (C/EBPalpha), peroxisome proliferator-activated receptor gamma (PPARgamma), fatty acid binding protein 4 (FABP4) and Glycerol-3-phosphate dehydrogenase (GPD2). Cells not induced for differentiation were compared with the induced cells as a control group. RESULTS: Chorion-derived cells showed the same pattern as fibroblasts, and expressed CD73, CD105, and CD166 antigens, but not CD45, CD34, and HLA-DR antigens. On day 3 after differentiation, cells began to stain positively upon Oil red O staining, and continuously increased in lipid granules for 4 weeks. The expression level of C/EBPalpha increased 4.6 fold on day 3 after induction, and continued to increase for 4 weeks. PPARgamma was expressed at a maximum of 2.9 fold on day 21. FABP4 and GPD2 were significantly expressed at 4.7- and 3.0-fold, respectively, on day 21, compared to controls, and further increased thereafter. CONCLUSION: Human chorion-derived mesenchymal stem cells exhibited the sequential expression pattern of adipocyte marker genes during differentiation, corresponding to adipogenesis.

Efficacy of human papillomavirus vaccines including cross protection : A review of recent evidence / 대한산부인과학회지

The efficacy and immunogenicity of human papillomavirus (HPV) vaccines has proven excellent in several phase 2 and phase 3 trials involving tens of thousand women. Two versions of HPV vaccine had been developed, both target HPV 16 and HPV 18, which involve approximately 70% of cervical cancer. We have summarized the recent review of all randomized controlled trials in which vaccines against HPV were compared with placebo regarding efficacy, safety, and immunogenicity. Both vaccines have an excellent safety profile, are highly immunogenic, and have atributed complete type specific protection against persistent infection and associated lesions in fully vaccinated girls and young women. Data strongly suggest that both vaccines can have a variable level of cross protection against HPV types genetically and antigenically-closely related to vaccine types. Demonstration of cross protection against combined endpoints [cervical intraepithelial neoplasia (CIN) 2/3 and adenocarcinoma in situ] for HPV-31 has been reached for the quadrivalent vaccine. Bivalent HPV vaccine showed significant type-specific cross-protection against CIN2+ associated with HPV-31, HPV-33, and HPV-45. The bivalent vaccine is also registered for above age 26 in Australia, Israel and Korea. In our country, we have already set up the clinical guideline of both vaccines. Although these prophylactic vaccination is likely to provide important gains in the prevention of cervical cancer, we should have need to establish the new screening guideline in post-vaccination period and to make next version of vaccination-guidelines related of specific subgroups of patients who would benefit from the vaccine (women older than 26 years, boys, and men).

Primary nasal type NK/T cell lymphoma of the endometrium : A case report / 대한산부인과학회지

Non-Hodgkin lymphoma can involve the female genital tract usually as a manifestation of systemic disease, the vast majority of cases being B cell lineage. We report here one case of nasal type NK/T cell lymphoma arising in the uterus, of a 45-year-old Korean woman. The endometrium and myometrium showed diffuse infiltrative mass with hemorrhage and necrosis. Microscopic examination of the tumor revealed medium-sized atypical lymphoid cells. The tumor cells were positive for cytoplasmic CD3 and CD56, and were negative for vimentin, CD10, smooth muscle actin and desmin. Furthermore, In situ hybridization analysis for Epstein-Barr virus (EBV) RNA was positive. The histopathologic and immunohistochemical findings were consistent with extranodal nasal type NK/T cell lymphoma. We report this case to illustrate that NK/T cell lymphomas can involve, and rarely arise in, the gynecologic tract.

