Knowledge and Acceptability about Adult Pertussis Immunization in Korean Women of Childbearing Age

PURPOSE: The adult tetanus, reduced diphtheria, and acellular pertussis (Tdap) vaccine has been introduced in order to provide individual protection and reduce the risk of transmitting pertussis to infants. We assessed the knowledge and acceptability of the Tdap vaccine around pregnancy. MATERIALS AND METHODS: This study was a cross-sectional survey of women of childbearing age (20-45 years) who visited obstetrics and gynecologic units of primary, secondary, or tertiary hospitals. They were asked to fill in a questionnaire assessing their knowledge, attitudes, and acceptability of Tdap. RESULTS: The questionnaire was completed by 308 women; 293 (95.1%) had not received information from doctors about Tdap, and 250 (81.2%) did not know about the need for vaccination. A significantly important factor related to subjects' intention to be vaccinated, identified by stepwise multiple logistic regression, was the knowledge (OR 13.5, CI 3.92-46.33) that adult Tdap is effective in preventing pertussis for infants aged 0-6 months. Additionally, 276 (89.6%) considered the recommendation of obstetric doctors as the most influencing factor about Tdap vaccination. CONCLUSION: In Korea, most women of childbearing age seem to be neither recommended nor adequately informed about the vaccination, although our population was not a nationwide representative sample. Information given by healthcare workers may be critical for improving awareness and preventing pertussis.

Knowledge, attitudes, and acceptability about influenza vaccination in Korean women of childbearing age

OBJECTIVE: The aims of the present study were to investigate the women's perspective on influenza infection and vaccination and to evaluate how they influence vaccine acceptability, in Korean women of childbearing age. METHODS: This was a prospective study by random survey of women of childbearing age (20 to 45 years). They were asked to complete a questionnaire assessing their knowledge, attitudes and acceptability of influenza vaccination before and during pregnancy. This study utilized data from the Korea National Health and Nutrition Examination Survey (KNHANES) between 2008 and 2012, to analyze the recent influenza vaccination trends. RESULTS: According to KNHANES (2008-2012), influenza vaccination rates in women of childbearing age have increased up to 26.4%, after 2009. The questionnaire was completed by 308 women. Vaccination rate during pregnancy or planning a pregnancy was 38.6%. The immunization rate increased significantly with the mean number of correct answers (P<0.001). Women who received influenza vaccination were more likely to be previously informed of the recommendations concerning the influenza vaccination before or during pregnancy, received the influenza vaccination in the past, and of the opinion that influenza vaccination is not dangerous during pregnancy, with odds ratios of 14.6 (95% confidence interval [CI], 6.44 to 33.33; P<0.0001), 3.6 (95% CI, 1.84 to 6.97; P=0.0002) and 2.7 (95% CI, 1.34 to 5.47; P=0.0057). CONCLUSION: Influenza vaccination rate in women of childbearing age has increased in this study and national data. More information and recommendation by healthcare workers, especially obstetricians, including safety of vaccination, might be critical for improving vaccination rate in women of childbearing age.

Leg Weakness Caused by Bilateral Piriformis Syndrome: A Case Report

Piriformis syndrome (PS) is an uncommon neuromuscular disorder caused by the piriformis muscle (PM) compressing the sciatic nerve (SN). The main symptom of PS is sciatica, which worsens with certain triggering conditions. Because the pathophysiology is poorly understood, there are no definite diagnostic and therapeutic choices for PS. This case report presents a young woman who mainly complained of bilateral leg weakness. Electromyography revealed bilateral sciatic neuropathy and magnetic resonance imaging confirmed structural lesions causing entrapment of the bilateral SNs. After a laborious diagnosis of bilateral PS, she underwent PM releasing surgery. Few PS cases present with bilateral symptoms and leg weakness. Therefore, in such cases, a high level of suspicion is necessary for accurate and prompt diagnosis and treatment.

