Successful pregnancy and delivery of a patient with congenital adrenal hyperplasia

Congenital adrenal hyperplasia (CAH) during pregnancy is a rare condition. Only a few cases have been reported in the literature. CAH patients has lower pregnancy rate compared to normal women. A 27-year-old nulliparous woman, a diagnosed case of 21-hydroxylase deficient simple virilising form of classic CAH visited. She got pregnant spontaneously without any trial of assisted reproductive technology. At the age of 12, she underwent clitoral resection and vaginoplasty. She took dexamethasone or prednisolone after operation. She delivered healthy singleton female baby by cesarean section. Four years later, she delivered healthy singleton female baby by repeat cesarean section. Two female babies have shown normal external genitalia. Here, we report a case of successful pregnancy and delivery in a patient with CAH.

Oxidative Stress Markers in the Venous Plasma of Women with Preterm Labor and Preterm Premature Rupture of Membranes / 대한주산의학회잡지

PURPOSE: This study was performed to investigate the oxidation and antioxidation capacity in the maternal venous plasma of preterm labor with intact membranes, and premature rupture of membranes (PPROM), and also to evaluate their roles in the pathophysiology of PPROM. METHODS: Seventy five women in the following categories had venous blood retrieved: (1) Group A, normal pregnancy (n=24). (2) Group B, preterm labor with intact membranes (n=25). (3) Group C, preterm premature rupture of membranes (n=26). Malondialdehyde (MDA) levels as a marker of lipid peroxidation by thiobarbituric acid reaction, protein carbonyl content by 2,4-dinitrophenylhydrazine reaction, and total antioxidant capacity by oxygen radical absorbance capacity assay (ORAC) were measured. Mann-Whitney U test, Kruskal-Wallis test were used for statistical analysis. RESULTS: Lipid peroxide levels in the venous plasma of group B and C were significantly higher than those of group A (group B: 4.59+/-0.30, group C: 5.40+/-0.22 vs. group A: 3.90+/-0.26 nmol/mg protein, P<0.05). Lipid peroxide levels in the venous plasma of group C were significantly higher than those of group B (P<0.05). Protein carbonyl levels in the venous plasma of group C were significantly higher than those of group A (group C: 5.68+/-0.42 vs. group A: 5.43+/-0.41 nmol/mg protein, P<0.05). There was no significant difference of protein carbonyl levels in the venous plasma between group A and B. ORAC levels in the venous plasma of group B and C were significantly lower than those of group A (group B: 117.90+/-0.48, group C: 111.68+/-1.23 vs. group A: 119.14+/-1.12 mM/mL, P<0.05). ORAC levels in the venous plasma of group C were significantly lower than those of group B (P<0.05). CONCLUSION: In the blood of the women with preterm premature rupture of membranes, the lipid peroxidation was increased and the antioxidant capacity was decreased compared to women with normal pregnancy and preterm labor with intact membranes. These results suggest that oxidative stress was increased in preterm premature rupture of membranes.

Comparison of oxidative stress markers in umbilical cord blood after vaginal and cesarean delivery

OBJECTIVE: The purpose of our study was to investigate the effect of the mode of delivery on the oxidant and antioxidant system in umbilical cord blood. METHODS: We performed gas analysis of umbilical venous blood and umbilical arterial blood immediately after delivery in 38 women; eighteen women had a vaginal delivery while 20 women delivered via cesarean section at over 37 weeks gestation. We examined lipid peroxide concentration by thiobarbituric acid reaction, protein carbonyl content by 2,4-dinitrophenylhydrazine reaction, and total antioxidant capacity by oxygen radical absorbance capacity assay. RESULTS: Lipid peroxide levels in umbilical venous blood were significantly higher in patients delivering by planned cesarean section (1.81 +/- 0.06 nmol/mg protein) than those with vaginal delivery (1.24 +/- 0.05 nmol/mg protein) (P < 0.05). Antioxidant capacity in umbilical venous blood was significantly higher in patients delivering by planned cesarean section (119.70 +/- 0.13 microM/microL) than those with a vaginal delivery (118.70 +/- 0.29 microM/microL) (P < 0.05). There was no significant difference in the carbonyl content of umbilical venous blood or in the lipid peroxide, carbonyl content, and total antioxidant capacity of umbilical arterial blood. CONCLUSION: Lipid peroxidation levels and antioxidant capacity in umbilical venous blood were higher in patients delivering by planned cesarean section than those with a vaginal delivery. Therefore, we propose that both the mother and neonate are exposed to higher oxidative stress during cesarean section delivery.