A case of ruptured tuboovarian abscess into the anterior abdominal wall / 대한산부인과학회지

Rupture of a tuboovarian abscess usually presents with sudden worsening of the patient's condition. Delays in surgical debridement and drainage increase the rate of associated mortality. A 39-year-old woman represents extraperitoneal spillage of abscess contents from rupture of a tuboovarian abscess into the anterior abdominal wall. She presented with gradually worsening abdominal pain over several months. She had fever, pelvic tenderness, an elevated white blood cell count and evidence of a tuboovarian abscess. Also she was found to have an abscess that had ruptured into the anterior left abdominal wall. After triple antibiotic therapy without a clinical improvement, she underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and surgical debridement of the abdominal wall. Over the following several weeks, the patient required extensive wound care for wound drainage and skin flap.

A case of bowel obstruction due to endometriosis / 대한산부인과학회지

We have experienced a case of intestinal obstruction due to endometriosis. It may involve intestinal wall and protrude into its lumen and patients with severe intestinal involvement usually require surgical resection. Clinical manifestations are not specific, making the preoperative diagnosis difficult to establish. An emergency laparotomy was performed. The pathologic examination of the resected sample revealed endometriosis of sigmoid colon. Endometriosis can involve the intestinal tract extensively, causing a variety of clinical symptoms, and can result in a spectrum of mucosal alterations.

Clinical analysis of laparoscopic surgery of tuboovarian abscess in acute pelvic inflammatory disease / 대한산부인과학회지

OBJECTIVE: To evaluate the clinical characteristics between patients with tuboovarian abscess and those presenting with non-tuboovarian abscess in acute pelvic inflammatory disease according to the operation findings. METHODS: The patients were divided into 2 groups based on the operation findings at laparoscopic surgery; 56 patients diagnosed with evidence of tuboovarian abscess and 74 patients diagnosed with acute pelvic inflammatory disease without tuboovarian abscess. Those were compared with respect to patient characteristics, clinical and laboratory findings depending on the significant differences. RESULTS: There were no significant differences between the two groups considering the percentage of age, parity, mean abortion rate and rate of the history of previous pelvic inflammatory disease. But there were differences in mean white blood cell count, erythrocyte sedimentation rate and C-reactive protein level. A higher number of patients having intrauterine devices were observed in the tuboovarian abscess group than in the non-tuboovarian abscess group. Also, statistical significance was noted in hospital stay after operation but there was no difference in number of sick days prior to operation. CONCLUSION: Our results suggest that some variables noted between the tuboovarian abscess group and acute pelvic inflammatory disease group. These results make easier to calculate diagnostic accuracy of patients prone to developing tuboovarian abscess and prevent subsequent complications from the delay of treatment if sensitivity, specificity, negative and positive predictive values were assessed.

Surgical management of recurrent pneumothorax in the second trimester of pregnancy / 대한주산의학회잡지

Spontaneous pneumothorax in pregnancy is generally regarded as an unusual disorder, with only approximately 44 cases having been reported in the world literature. The most common cause is the rupture of a subpleural apical bulla or bleb, due to increased respiratory demand of the peripartum period. Pneumothorax should be considered in any pregnant woman with chest pain and/or dyspnea and must be confirmed radiographically. Treatment of simple pneumothorax during pregnancy is controversal. Admission and close observation of the patient is usually done with small pneumothorax. Other treatment options are needle aspiration, needle decompression (eg, intension pneumothorax), pleurodesis, tube thoracostomy, thoracotomy, and thoracoscopy. We report a recent experience of a 34 years-old pregnant woman with recurrent pneumothorax, who was treated with thoracotomy during the 28th weeks of pregnancy. She had previously been well during pregnancy and all antenatal investigations, including ultrasound scan, were normal. Cardiovascular examination did not reveal any abnormality. On chest auscultation, air entry was reduced on the left side of the chest. Chest X-ray revealed significantly expanded left lung with a large pneumothorax. After successfully treated with surgical approach, the patient had vaginal delivery of a healthy male infant, weighing 2.93 kg, safely during 39th weeks of pregnancy.