Effectiveness of sacrospinous colpopexy in vault prolapse patients / 대한산부인과학회지

OBJECTIVE: To evaluate the effectiveness of sacrospinous colpopexy in vault prolapse patients. METHODS: It is the retrospective study including 10 vault prolapse patients who received sacrospinous colpopexy at St. Paul Hospital, the Catholic University from July 1999 to April 2004. RESULTS: The 10 patients receiving sacrospinous colpopexy had the average age of 58.9 years, and the parity of 3.4. They were moderately overweighted with average BMI of 24.5. The average period from hysterectomy to diagnosis of vault prolapse was 11.1 years. Hypertension was noted on most of patients (70.0%). The average operation time was 68.5 minutes and postoperative hemoglobin decrement was 2.4 on average. During 2-month period of postoperative follow-up, there were no significant complications noted except one case of wound infection associated with diabetes and one case of transfusion due to anemia. After sacrospinous colpopexy, protruding mass out of vagina was resolved on 100% and urologic and other complications were improved over 50% of cases. CONCLUSION: Considering that several underlying medical conditions such as hypertension, obesity are associated with vault prolapse patients, sacrospinous colpopexy in case of vault prolapse is an excellent operative approach with low complication and recurrence rates.

Cytogenetic Analysis in 3,503 Cases of Midtrimester Amniocentesis: CUMC Experience (II) / 대한산부인과학회잡지

OBJECTIVE: To analyze chromosomal abnormalities according to patient's age and indications of patients in midtrimester amniocentesis for prenatal genetic diagnosis. METHODS: We retrospectively analyzed 3,503 cases of midtrimester prenatal genetic amniocentesis cases which were done in the cytogenetic laboratory at Kangnam St. Mary's Hospital, Catholic University Medical College. RESULTS: In 3,503 cases, the most common maternal and gestational age distributions were 35 to 39 years old and 17 to 17 week 6 days (32.2% and 21.5%, respectively). Abnormal maternal serum markers was the most common indication for amniocentesis (46.4%), and followed by advanced maternal age (40.3%) and abnormal ultrasonographic findings (3.2%). The overall incidence of chromosomal abnormalities was 180 cases (5.1%), of which numerical abnormalities and structural abnormalities were 78 cases (2.2%) and 102 cases (2.9%), respectively. Among the autosomal abnormalities, Down syndrome was most common (33 cases, 0.9%), and followed by Edward syndrome (17 cases, 0.5%). Among the sex chromosomal abnormalities, 45,X was the most common (6 cases, 0.2%). Chromosomal abnormalities were most frequently noted in the maternal age 18-19 years old (14.3%), 40 to 44 years old (7.0%), 25 to 29 years old (6.1%), 30 to 34 years old (5.2%), and followed by 20 to 24 years old (4.1%). On the other hand, chromosomal abnormalities were most frequently noted in abnormal ultrasonographic findings (12.4%), previous history of aneuploidy (8.3%), and followed by family history of aneuploidy (7.0%). CONCLUSION: This study suggested that although advanced maternal age is still important indication in midtrimester amniocentesis for prenatal diagnosis, abnormal maternal serum markers and ultrasonographic findings might be also important as indications. Therefore, they should be considered in prenatal genetic counseling.

Analysis of Mycoplasma Hominis and Ureaplasma Urealyticum Infection in Preterm Labor and PROM Patients / 대한산부인과학회잡지