Incidentally detected ganglioneuroma during pregnancy: A case report

Retroperitoneal ganglioneuroma is a rare benign tumor, which is included in the neuroblastomas group. It can occur anywhere along the peripheral autonomic ganglion sites, and the tumor is often incidentally detected in asymptomatic patients or may produce symptoms related to the slow growing tumor. Surgical excision is the treatment of choice and the prognosis is good. We report a case of retroperitoneal ganglioneuroma, which was incidentally detected in the first trimester of pregnancy in a 29-year-old woman. Surgical resection of the ganglioneuroma was done at the time of cesarean section at full term without complications.

Significance of Gray-Level Histogram of the Uterine Cervix as a Predictor of Preterm Birth in Pregnant Women with Preterm Labor / 대한주산의학회잡지

PURPOSE: The aim of this study was to determine the value of a gray-level histogram of the cervix as a predictor of preterm birth in women who admitted for preterm labor. METHODS: Ninety-seven women who admitted Chonnam national university for preterm labor were enrolled in this prospective study. A transvaginal ultrasonography for measurement of cervical length (CL), gray-scale histogram and cervical volume was performed when patients were admitted. Anterior and posterior cervical walls and AP (anterior and posterior) difference in MGL (mean gray level between anterior and posterior) were checked. And we analyzed the relationship between the value and preterm birth. RESULTS: The overall rate of preterm birth before 37 weeks was 53.6% and after 37 weeks was 46.4%, respectively. Logistic regression analysis demonstrated that not only cervix length (P=0.003; odds ratio [OR], 0.189; 95% confidence interval [CI], 0.064-0.560) but also anterior histogram (P=0.028; OR, 0.319; 95% CI, 0.115-0.884) was independent predictor of preterm birth before 37 weeks. The receiver operator characteristics (ROC) curves were analyzed for the anterior histogram, a value of 85.9 was the best cut-off value to determine the preterm birth. The areas under the ROC curve indicate that the variable provides a prognostic value for the prediction for preterm birth. To predict a preterm birth, anterior histogram had 78.8% sensitivity and 46.7% specificity. CONCLUSION: Gray-level histogram of the uterine cervix may predict the preterm birth in pregnant women with preterm labor.

Analysis of High-Risk Infant Births and Their Mortality: Ten Years' Data from Chonnam National University Hospital / 전남의대학술지

Prematurity and low birth weight are major factors associated with neonatal morbidity and mortality, and their incidence is not decreasing despite an annual decrease in the total number of live births in Korea. The objective of this study was to establish a strategy to reduce neonatal mortality by analyzing the clinical characteristics of high-risk infant births along with their mortality and causes of death. We retrospectively surveyed the medical records of infants born at Chonnam National University Hospital and of patients admitted to the neonatal intensive care unit (NICU) for 10 years from October 1999 to December 2008. Premature and low birth weight infants were almost half of the live births, and their NICU admission rate increased with increases in the numbers of outborns and multiples. Also, their mortality decreased dramatically over the past 10 years. About 60% of deaths occurred within 1 week of life, and the causes of death were mostly related to prematurity. Perinatal asphyxia was the major cause of death in infants less than 1 week old, whereas sepsis was the major cause after 4 weeks of age. The major cause of death was sepsis in premature or low birth weight infants and perinatal asphyxia in term or normal weight infants. The major cause of death was sepsis in inborns and perinatal asphyxia in outborns. Our results suggest that medical personnel training for immediate postnatal care including neonatal resuscitation, infection control, and a systematic team approach to regionalization are all needed to reduce the mortality rate.