Cytotoxic effects of Belotecan in the cervical cancer cell lines / 대한산부인과학회지

OBJECTIVE: In our domestic market, Belotecan (Camptobel(R), chongkeundang, Korea) is newly introduced recently. Belotecan has many advantages of improved water solubility and fewer side effects like severe diarrhea or GI bleeding compare to other camptothecin derivatives. In this study, primary focus is aiming to evaluate the effectiveness of belotecan by providing the cytotoxicity and apoptotic pathway on cervical cancer cells. METHODS: Cervical cancer cell line, HeLa and Caski were used. Belotecan applied on both cell lines and checked whether it has anti tumor effect on cancer cell by using MTT assay. DNA fragmentation and western blot was performed to confirm cellular apoptosis pathway. Also cDNA microarray and RT-PCR were serially carried out in order to identify responsible genes for apoptosis. RESULT: Dose- and time- dependent inhibition of cell proliferation is noted on the Belotecan applied HeLa and CaSki cervical carcinoma cell line by MTT assay. DNA fragmentation assay showed the DNA ladder indicating apopoptosis. Also apoptotic pathway and genes that are related with Belotecan activities are identified. Apoptosis, cell cycle, and drug metabolism related gene, and DNA repair gene were found to be differently regulated by treatment of Belotecan in HeLa cells. Among the DNA repair gene, RT-PCR reconfirmed the increased expression of CIB1(Calcium and intergrin binding 1), APEX1 (APEX nuclease 1) and the decresed expression of EXO1 (Exonuclease 1), WDR33 (WD repeat domain 33), and GADD45A (Growth arrest and DNA-damage-inducible, alpha). CONCLUSION: The first domestically introduced 1st line anti- tumor agent, Belotecan shows its excellent inhibiting action on cervical cancer cell proliferation by apoptotic pathway in this study. Also genetic alterations in cDNA microarray leads to the new fact that Belotecan, as a topoisomerase I inhibitor, is not only involved with apoptotic, cell cycle-related pathway but also involved in DNA repair.

Transcutaneous DNA immunization of HPV-16 E7 with hair-follicle specific promoter in mice / 대한산부인과학회지

OBJECTIVE: Previous reports have shown that transcutaneous immunization (TCI) with proteins or peptides in combination with adjuvants efficiently induces specific cellular and humoral immune responses. We compared the immune response after TCI with new construct which was derived from HPV-16 E7opt+K and pK6hf promoter instead of pCMV promoter and various adjuvant. METHODS: First, we made new construct ligated with HPV-16 E7 opt+K to Hair-follicle Specific pK6hf Promoter. Second, we applied pk6hf-E7 opt+K DNA with or without Lipofectamine 2000 and a combination of cholera toxin (CT) and CpG oligodeoxynucleotide (CpG) onto cold wax-depilated and hydrated bare skin of C57 BL/6 mice. To assess the ability of CTL(cytotoxic T-lymphocyte) activity, we performed intracellular cytokine staining with flow cytometric analysis to determine the number of E7-specific IFN-gamma- secreting CD8+ T cells generated in vaccinated mice with the DNA vaccine. RESULTS: Female C57BL/6 mice immunized by TCI methods with 30 microgram of pk6hf-E7 opt+K DNA with Lipofectamine2000 and CT efficiently generated E7-specific CD8(+) T cells compared with the group of pk6hf-E7 opt+K DNA only or DNA with Lipofectamine2000. CONCLUSION: Our results demonstrate that TCI of the linkaged-E7 DNA , E7 opt+K DNA to pk6hf, and Lipofectamine2000 and CT induced an antigen-specific CTL response. This result is of potential relevance for the development of therapeutic HPV-specific DNA vaccines with TCI and pK6hf promoter can be used safely.