OBJECTIVE: To investigate the infection rate and clinical importance of Mycoplasma hominis (M. hominis) in comparison with Ureaplasma urealyticum (U. urealyticum) in association with preterm labor and preterm rupture of membranes. METHODS: We included 57 women with preterm labor or preterm rupture of membranes admitted at Kangnam St. Mary Hospital, University of Catholic, from March 2002 to April 2003. Mycoscreen kit (Mycoscreen, international microbio, Paris, France) was used for culture of all specimens. Statistical analysis was done by chi-square test (SPSS). RESULTS: The study subjects included 57 women, 15 of premature rupture of membranes (PROM), 16 of preterm prematurely rupture of membranes (PPROM), and 36 of preterm labor. There were 4 women infected by both M. hominis and U. urealyticum, 21 with single infection by M. hominis, 9 with single infection by U. urealyticum, and 23 with negative results from Mycoscreen test. M. hominis infection was noted on 6 of 15 PROM, 5 of 16 PPROM and 2 of 36 preterm labor. And thus, infection by M. hominis is statistically significant in preterm rupture of membranes group in comparison with preterm group (p=0.038). Among 15 cases with leukocytosis on the Gram stain, 2 cases resulted in bacterial growth on the culture. Therefore, leukocytosis on the Gram stain does not show the infection with M. hominis and U. urealyticum. CONCLUSION: Mycoplasma screening in prenatal care provides the predictable information on preterm labor or low birth weight, and could be useful in predicting preterm rupture of membranes. It is thought that further studies are needed with a large number of samples.

Analysis of Mycoplasma Hominis and Ureaplasma Urealyticum Infection in Preterm Labor and PROM Patients / 대한산부인과학회잡지

OBJECTIVE: To investigate the infection rate and clinical importance of Mycoplasma hominis (M. hominis) in comparison with Ureaplasma urealyticum (U. urealyticum) in association with preterm labor and preterm rupture of membranes. METHODS: We included 57 women with preterm labor or preterm rupture of membranes admitted at Kangnam St. Mary Hospital, University of Catholic, from March 2002 to April 2003. Mycoscreen kit (Mycoscreen, international microbio, Paris, France) was used for culture of all specimens. Statistical analysis was done by chi-square test (SPSS). RESULTS: The study subjects included 57 women, 15 of premature rupture of membranes (PROM), 16 of preterm prematurely rupture of membranes (PPROM), and 36 of preterm labor. There were 4 women infected by both M. hominis and U. urealyticum, 21 with single infection by M. hominis, 9 with single infection by U. urealyticum, and 23 with negative results from Mycoscreen test. M. hominis infection was noted on 6 of 15 PROM, 5 of 16 PPROM and 2 of 36 preterm labor. And thus, infection by M. hominis is statistically significant in preterm rupture of membranes group in comparison with preterm group (p=0.038). Among 15 cases with leukocytosis on the Gram stain, 2 cases resulted in bacterial growth on the culture. Therefore, leukocytosis on the Gram stain does not show the infection with M. hominis and U. urealyticum. CONCLUSION: Mycoplasma screening in prenatal care provides the predictable information on preterm labor or low birth weight, and could be useful in predicting preterm rupture of membranes. It is thought that further studies are needed with a large number of samples.

Influence of Hypoxia on Vascular Endothelial Growth Factor and Basic Fibroblast Growth Factor in Cultured Human Trophoblast / 대한산부인과학회잡지

OBJECTIVE: To investigate whether the hypoxic condition influences on the expression of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) mRNA in the cultured human trophoblast. METHODS: Trophoblasts were isolated from the normal placenta in early pregnancy (6-10 weeks in gestation). Isolated trophoblasts were cultured under normoxic (5% CO2, 95% humid air in incubator) and hypoxic (MERCK, 1% O2, 99% CO2) conditions for 24, 48 and 72 hours, respectively. Total RNA was extracted from the cultured trophoblasts in each culture condition. The expressions of VEGF and bFGF mRNA were determined by reverse transcription-polymerase chain reaction (RT-PCR) and Northern blot analysis. RESULTS: The expression of VEGF189 mRNA was significantly increased in the hypoxic condition compared to the normoxic condition and control after 24 hours (p<0.05, p<0.05, respectively). The expression of VEGF206 mRNA was also significantly increased in the hypoxic condition compared to the normoxic condition and control after 48 hours (p<0.05, p<0.05, respectively). However, there was no significant difference between the normoxic and hypoxic conditions in the expression of VEGF121 and VEGF165 mRNA. The expression of bFGF mRNA was significantly increased in the hypoxic condition compared to the normoxic condition and control at 24 hours and 48 hours (p<0.05, p<0.05, respectively). bFGF mRNA was more expressed than VEGF mRNA in the hypoxic condition. CONCLUSION: These findings suggest that the hypoxic condition may stimulates the expression of bFGF and VEGF mRNA, and besides bFGF may be a more potent inducer of angiogenesis rather than VEGF in early human gestation.