Analysis of High-Risk Infant Births and Their Mortality: Ten Years' Data from Chonnam National University Hospital / 전남의대학술지

Prematurity and low birth weight are major factors associated with neonatal morbidity and mortality, and their incidence is not decreasing despite an annual decrease in the total number of live births in Korea. The objective of this study was to establish a strategy to reduce neonatal mortality by analyzing the clinical characteristics of high-risk infant births along with their mortality and causes of death. We retrospectively surveyed the medical records of infants born at Chonnam National University Hospital and of patients admitted to the neonatal intensive care unit (NICU) for 10 years from October 1999 to December 2008. Premature and low birth weight infants were almost half of the live births, and their NICU admission rate increased with increases in the numbers of outborns and multiples. Also, their mortality decreased dramatically over the past 10 years. About 60% of deaths occurred within 1 week of life, and the causes of death were mostly related to prematurity. Perinatal asphyxia was the major cause of death in infants less than 1 week old, whereas sepsis was the major cause after 4 weeks of age. The major cause of death was sepsis in premature or low birth weight infants and perinatal asphyxia in term or normal weight infants. The major cause of death was sepsis in inborns and perinatal asphyxia in outborns. Our results suggest that medical personnel training for immediate postnatal care including neonatal resuscitation, infection control, and a systematic team approach to regionalization are all needed to reduce the mortality rate.

A Study of Maternal and Perinatal Risk Factors on Intrauterine Fetal Death / 대한주산의학회잡지

PURPOSE: The purpose of this study was to identify the risk factors for intrauterine fetal death (IUFD). METHODS: We carried out a case control retrospective study, at the Chonnam National University Hospital, Korea. We included all pregnant women diagnosed as singleton IUFD in pregnancies of 28 weeks of gestation or more, admitted to the hospital from Jan 2003 to Dec 2007. There were 53 cases of singleton IUFD and 3,298 cases of singleton live birth during that period. The incidence, age distribution, and prevalent gestational weeks were analysed. The risk factors were analyzed by using odds ratio, student's t test, and Chisquare test. Logistic regression analysis was applied to determine independent risk factors. RESULTS: The overall incidence of IUFD was 1.6%. The age distribution of mother with IUFD was highest in the age group of 20 year old or less (5.3%). IUFD was the most prevalent at 28-32 weeks of gestation (41.5%). Significant risk factors were maternal body weight just before delivery, weight gain during pregnancy, and abruptio placentae. The independent risk factors were weight gain during pregnancy (beta=0.002, P=0.000) and abruptio placentae (beta=-0.067, P=0.000). CONCLUSION: Lower maternal body weight just before delivery, lower weight gain during pregnancy, and abruptio placentae are factors significantly associated with IUFD. Further investigations are needed to understand the complex etiology of stillbirth.

Evaluation of length, volume and gray-scale histogram of the cervix as predictors of successful induction / 대한산부인과학회지

OBJECTIVE: The aim of this study was to evaluate whether the Bishop score, length, volume and gray-scale histogram of the cervix has a predictive value of assessing the rate of success in trial of induction. METHODS: Forty-one nulliparous patients with its Bishop score six or less were enrolled for this prospective study. All were on prostaglandin E2 (PGE2, Propess(R); Controlled Therapeutics Ltd) pessary. Three-dimensional transvaginal ultrasound scans of the cervix were performed on the ACCUVIX XQ (Medison) to measure length, volume, and gray-scale histogram. Bishop score was determined by digital examination. The successful induction was defined as the ability to achieve the active phase of labor corresponding to a cervical dilatation of > or =4 cm within 12 hours of removing the PGE2 pessary. The receiver operating characteristics (ROC) curves were also used to estimate an optimal cutoff point for the Bishop score, length, volume, and gray-scale histogram of the cervix. Logistic regression analysis was used for statistical analyses. RESULTS: The overall successful rate of labor induction was 73.2% (30/41). Multiple logistic regression analyses demonstrated that the value of anterior lip histogram was significantly associated with the successful labor induction. ROC curve for anterior lip histogram value in predicting success of induction indicated a significant relationship with successful induction. The best cutoff value was 69.4. CONCLUSION: The value of anterior lip histogram associates significantly with the prediction of successful induction in nulliparous women. But, Bishop score and other sonographic measurement of cervical length, volume, and posterior lip histogram have no predictive values for successful induction.