Clinical Effects of Continuous Transabdominal Amnioinfusion in Preterm Premature Rupture of Membranes : Retrospective Study / 대한주산의학회잡지

OBJECTIVE : To assess the clinical role of continuous transabdominal amnioinfusion in pregnancies with preterm premature rupture of membranes (PPROM) less than 34 weeks of gestation. METHODS : In this retrospective study between January 1999 and December 2003, 76 singleton pregnancies complicated with PPROM less than 34+0 weeks of gestation, were included. Thirty-eight patients consented to undergo the continuous transabdominal amnioinfusion. The control group, matched with the amnioinfusion group by parity and gestational age at rupture of membranes, was managed expectantly. RESULTS : The median intervals from PPROM and delivery (latency period) (8.0+/-7.3 days vs. 1.7+/-2.5 days, p<0.001), the gestational age at delivery (223+/-17.8 days vs. 211+/-18.0 days, p=0.003) and the birth weight (1,853+/-465 g vs. 1,556+/-459 g, p=0.006) were significantly increased in the amnioinfusion group compared to the control group, respectively. In maternal complications, the amnioinfusion group showed higher rate of placental abruption (5.2% vs. 2.6%, p=0.556) than the control group, but were comparable in the rates of cesarean section (44.7% vs. 42.1%, p=0.817) and clinical chorioamnionitis (18.4% vs. 18.4%). The rate of neonatal ventilator care of positive pressure ventilation was significantly decreased in the amnioinfusion group, compared to the control group (15.8% vs. 50.0%, p=0.002). In neonatal morbidity, respiratory distress syndrome was more frequent in the control group compared to the amnioinfusion group, although it did not show statistical significance (34.2% vs. 15.8%, p=0.06). There were no significant differences in rates of Intraventricular hemorrhage (IVH) grade III, IV, neonatal sepsis and neonatal mortality between two groups. CONCLUSION : Our results suggest that, in pregnancies complicated with preterm premature rupture of membranes less than 34 weeks of gestation, the continuous transabdominal amnioinfusion might have improved the neonatal outcome without increasing the perinatal infection rate.

Prognostic outcome of patients with clinical stage I-II endometrial cancer according to bilateral salpino-oophorectomy / 대한산부인과학회지

OBJECTIVE: The aim of this study is to verify the clinical outcome of staging surgery with and (or) without bilateral salpingo-oophorectomy (BSO) in clinical stage I-II endometrial cancer patients. METHODS: We reviewed the medical records of 178 surgically treated patients in clinical stage I-II endometrial cancer between January 1994 and December 2004. Overall survival (OS) and disease free survival (DFS) were analyzed by using data gathered from the National Statistics Office. The clinical outcome was compared between patients who underwent hysterectomy with and without BSO. RESULTS: One hundred sixty patients were in clinical stage I, and 18 patients were in clinical stage II. Most of the cases showed endometrioid (93.8%) in histology and G1 (56.1%) in differentiation. BSO was performed in 142 patients. Surgico-pathological features of two group are not different but the group without BSO were younger (40.7 vs. 55.8 years old) and less myometrial invasion than the group with BSO. After mean 39.27 months follow up, we found no difference in OS and DFS between the two groups with BSO and without BSO. No factors except stage were significantly related with OS and DFS by multivariate Cox regression analysis. The rate of pelvic and paraaortic lymph node metastasis was not different between two groups. CONCLUSION: The retrospective data in the study reveals that staging surgery with and without BSO does not affect OS and DFS in clinical stage I-II endometrial cancer patients. In limited cases, such as young women, omitting BSO can be considered carefully.

A Case of Recurrent Aggressive Angiomyxoma of the Vulva / 대한산부인과학회지

Aggressive angiomyxoma (AAM) is an extremely uncommon neoplasm of the female genitalia. This tumor arises from soft tissue of the perineum, and affects predominantly young women. Although surgical excision with wide tumor-free margins may be necessary to obtain a complete cure, some of patients experience local recurrences because of the infiltrative nature of this tumor. We experienced a case of recurrent huge AAM on the right vulva in 29-year-old woman and reported it with a brief review of literature.