ATP and Adenosine Induce Growth Inhibition and Apoptosis in Human Trophoblast-like (TL) Cell Line / 대한산부인과학회잡지

BACKGROUND: Although nucleotides -like Adenosine Triphosphate (ATP) and its derivatives Adenosine, were known to induce growth inhibition and apoptosis in diverse cell lines, little is known about their effects on trophoblast. OBJECTIVE: To elucidate the effects of extracellular ATP and adenosine on trophoblast cell growth and to delineate if apoptosis is involved in this mechanism. MATERIALS AND METHODS: We used TL cell line, derived from human term placenta. The cells were cultured for 24, 48, and 72 hours after being treated with ATP and adenosine, each. Also, cell growth according to different concentrations of ATP and adenosine was evaluated. To test whether apoptosis was induced by each nucleotide, DNA fragmentation and nuclear condensation by Hoechst 33258 stain and P53 protein expression were evaluated. RESULTS: Cell growth was inhibited by ATP and adenosine in time and dose-dependent manner. Furthermore, the growth inhibitory effect of adenosine was stronger than ATP, whereas signs of DNA fragmentation and nuclear condensation were observed in ATP treated cells, but not in adenosine treated ones. CONCLUSION: Our results shows that ATP and adenosine exert inhibitory effect on growth in TL cell line. These findings suggest that pathological production of ATP or its metabolites, adenosine, may lead to a pathologic status such as preeclampsia or intrauterine growth restriction.

Clinical Analysis of Ovarian Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The frequency of ectopic pregnancy has been recently increased by various causes. Especially in ovarian pregnancy, definitive preoperative diagnostic criteria have not been established. This study is aimed to focus on helpful clinical characterstics which can later on serve as diagnostic key points in case of suspicious ovarian pregnancy. METHODS: The study included 23 patients pathologically diagnosed with ovarian pregnancy from January 1991 to December 2002 in Kangnam St. Mary Hospital. We analyzed the age at diagnosis, pregnancy and delivery history, presence of underlying disease, clinical symptoms, therapeutic methods, human chorionic gonadotropin level, and sonographic findings for these patients. RESULTS: The average age at diagnosis was 31.6 year and 39.1% of the patients were older than the age of 35. More than half of the patients had the history of multiple pregnancy (52.2%). The common clinical symptoms were lower abdominal pain (95.6%) and vaginal bleeding (21.8%). Ipsilateral ovarian wedge resection was performed at the most frequent rate (78.3%) and ipsilateral adnexectomy was done at second most frequent rate (21.7%). HCG level was measured on 19 cases showing various individual difference. Most common sonographic findings included the fluid stasis surrounding the ovarian pregnancy lesions and ipsilateral ovary enlargement (91.3%). CONCLUSION: This study showed that ovarian pregnancy should be suspected in young woman. Of the age between 25 and 30 years, with symptom of lower abdominal pain, nulliparity, havior history of pelvic adhesion, pelvic inflammation, and showing sonographic findings of fluid collection around ovary or enlarged ovary.

A Case of Prenatally Diagnosed Fetal Unilateral Renal Agenesis with Contralateral Renal Hypoplasia / 대한산부인과학회잡지

Renal agenesis is a disorder characterized by the congenital absence of one or both kidneys due to complete failure of the kidney to form. The syndrome of renal agenesis is severe oligohydramnios, amnion nodosum, flattened face, low-set and floppy ears, and bilateral pulmonary hypoplasia. Bilateral renal agenesis occurs in 0.1 to 0.3 per 1000 births and unilateral involvement occurs in 1 in 500 to 1 in 1300 live births.1,2 Bilateral renal agenesis is an invariably lethal condition, and is associated in more than half of the affected individuals with malformations of the genitourinary tract, cardiovascular system, vertebral bodies or imperforated anus.2 Accurate diagnosis in the mid-trimester permits the parents to allow elective termination. However, the nearly absent amniotic fluid makes an accurate assessment of fetal kidney difficult. We present a case of unilateral renal agenesis with contralateral renal hypoplasia, diagnosed by ultrasonography after amnioinfusion at 21 weeks gestation.