The Effects of Histologic Chorioamnionitis and Funisitis on Outcome of Very Low Birth Weight Infants / 대한주산의학회잡지

PURPOSE: The association of chorioamnionitis and preterm birth, chronic lung disease (CLD) and periventricular leukomalacia (PVL) has been reported, however, controversy is still present. The aim of this study was to investigate how the histologic chorioamnionitis (HC) and/or funisitis (F) affected the clinical outcomes of very low birth weight infants (VLBWI, <1,500 g). METHODS: The medical records of VLBWI who were admitted at NICU, Chonnam University Hospital from 2004 to 2008 with placental biopsy results were reviewed retrospectively. Maternal (n=324) and neonatal (n=363) characteristics and their clinical outcomes were investigated according to placental pathology. RESULTS: HC (+) mothers (n=88) had higher premature rupture of membranes and preterm labor, and lower rates of preeclampsia/eclampsia (p<0.05 at each) than HC (-) mothers (n=236). HC (+) infants (n=103) had lower birth weight and Apgar score, higher rate of Cesarean section and lower intrauterine growth restriction (p<0.05 at each) rates than HC (-) infants (n=260). HC (+) infants had higher rates of respiratory distress syndrome and mortality, and lower rate of necrotizing enterocolitis (p<0.05 at each), however, when adjusted for verified multivariables in the multiple regression analysis, HC didn't affect the clinical outcomes. CONCLUSION: It was known that intrauterine infection or fetal inflammatory response syndrome (FIRS) was associated with neonatal outcomes. However, our results suggest that HC with or without funisitis is not an isolated risk factor to affect the clinical outcomes in VLBWI.

Changes of antioxidant levels in the uterine venous plasma amniotic fluid, and chorioamnion after maternal supplementation with vitamin C and vitamin E / 대한주산의학회잡지

PURPOSE:To investigate the change in the antioxidant vitamin levels in maternal uterine venous plasma (MUVP), amniotic fluid (AF), and chorioamnion after vitamin C and E supplementation during pregnancy. METHODS:Thirty pregnant women who were scheduled for elective cesarean section between 37 and 39 gestational weeks were randomized in this study. Fifteen women were given a daily oral dose of vitamin C 1,000 mg and vitamin E 400 IU from 33~34 gestational weeks to delivery. The other fifteen women were not given, as a control group. Maternal uterine venous blood, AF, and chorioamnion were obtained after cesarean section. Lipid peroxides and oxygen-radical absorbance capacity value were measured by thiobarbituric acid reaction and Cao's method respectively. Ascorbic acid, uric acid, beta-carotene, retinol, alpha-tocopherol, and gamma-tocopherol were measured by high performance liquid chromatography. The tissue sections of chorioamnion were stained with hematoxylin-eosin and Masson-trichrome stain, and immunohistochemical stain for collagen type IV was also performed. RESULTS:The lipid peroxide levels in MUVP of the study group were significantly lower than those of the control group but in contrast, ORAC (Oxygen-radical absorbance capacity) values were lower in the control group. The alpha-tocopherol levels in MUVP, AF, and chorioamnion study group were significantly higher than those of the control group. Amniotic membrane and subepithelial stromal tissue in the study group were thicker than those in the control group. And subchorionic type IV collagen of placenta tissue in the study group was more stained than that of the control group. CONCLUSION:Maternal vitamin C and E supplementation may be beneficial in the prevention of diseases caused by oxidative stress such as preeclampsia and PROM and in increasing fibrin and type IV collagen in chorioamnion.

Perinatal outcome of preterm infants born to severe pregnancy induced hypertension mothers with or without HELLP syndrome / 대한주산의학회잡지

