Risk factors for acute postpartum urinary retention after vaginal delivery: focus on episiotomy direction.

OBJECTIVE: This study aimed to investigate the independent factors for acute postpartum urinary retention (APUR) after vaginal delivery. METHODS: From January 2008 to December 2013, 98 patients with APUR after vaginal delivery without instrument use were compared with 108 control patients matched by age and medical history. Multivariate logistic regression analysis was performed to identify independent risk factors for APUR. Predictive accuracy for the multivariate model was assessed using the derived area under a receiver operating characteristics curve. RESULTS: Among maternal previous partial history, mean live birth history was lower in the APUR group (0.12 versus 0.31, p = 0.017). Regional anesthesia use (76.5% versus 60.2%, p = 0.036), mediolateral episiotomy (63.3% versus 31.5%, p < 0.001) and labor time were significantly higher in the APUR group. Multivariate logistic regression analysis showed that mediolateral episiotomy, labor time and the presence of regional anesthesia were independent contributing factors for the development of APUR. This model's predictive accuracy for APUR was 73.1%. CONCLUSION: Prolonged labor time, regional anesthesia and mediolateral episiotomy were independent factors for APUR. Therefore, we considered median episiotomy to be the best approach during vaginal delivery avoiding APUR.

Endothelial nitric oxide synthase gene polymorphisms (-786T>C, 4a4b, 894G>T) and haplotypes in Korean patients with recurrent spontaneous abortion.

OBJECTIVE: To investigate the association of three common polymorphisms (-786T>C, 4a4b, 894G>T) of the endothelial nitric oxide synthase (eNOS) gene with idiopathic recurrent spontaneous abortion (RSA). STUDY DESIGN: In a prospective case-control study, 340 patients with unexplained recurrent spontaneous abortion and 115 controls with at least one live birth and no history of pregnancy loss were enrolled. Polymerase chain reaction and restriction fragment length polymorphism analysis were performed to identify the genotypes. RESULTS: The recurrent spontaneous abortion patients exhibited a significantly higher frequency of the eNOS 894GT+TT genotype (Odds ratio (OR), 2.39; 95% confidence interval (CI), 1.25-4.58; p=0.008) compared to the control group; no significant differences in the -786T>C and 4a4b genotype frequencies were observed. The eNOS 894GT genotype (OR, 1.94; 95% CI, 1.00-3.75; p=0.056) was marginally different between recurrent spontaneous abortion and control groups. The frequency of the -786T-4b-894T haplotype (p=0.001) was significantly higher in the idiopathic RSA group than in the control group. CONCLUSION: The eNOS 894GT+TT genotype and the -786T-4b-894T haplotype are significantly associated with idiopathic recurrent spontaneous abortion in Korean women.

Alcohol Use during Pregnancy and Related Risk Factors in Korea.

OBJECTIVE: The number of Korean women of childbearing age who drink alcohol and binge drink has increased remarkably in recent years. In the present study, we examined self-reported rates of alcohol use before and during pregnancy and identified maternal characteristics associated with drinking in pregnancy. METHODS: One thousand pregnant Korean women who visited the Department of Obstetrics and Gynecology (OB/GYN) completed a self-administered questionnaire that sought information on their demographic characteristics and incorporated features of the Alcohol Use Disorder Identification Test (AUDIT)-C to investigate their use of alcohol, including binge drinking, during three time periods ("in the year before this pregnancy," "during this pregnancy," and "in the previous 30 days"). RESULTS: Of these participants, 16.4% reported using alcohol during their pregnancy, 12.2% had used alcohol in the previous 30 days, and 1.7% reported binge drinking during their pregnancy. In the year before pregnancy, 77.1% had used alcohol, and 22.3% had binge drunk. The group using any amount of any alcohol during pregnancy showed a lower educational level, a lower rate of planned pregnancy, a lower level of knowledge relating to the risks of drinking alcohol during pregnancy, and a higher frequency of alcohol drinking in the year before pregnancy when compared with the abstinent group. Low educational level and unplanned pregnancy were revealed to be significant risk factors for alcohol consumption in pregnant women. CONCLUSION: This is the first study to examine any alcohol and binge alcohol drinking during pregnancy in Korea. Clinical attention and monitoring system on alcohol use during pregnancy are necessary in Korea.

Association study of vascular endothelial growth factor polymorphisms with the risk of recurrent spontaneous abortion.