A Case of Prenatally Diagnosed Fetal Retroperitoneal Cystic Lymphangioma / 대한산부인과학회잡지

Lymphangiomas are congenital malformations of lymphatic vessels that have the potential to infiltrate surrounding structures. In 95% of cases, they are located in the neck (cystic hygroma), head and axilla. But they can occur in a variety of anatomical locations, such as the abdominal cavity, extremities and urinary bladder. Pathologically they can be classified into three group: lymphangioma simplex; carvenous lymphangioma; and cystic lymphangiomas or hygromas. Mixed lesions may coexist in different areas of the same lymphangioma. Although these lesions are benign, they have a propensity for rapid growth and invasion into the underlying muscles and connective tissues. A extensive mass can compress adjacent vital organs, which determines the severity of the lesion. Accurate prenatal diagnosis and anatomical evaluation are important as they permit planned delivery and prompt postnatal resuscitation, and allow the option of terminating the pregnancy if a poor outcome is predicted. Prenatal MRI can confirm ultrasonographic findings, provide detailed fetal anatomical evaluation, and demonstrate the extent and character of lymphangiomas. We present a case of a huge retroperitoneal cystic lymphangioma diagnosed prenatally using ultrasound and MRI at 26 weeks gestation.

Diffuse Large B-cell Lymphoma Successfully Treated in a Pregnant Patient / 대한산부인과학회잡지

The concurrence of lymphoma with pregnancy has been rare but is most commonly associated with an aggressive histology and disseminated disease. Thus, extensive staging is required, and either local radiotherapy or systemic chemotherapy is indicated as soon as possible. We have experienced a case of diffuse, large B-cell lymphoma, stage III2 diagnosed at 31 weeks of gestational age. During pregnancy period, CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy was performed and complete remission of disease was attained. The infant was successfully delivered at 34 weeks in gestation without any gross anomaly or combined disease. We report a case of diffuse large B-cell lymphoma successfully treated with combination chemotherapy during pregnancy and a brief review of the literatures.

Successful Delivery In Women With Advanced Liver Cirrhosis: Report Of 3 Cases / 대한산부인과학회잡지

There is high prevalence of HBV infection in Asian countries including South Korea. In fact, 8% of Koreans are HBV carriers, and 20-25% of them progress to liver cirrhosis. Liver cirrhosis, known to be the last stage of chronic liver diseases, is the most prominent cause of death in Korean males in their forties. However, women participation to social activities increased and also increased psychological stress that changed life style now days, and due to increased alcohol consumption liver disease has become a serious problem in korean women population. But as liver cirrhosis usually occurs after the menopause, and decreased fertility in cirrhotic patients, pregnancy in women with liver cirrhosis is rare. However, improved general care increased pregnancy rates and reports of pregnancy in women with liver disease worldwide. Studies on the effect of liver cirrhosis on pregnancy and the effect of pregnancy on the clinical progression of liver cirrhosis have not been well established, and the continuation of pregnancy in a patient with liver cirrhosis has been controversial. Recently, it has become favorable for the argument that pregnancy can be kept as long as liver function is maintained at certain level and portal hypertension is mild. The most common and fatal maternal complication is gastrointestinal hemorrhage. It increases maternal mortality and intrauterine developmental defect resulting in neonatal morbidity. Although South Korea is an area of high prevalence of HBV infection, there are few reports of pregnancies in women with liver cirrhosis. Recently, we have experienced the 3 cases of pregnancies in women with progressive liver cirrhosis who became pregnant. Although thrombocytopenia and increased coagulopathy complicated the pregnancy course, all women delivered healthy babies and were discharged in good condition.