PURPOSE:The aim of this study was to compare the perinatal outcome of preterm infants born to severe pregnancy induced hypertension (PIH) mothers according to the presence or absence of HELLP syndrome. METHODS:A retrospective analysis was done in 314 premature live infants born to 302 severe PIH mothers who admitted at Chonnam National University Hospital from January 2002 to May 2008. Maternal and neonatal characteristics and their outcome were compared between the groups. Statistical analysis was performed by SPSS program using Student's t test, Chi-square analysis, Fisher's exact test, and logistic regression test. RESULTS:Among 302 severe PIH mothers (single pregnancy 270, twin pregnancy 32), 84 (27.8%) were associated with HELLP syndrome. Among their 334 fetuses (singleton 270, twins 64), total 20 (6.0%) resulted in fetal death and the rate of fetal death was higher in HELLP syndrome group compared to the control group (12.2% vs. 3.4%, P=0.006). Among the 314 live premature infants, 86 (27.4%) were born to severe PIH with HELLP syndrome (study group) and 228 (72.6%) were born to the control group. There were no differences in maternal and neonatal characteristics, maternal death, neonatal morbidity and neonatal death between the groups. However, the duration of mechanical ventilation (12.2+/-14.5 vs. 7.6+/-9.9 days, P=0.019) and hospitalization (25.6+/-12.3 vs. 13.0+/-10.5 days, P=0.013) were longer in the study group. CONCLUSION:Most of severe PIH mothers complicated by preterm birth, and especially combined with HELLP syndrome showed higher fetal and perinatal death than without HELLP syndrome. Moreover, their live-born premature infants needed longer duration of mechanical ventilation and hospitalization. These results indicate that careful fetal monitoring and delivery with the co-operations of obstetricians and neonatologists is essential to improve the perinatal outcome.

Effect of vitamin C and E on the lipid peroxide, antioxidant ability, and antioxidant vitamin levels in maternal and umbilical venous plasma / 대한산부인과학회지

OBJECTIVE: This controlled trial investigated the effect of supplementation with vitamins C and E on the lipid peroxide, antioxidant ability, and antioxidant vitamin levels in full term maternal and umbilical venous plasma. METHODS: Forty pregnant women were randomized in this study. They were nulliparous or multiparous women with history of preeclampsia or preterm premature rupture of membranes (PPROM). Twenty women were given vitamin C (1,000 mg/day) and vitamin E (400 IU/day) from 15~20 gestational weeks to delivery. The others were not given, as a control group. Maternal venous blood was obtained before vitamin supplementation and just before delivery. Umbilical venous blood was obtained after delivery. Lipid peroxide level and oxygen-radical absorbance capacity (ORAC) were measured by thiobarbituric acid reaction and Cao's method, respectively. Ascorbic acid, uric acid, beta-carotene, retinol, alpha-tocopherol, and gamma-tocopherol were measured by high performance liquid chromatography. Results: Supplementation with vitamins C and E was associated with decrease in lipid peroxide levels and increase in ORAC values and alpha-tocopherol levels in maternal venous plasma. And it was also associated with decrease in lipid peroxide levels and increase in ORAC values and alpha-tocopherol levels in umbilical venous plasma. CONCLUSION: Supplementation with vitamins C and E may be beneficial in the prevention of oxidant-antioxidant imbalance origin diseases such as preeclampsia, PPROM. And it also may affect antioxidant ability of the fetus.

Successful full-term delivery after abdominal radical trachelectomy and concurrent cervicoisthmic cerclage for early stage cervical cancer: Two cases / 대한산부인과학회지

Since the screening tool was introduced, the incidence and mortality of cervical carcinoma has decreased. However, the incidence of early stage cervical cancer is increasing in young women who want to preserve their fertility. The risk of preterm delivery after trachelectomy is high and remains problematic. Herein we report two patients who had successful full-term delivery after abdominal radical trachelectomy and concurrent cervicoisthmic cerclage for early stage cervical cancer.

Fetal Head Injury due to Penetrating Abdominal Stab Wound in a 31 Weeks Pregnant Woman / 대한주산의학회잡지

Penetrating trauma in a fetus is uncommon but may cause potentially life-threatening injuries. We experienced a case of preterm infant who delivered by C-section and showed two deep laceration wounds on face, facial nerve palsy, skull fracture and intracranial hemorrhage due to penetrating injury of an abdominal stab wound in a 31 weeks pregnant woman.

Three Cases of Russell-Silver Syndrome in One of Twins Conceived by In Vitro Fertilization / 대한주산의학회잡지

In vitro fertilization (IVF) is a main option for the infertility treatment and its major concerns are the risk of multiple pregnancy, preterm delivery, intrauterine growth retardation (IUGR), and congenital malformation. Russell-Silver syndrome (RS) is a congenital disorder characterized by intrauterine and postnatal growth retardation associated with inverted triangular face, clinodactyly, and asymmetry of the body. The possibility of genomic imprinting defect has been suggested because the risk of RS syndrome is increased after IVF like other imprinting defect disorders such as Angelman or Beckwith-Wiedemann syndrome, and the major epigenetic disturbance of RS syndrome is the hypomethylation of the imprinting in 11p15. We report three cases of RS syndrome in one of IVF twins with a review of the literature.