Clinical Characteristics of Urinary-Vaginal Fistulas After Various types of hysterectomy / 대한산부인과학회지

OBJECTIVE: We reviewed the frequency and characteristics of urinary-vaginal fistulas after various types of total hysterectomy. METHODS: We analyzed retrospectively 12 women with urinary-vaginal fistulas (10 vesicovaginal, 2 ureterovaginal) after total hysterectomy from January 1994 to December 2003. Hysterectomies included total abdominal hysterectomies (TAH), vaginal hysterectomies (TVH), laparoscopic hysterectomies (TLH), radical hysterectomies (RH), and cesarean hysterectomies (CH). The parameters that were analyzed included age, incidence with respect to the type of hysterectomy, past history, time of onset of the urine leakage and interval between leakage, corrective surgery, location of fistula, type of repair, and results. RESULTS: During the study period, 3,561 hysterectomies were carried out. TAH accounted for 68.9% of procedures, TVH for 14.4%, TLH for 11.6%, RH for 3.3%, and CH for 1.7%. The incidence of vesicovaginal and ureterovaginal fistula was 0.24% and 0% for TAH, 0.48% and 0.48% for TLH, 0.84% and 0% for RH, and 1.67% and 0% for CH, respectively. No fistula was developed after TVH. Urine leakages were developed 5 to 28 days (mean, 14.5 days) after hysterectomies and the intervals between urine leakage and corrective surgery were 7 to 28 days (mean, 16.3 days). The intervals between hysterectomy and corrective surgery were 21 to 54 days (mean, 34.6 days). Corrective surgeries (10 suprapubic transvesical repairs for vesicovaginal fistulas and 2 ureteroneocystostomies for ureterovaginal fistulas) were performed soon after establishment of diagnosis. There was no significant complication and recurrence of fistula after corrective surgery. CONCLUSION: The overall incidence of urinary-vaginal fistula was 0.3%, respectively. The fistulas were more frequently developed after CH than other types of hysterectomy. And the fistulas may be repaired definitively soon after diagnosis of the problem with good results.

Identification of TACC3 (Transforming Acidic Coiled-Coil 3) as a novel target of paclitaxel-mediated tumor therapy in cervical cancer cells / 부인종양

OBJECTIVE: Paclitaxel is currently used in the treatment of ovarian, breast, gastric, colorectal, lung and recurrent cervical cancer. Initial studies on the mechanism of action of paclitaxel have demonstrated that this drug alters microtubule assembly, by inhibiting microtubule depolymerization and changing microtubule dynamics. Although treatment of various tumor cells with paclitaxel induces apoptosis, but early paclitaxel-targeted proteins is not yet known. We tried to search paclitaxel-targeted proteins and to investigate its functions. METHODS: The effects of paclitaxel on HeLa cervical cancer cell growth were evaluated by cell proliferation assay, DAPI stain, and FACS analysis. We performed proteome analysis including 2-DE and MALDI-TOF-MS in nontreated-and paclitaxel-treated HeLa cells, as a result, we identified TACC3 protein that is down-regulated with paclitaxel treatment. We tried to characterize TACC3 functions through in vitro treatment of paclitaxel or RNAi technique. RESULTS: Paclitaxel- and TACC3 siRNA-treated cells are unable to proceed normally through the cell cycle and are arrested in G2/M phase and reveal apoptotic morphology. TACC3 levels after paclitaxel treatment decreased as a time- and dose- dependent manner both mRNA and protein levels. We confirmed that the role of TACC3 down-regulation for microtubule stabilization was similar to that of paclitaxel. Also, TACC3 is expressed at high levels in various cancer cells and tumor tissues. CONCLUSION: This study is proposed that the TACC3 protein may be participated in microtubule formation as an oncoprotein during mitosis and be regulated by paclitaxel as a novel target.