Successful Delivery In Women With Advanced Liver Cirrhosis: Report Of 3 Cases / 대한산부인과학회잡지

There is high prevalence of HBV infection in Asian countries including South Korea. In fact, 8% of Koreans are HBV carriers, and 20-25% of them progress to liver cirrhosis. Liver cirrhosis, known to be the last stage of chronic liver diseases, is the most prominent cause of death in Korean males in their forties. However, women participation to social activities increased and also increased psychological stress that changed life style now days, and due to increased alcohol consumption liver disease has become a serious problem in korean women population. But as liver cirrhosis usually occurs after the menopause, and decreased fertility in cirrhotic patients, pregnancy in women with liver cirrhosis is rare. However, improved general care increased pregnancy rates and reports of pregnancy in women with liver disease worldwide. Studies on the effect of liver cirrhosis on pregnancy and the effect of pregnancy on the clinical progression of liver cirrhosis have not been well established, and the continuation of pregnancy in a patient with liver cirrhosis has been controversial. Recently, it has become favorable for the argument that pregnancy can be kept as long as liver function is maintained at certain level and portal hypertension is mild. The most common and fatal maternal complication is gastrointestinal hemorrhage. It increases maternal mortality and intrauterine developmental defect resulting in neonatal morbidity. Although South Korea is an area of high prevalence of HBV infection, there are few reports of pregnancies in women with liver cirrhosis. Recently, we have experienced the 3 cases of pregnancies in women with progressive liver cirrhosis who became pregnant. Although thrombocytopenia and increased coagulopathy complicated the pregnancy course, all women delivered healthy babies and were discharged in good condition.

A case of false positive amniotic acetylcholinesterase in a normal pregnancy / 대한산부인과학회잡지

Maternal serum alpha-fetoprotein (AFP) has been used for a long time for the prenatal diagnosis of neural tube defects in women at midtrimester of gestation. But AFP is elevated not only in cases of neural tube defects, but also in fetus with congenital nephrosis, abdominal wall defects, fetal demise, low birth weight or simply erroneously calculated gestational age. So, when maternal serum AFP is increased, gestational age of the fetus must be re-evaluated and targeted ultrasonographic evaluation is indicated to rule out neural tube defects. If NTDs are suspected or ultrasound is non-diagnostic, amniotic fluid AFP are measured and when AF-AFP is elevated, the presence or absence of acetylcholinesterase should be evaluated. The detection rate of open neural tube defects using amniotic acetylcholiesterase is reported to be as high as 96 to 99% with a 0.06% and 0.14% of false positive rate in amniotic fluids non-contaminated and contaminated by blood, respectively. We report a case with elevated mid-trimester MS-AFP, AF-AFP and positive amniotic acetylcholin-esterase, but in which repeated sonographic findings were normal, and result in delivery of a heathy baby without anomalies.

A case of false positive amniotic acetylcholinesterase in a normal pregnancy / 대한산부인과학회잡지

Maternal serum alpha-fetoprotein (AFP) has been used for a long time for the prenatal diagnosis of neural tube defects in women at midtrimester of gestation. But AFP is elevated not only in cases of neural tube defects, but also in fetus with congenital nephrosis, abdominal wall defects, fetal demise, low birth weight or simply erroneously calculated gestational age. So, when maternal serum AFP is increased, gestational age of the fetus must be re-evaluated and targeted ultrasonographic evaluation is indicated to rule out neural tube defects. If NTDs are suspected or ultrasound is non-diagnostic, amniotic fluid AFP are measured and when AF-AFP is elevated, the presence or absence of acetylcholinesterase should be evaluated. The detection rate of open neural tube defects using amniotic acetylcholiesterase is reported to be as high as 96 to 99% with a 0.06% and 0.14% of false positive rate in amniotic fluids non-contaminated and contaminated by blood, respectively. We report a case with elevated mid-trimester MS-AFP, AF-AFP and positive amniotic acetylcholin-esterase, but in which repeated sonographic findings were normal, and result in delivery of a heathy baby without anomalies.