Lipid peroxidation and total antioxidant ability in venous plasma and amniotic fluid of pregnant women with preterm premature rupture of membranes / 대한산부인과학회지

OBJECTIVE: To evaluate their roles in the pathophysiology of preterm premature rupture of membranes (PPROM), we checked interleukin (IL)-6, lipid peroxide, oxygen-radical absorbance capacity (ORAC) and antioxidant vitamin in the venous plasma and amniotic fluid of women with PPROM. METHODS: Venous plasma and amniotic fluid was taken from 20 normal pregnant women and 20 PPROM pregnancy women. IL-6 levels was determined by enzyme-linked immunosorbent assay. Lipid peroxide levels were measured by thiobarbituric acid reaction. The ORAC levels and the antioxidant levels were measured by Cao's method and by high performance liquid chromatography. RESULTS: The IL-6 levels in the venous plasma and amniotic fluid of PPROM pregnancy women were significantly higher than normal pregancy (P<0.01, P<0.01). The lipid peroxide levels in the venous plasma and amniotic fluid of PPROM pregnancy women were significantly higher than normal pregancy (P<0.01, P<0.01). The ORAC values in the venous plasma and amniotic fluid of PPROM pregnancy women were significantly higher than normal pregancy (P<0.01, P<0.01). The ORAC values/lipid peroxide levels in the venous plasma and amniotic fluid of PPROM pregnancy women were significantly higher than normal pregancy (P<0.01, P<0.01). The ascorbic acid levels in the venous plasma and amniotic fluid of PPROM pregnancy women were significantly higher than normal pregancy (P<0.05, P<0.01). CONCLUSION: This result suggest that the increased inflammatory bioactivity, increased lipid peroxidation and decreased antioxidant activity may be involved in the pathophysiology of PPROM. Low levels of ascorbic acid appears to be an important determinant of PPROM.

Changes in lipid peroxidation and protein oxidation by antibiotic therapy in the maternal venous plasma of preterm premature rupture of membranes / 대한산부인과학회지

OBJECTIVE: To investigate and compare the amount of the lipid peroxidation and the protein carbonyls formation in maternal venous plasma of preterm premature rupture of membranes (PPROM) during antibiotics administration. METHODS: PPROM were selected between 25 and 32 weeks of gestation. Eighteen patients (group 1) were treated with amoxicillin and erythromycin for 7 day period, 18 patients (group 2) were treated with 3rd generation cephalosporin (cefodizime, cefditoren) and erythromycin for the same period. Maternal blood were obtained from the two groups before and after the antibiotics administration, day 3 and day 7. Lipid peroxidation levels and protein carbonyl contents were measured by thiobarbituric acid reaction and 2,4-dinitrophenyl hydrazine method. Other 18 women with normal pregnancy between 25 and 32 weeks of gestation of venous blood were checked same things in vitro. Interleukin (IL) -6 was measured by enzyme-linked immunosorbent assay. RESULTS: 1. The lipid peroxidation levels and protein carbonyls formation in the maternal venous plasma of PPROM was significantly higher than that of normal pregnancy (lipid peroxidation levels; 4.77+/-.36 vs 7.11+/-.41 nmol/mg protein, P<001, protein carbonyls formation; 3.55+/-.22 vs 5.69+/-.30 nmol/mg protein, P<001). 2. There were no significant differences in the lipid peroxidation levels and protein carbonyls formation of the maternal venous plasma with PPROM mixed and incubated by amoxicillin, cefodizime, cefditoren, and erythromycin (in vitro). 3. There were no significant differences in the lipid peroxidation levels and protein carbonyls formation of the venous plasma of group 1 between before and after antibiotics administration, day 3 and day 7. 4. There were no significant differences in the lipid peroxide levels of the venous plasma of group 2 between before and after antibiotics administration, day 3 and day 7. 5. The protein carbonyls formation in the venous plasma of group 2 was significantly decreased at day 3 and day 7 after antibiotics administration than that of before (6.04+/-.44 and 5.53+/-.37 vs. 7.04+/-.51 nmol/mg protein, P<005). 6. The levels of IL-6 in the venous plasma of group 2 was significantly decreased at day 7 after antibiotics administration than that of before (7.50+/-.35 vs. 3.13+/-.37 pg/mL, P<005). CONCLUSION: In the maternal venous plasma of PPROM, the lipid peroxidation levels and protein carbonyls formation were increased. The formation of protein carbonyls and IL-6 in the maternal blood of PPROM was decreased by combined treatment of 3rd generation cephalosporin and erythromycin. The results suggest that reactive oxygen species formation by inflammatory reaction is suppressed by the 3rd generation cephalosporins and erythromycin combined treatment.