Transcutaneous DNA vaccination increase the CTL response: Preliminary results for the therapeutic HPV DNA vaccination / 부인종양

OBJECTIVE: Transcutaneous immunization (TCI) is a novel vaccination based on the application onto bare skin. We compared the immune response after TCI with the model DNA (OVALBUMIN) to HPV E7 and various adjuvant with intramuscular injection. We investigated the efficacy of immunization with new construct driven by K6hf promoter and compared with CMV promoter. METHODS: First, we make new construct ligated with OVA to Hair-follicle Specific pK6hf Promoter and evaluated the expression. Mouse skin was transfected with pCMV-OVA, pK6hf-OVA, pCMV-beta gal and pK6hf-beta gal and expression was determined by RT-PCR and X-Gal staining. OVA protein expression was analyzed by Western blot. Second, we immunized C57/ BL6 mice with pCMV-OVA or pK6hf-OVA DNA and cholera toxin (CT) and/or CpG. CTL was measured by ELISPOT assay of the splenocytes from the mmunized mice with the DNA vaccine. RESULTS: The beta-Galactosidase activity by X-Gal staining was detected in the epithelium of the mice skin after pK6hf-beta gal application. The mRNA and protein expression from pK6hf-OVA were evident following transcutaneous methods. Those were weaker than pCMV-OVA. TCI with pCMV-OVA and LipofectAMINE 2000 trigered an speicific CTL and Th2 response. CpG was the adjuvant for CTL after pCMV-OVA. CT and CpG did increase the CTL after pK6hf-OVA. CONCLUSION: Our data demonstrate that TCI of DNA is possible methods of CTL. CpG and CT were useful in the adjuvant for CTL. The pK6hf-OVA can induce specific CTL. This result is of potential relevance for the development of therapeutic HPV- specific DNA vaccines with TCI and pK6hf promoter can be used safely.

Expression of E-cadherin and Catenin (alpha-, beta-catenin) in Endometrial Cancer and Atypical Complex Endometrial Hyperplasia / 대한산부인과학회지

OBJECTIVE: To evaluate the correlation of the expression of E-cadherin, alpha-catenin, beta-catenin and the clinicopathological features in endometrial cancer (EC) and atypical complex endometrial hyperplasia (ACEH). METHODS: Immunohistochemical (IHC) staining of E-cadherin, alpha-catenin, beta-catenin was performed in tissues of 6 ACEHs, 44 endometrioid ECs. We analyzed the correlation of the expression of IHC staining with the prognostic factors according to tumor stage of ACEH and EC, histopathologic grade, and myometrial invasion. RESULTS: According to tumor stage, reduced E-cadherin expression and abnormal alpha-catenin expression were observed more frequently in advanced stage (reduced E-cadherin: ACEH 0%, stage I-II 47.2%, stage III-IV 62.5%, p=0.050; abnormal alpha-catenin: ACEH 0%, stage I-II 27.8%, stage III-IV 62.5%, p=0.035). All of the IHC staining showed no correlation with the depth of myometrial invasion but showed correlation with presence of myometrial invasion (reduced E-cadherin: invasion(-) 14.3%, invasion(+) 66.7%, p =0.001; abnormal alpha-catenin: invasion(-) 7.1%, invasion (+) 46.0%, p=0.010; abnormal beta-catenin: invasion(-) 7.1%, invasion(+) 63.0%, p=0.000). According to histological differentiation only abnormal beta-catenin expression shows relationship with histopathologic grade (grade 1:23.1%, grade 2:60%, grade 3:62.5%, p=0.039). CONCLUSION: Expression of E-cadherin and alpha-catenin showed significantly more reduced expression in EC than in ACEH, and more reduced expression in advanced stage, myometrial invasion and high histopathologic grade. And alpha-catenin showed more frequent abnormal expression in advanced stage, myometrial invasion and beta-catenin showed more frequent in myometrial invasion, high histopathologic grade significantly. These results suggests that the expression of E-cadherin and alpha-catenin, beta-catenin in EC and ACEH could be related to prognosis of the tumor.