The clinical efficacy and cost-effectiveness of Lamellar body count in fetal lung maturation test / 대한산부인과학회잡지

OBJECTIVE: To evaluate the availability and efficacy of the Lamellar body count as a predictor of fetal lung maturity METHODS: Amniocentesis was performed for evaluation of fetal lung maturity status within 72 hours of delivery in 32 patients. A Lamellar body count in clean amniotic fluid (AF) was analyzed right after amniocentesis. In case of contaminated AF with meconium or blood, samples was centrifuged for 3 minutes and divided into three. The average of three samples was analyzed successively from Coulter counter. RESULTS: The incidence of RDS showed significant relation with gestational age, 1-minute and 5-minute Apgar Score. Using a value greater than 30,000/ l to indicate pulmonary maturity, the Lamellar body count predicted all lung-maturated cases with no false-negative results (100% negative predictive value). All 4 cases of RDS demonstrated Lamellar body count less than 30,000/microl. By using a lower cutoff of 10,000/microl to predict pulmonary immaturity. Positive predictive value was 100% in RDS patients. CONCLUSION: In high risk pregnancy, fetal lung maturity test from amniotic fluid lamellar body count is a rapid, simple and reliable method in making a decision of delivery-time. And also it has universal availability with cost-effectiveness when we consider the reality of korean medical situation

A Case of Twin Pregnancy with One Anencephalic Fetus / 대한산부인과학회잡지

Congenital anomalies occur in 2-3% of neonates but this incidence increases in multiple pregnancies, especially when fetuses are monozygotic. when pregnancies are affected with one anomalous fetus combined to a normal one, the proper management and counseling is difficult.We experienced a twin pregnancy in which one anencephalic fetus was combined to a normal one. Karyotype analysis was normal in both fetus. After close counseling we decided to continue the pregnancy. Intermittent amnioreduction was done for persistent polyhydramnios. At 29 weeks of gestation membrane was ruptured prematurely and we delivered by cesarean section due to breech-cephalic presentation. The birth weight of the normal and anencephalic fetuses were 1070 gm and 1050 gm, respectively. The anencephalic fetus died immediately after birth but the healthy one showed good crying and movement and its Apgar score was 6 in 1 minute and 8 in 5 minute. Although the infant needed intensive care for 90 days in the nursery room finally discharged in good condition. We report a case of twin pregnancy in which anencephaly was associated with a normal fetus, so after close counseling we opted to continue the pregnancy resulting in the delivery of a viable fetus.

Role of nitric oxide and interleukin-1beta on expression of matrix metalloproteinase-2 in TL cell line / 대한산부인과학회잡지

OBJECTIVE: We studied to investigate whether nitric oxide (NO) and IL-1beta modulate MMP-2 and MMP-9 using TL cell line obtained from the normal term placenta. METHODS: After culturing TL cell line for 4 hours, we treated 0.1 mM of SNAP (NO donor) and 50 ng/ml of IL-1beta for 0, 1, 3, 6, and 12 hours, for investigating changes from time. We treated SNAP of 0, 0.01, 0.1, and 0.5 mM for 12 hours and IL-1beta of 0, 1, 10, and 50 ng/ml, for investigating changes from concentration. After extraction of total RNA, we performed reverse transcriptase-polymerase chain reaction (RT-PCR), gelatine zymography and Western blot analysis, for investigating expression of MMP-2 and MMP-9. RESULTS: MMP-9 was not observed in TL cell line. The expressions of MMP-2 mRNA and protein were gradually increased according to the culture time in SNAP treated group. The expressions of MMP-2 mRNA and protein were gradually increased according to the culture time in IL-1beta treated group. The expression of MMP-2 protein was not more increase in SNAP/IL-1beta-treated group than in IL-1beta treated group. The expression of MMP-2 protein was more reduced in SNAP/hemoglobin treated group than in SNAP treated group. MMP-2 protein activity was only increase in SNAP treated group. CONCLUSION: These results indicate that NO, rather than IL-1beta, upregulates the MMP-2 in TL cell line and furthermore may influence in the invasive process of trophoblasts.