Changes of lipid peroxide levels and prooxidative activity stimulating the protein carbonyl formation in the amniotic fluid of women with preterm premature rupture of membranes / 대한산부인과학회지

OBJECTIVE: To investigate the lipid peroxide levels and protein carbonyls levels in the amniotic fluid of pregnant women with preterm premature rupture of membranes (PPROM). METHODS: The lipid peroxide levels in the amniotic fluid of normal pregnancy (n=20) and pregnant women with PPROM (n=20) were measured by thiobarbituric acid reaction. The protein carbonyl contents in the amniotic fluid of normal pregnancy (n=20) and pregnant women with PPROM (n=20) were determined by the 2,4-dinitrophenylhydrazine method. After amniotic fluid of them were mixed and incubated up to 5 hours with 0.2 mL of 1mM moxalactam, cefodizime, amoxacillin, erythromycin, the lipid peroxide levels and protein carbonyl contents in them were measured. RESULTS: 1. The lipid peroxide levels in the amniotic fluid of pregnant women with PPROM was significantly higher than that of normal pregnancy (9.74+/-0.48 vs. 7.20+/-0.38 nmol/mg protein, P<0.01). 2. The protein carbonyl levels in the amniotic fluid of pregnant women with PPROM was significantly higher than that of normal pregnancy (13.0+/-0.33 vs. 11.27+/-0.17 nmol/mg protein P<0.01). 3. The lipid peroxide levels and protein carbonyls formation by moxalactam in the amniotic fluid of pregnant women with PPROM was significantly higher than basal level (12.08+/-0.81 vs. 9.74+/-0.48 nmol/mg protein, 20.08+/-0.66 vs. 13.0+/-0.33 nmol/mg protein, P<0.01). 4. The lipid peroxide levels and protein carbonyls formation by cefodizime in the amniotic fluid of pregnant women with PPROM was significantly lower than basal level (5.04+/-0.33 vs. 9.74+/-0.48 nmol/mg protein, 9.76+/-0.35 vs. 13.0+/-0.33 nmol/mg protein, P<0.01). 5. There were no significant differences in the levels of lipid peroxide and protein carbonyls by amoxacillin and erythromycin in the amniotic fluid of pregnant women with PPROM between antibiotics-induced and basal levels. CONCLUSION: The lipid peroxidation and the protein carbonyls formation were increased in the amniotic fluid of pregnant women with PPROM. Antibiotics-induced lipid peroxide and protein carbonyl levels were changed in the amniotic fluid of pregnant women with PPROM. Further studies on our results may be beneficial in the selection of antibiotics for pregnant women with PPROM.

A case of ureterouterine fistula as a complication of cesarean section / 대한산부인과학회지

Ureteral injury is usually iatrogenic in origin, in particular as a result of laparoscopic or gynecological surgery. Ureterouterine fistula constitute a rare subset of iatrogenic genitourinary fistulas. The most common presentation of ureterouterine fistula is in women who have had a cesarean section. The management options include conservative therapy (spontaneous healing), endourologic (stented repair) or open surgical operation (ureteroneocystostomy or ureteroureterostomy). Herein, we report on a case of ureterouterine fistula in a 33-year-old woman who underwent a cesarean section. The 17th day after the operation, she complained watery vaginal discharge. Clinical and urographic assessments revealed an iatrogenic ureterouterine fistula and an ureteroneocystostomy was performed after 3 months.