Incidence and clinical course of HELLP syndrome in pregnant women / 대한내과학회지

BACKGROUND: Although HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is a serious medical complications including coagulopathy, hypertension, hepatic and renal failures, and pulmonary edema in pregnant women, the data about HELLP syndrome were rarely reported in the medical journal in Korea. METHODS: Nineteen cases of HELLP syndrome were retrospectively studied out of 16,910 pregnant women from January 1998 to March 2004 at Uijongbu St. Mary's Hospital. We analyzed incidence, clinical symptoms, laboratory findings, maternal and clinical complications and clinical course of HELLP syndrome. RESULTS: The incidence of HELLP syndrome was 0.27% (19/16,910) in total pregnant women and 4.15% (19/458) in women with preeclampsia. All patients had evidence of hemolysis and serum aspartate aminotransferase level >or= 70 IU/L, and platelet counts

Umbilical Cord Arterial Blood pH Analysis at Term Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to assess the gestational age adjusted values of umbilical cord arterial blood pH in term pregnancy with normal Apgar score. METHODS: We performed in attempt to compare umbilical arterial blood pH values for in term 757 singleton pregnancy, immediately after delivery of live-born infants delivery, with normal 1 and 5 minutes Apgar score. They were divided into 380 cases of normal full term vaginal delivery without any complication and 377 cases of elective cesarean section with normal fetal heart rate tracing. We determined gestational age, parity, Apgar score. RESULTS: There was a significant decline correlation between gestational age and umbilical artery pH (P=0.018). In acidemia, the odds ratio was increasing from 37 weeks to 41 weeks but there was no association between normal Apgar score and pH less than 7.10 with increasing gestational age. We evaluated the umbilical artery pH level in different delivery mode. In uncomplicated normal vaginal delivery, negative significant correlation was found (P=0.022), and elective cesarean section case did not show a statistically significant level. CONCLUSION: Our data suggested that umbilical artery pH has a negative relation with gestational age during term period.

Labor Induction at Term with Different Regimens of Misoprostol / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the efficacy and the safety of two different dose regimens of intravaginal misoprostol for labor induction. METHODS: Sixty-seven consenting women with maternal or fetal indication for labor and no prior cesarean delivery were randomly assigned to receive either vaginal misoprostol 100 microgram or 50 microgram every 4 hours with maximum 6 doses. Uterine contraction, abnormal fetal heart rate pattern, mean time from induction to vaginal delivery, apgar score, and meconium staining were compaired. RESULTS: In two groups, dermographic characteristics and the average number of doses of misoprostol used were simliar. The group who were administered 100 ug misprostol showed shorter average time interval from induction to delivery. Both groups showed similiar result in terms of tachysystole, abnormal fetal heart rate tracing, meconium passage, fetal weight, low 1-min and 5-min Apgar scores, and admission to the neonatal intensive care unit. CONCLUSION: The optimal misoprostol dose to induce labor in term pregnant women has not been established. We also could not find any difference between two groups (100 microgram or 50 microgram every 4 hours) in time interval from induction to delivery and neonatal outcomes.

A Case of Ruptured Cornual Pregnancy in Adenomyosis Uterus at 29 Weeks' Gestation / 대한산부인과학회잡지

A case of ruptured cornual pregnancy in adenomyosis uterus at 29 weeks' gestation is presented here. A cornual pregnancy occurs when the conceptus implants at the junction between the tube and the uterus rather than in main part of uterine cavity. It is relatively rare entity, but the rich vascularity of the uterus in this location makes rupture particularly dangerous. resulting in higher maternal mortality. The presented case was unique in continuing till the third trimester of pregnancy. We present a case of a ruptured cornual pregnancy in adenomyosis uterus at the third trimester of pregnancy with a brief review of literatures.