OBJECTIVE: To investigate the association of vascular endothelial growth factor (VEGF) polymorphisms (-2578C>A, -1154G>A, -634G>C, 936C>T) with idiopathic recurrent spontaneous abortion (RSA) in Koreans. DESIGN: Prospective case-control study. SETTING: University-based hospital. PATIENT(S): Two hundred and fifteen patients with a history of two or more unexplained consecutive pregnancy losses and 113 healthy controls with at least one live birth and no history of pregnancy loss. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analyses were performed for the -2578C>A and 936C>T genotypes. Real-time PCR was also used to analyze the -1154G>A and -634G>C genotypes. RESULT(S): The GA (adjusted odds ratio [AOR] 2.774; 95% confidence interval [CI] 1.512-5.092) genotype of the VEGF -1154G>A polymorphism was significantly different between women with idiopathic RSA and controls. The difference in overall (GA + AA) frequency was also marginally significant between the controls and patients with idiopathic RSA (AOR, 2.006; 95% CI, 1.158-3.473). The differences in frequencies of the A-A-G-T and C-A-G-T haplotypes of the VEGF polymorphisms (-2578C>A, -1154G>A, -634G>C, 936C>T) were marginally significant between the patient and control groups. CONCLUSION(S): This study suggests that VEGF polymorphisms and haplotypes are a genetic determinant for the risk of idiopathic RSA in Korean women.

Characterization of Fetal Tissue-derived Mesenchymal Stem Cells.

Mesenchymal stem cells (MSCs) have unique immunologic properties that may someday prove useful in cell-based therapy for various degenerative diseases. Its potential is limited, however, by several factors, including the rarity of these cells and difficulty in isolating them. To evaluate their potential as new sources for cell therapy, we isolated MSCs from human fetal tissue (hfMSC) derived from spontaneous abortus (8∼10 weeks) then studied their cell cycle and cell surface marker expression using a fluorescence-activated cell sorter (FACS), as well as the expression of differentiation markers using real-time polymerase chain reaction (RT-PCR). The hfMSCs were able to undergo PCR up to 20 times without displaying significant changes in morphology or expression of various stemness markers (Nanog and human telomerase reverse transcriptase [hAFP]), including germ layer markers (hNF68, alpha-cardiac actin, and hAFP). Also, teratomas were not seen in mice with severe combined immunodeficiency syndrome (SCID) that received a transplantation of hfMSCs with hTERT activity. The FACS analysis revealed that the majority of hfMSCs express mesenchymal markers CD13, CD44, CD71, CD90, CD105, CD253a, and HLA-ABC, but did not express CD31, CD34, CD38, CD45, and HLA-DR. Interestingly, hfMSCs derived from the cell membrane during early passages were negative for both HLA-ABC and HLA-DR, although HLA-ABC expression was detected during later passages (>20 passages). We found that hfMSCs could be differentiated into an osteogenic lineage; this was indicated by modulation of osteoblast markers specific for mRNA. We conclude that hfMSCs could be used as a new source of cells to treat patients with osteogenic diseases, as well as to understand the mechanisms of immunosuppression by MSCs.

Occult hepatitis B virus infection in pregnant woman and its clinical implication.

BACKGROUND/AIMS: The objective of this study was to document the prevalence rate of occult hepatitis B virus (HBV) in healthy pregnant woman and the possibility of transmission to the foetus. METHODS: This study was performed prospectively with 202 healthy pregnant women. HBV-DNA testing was performed using two specific quantitative tests with two independent sets of sera and cord blood. DNA sequencing analysis was carried out to confirm the specificity of polymerase chain reaction (PCR) product of HBV-DNA testing. RESULTS: Eight of 202 (4%) individuals with the TaqMan PCR assay and 23 of 202 (11.4%) with the COBAS Amplicor HBV Monitor test were HBV-DNA positive. Six (3%) individuals were positive with both methods. Sequencing and genotyping analysis of HBV polymerase gene with sera of the 75th subject resulted in genotype C. HBV-DNA testing with four cord blood samples showed that all were HBV-DNA negative. CONCLUSION: Occult HBV infection shows a difference in prevalence rate depending on the test method but the existence has been confirmed by sequencing analysis. Our results also suggest that vertical transmission through the cord blood is not so high as to be clinical problems and warrants further investigation.

Association between folate metabolism-related gene polymorphisms and methylation of p16(INK4A) and hMLH1 genes in spontaneously aborted embryos with normal chromosomal integrity.

OBJECTIVE: To assess prevalent polymorphisms of 5,10-methylenetetrahydrofolate reductase (MTHFR) and thymidylate synthase enhancer region (TSER) and methylation patterns of p16(INK4A) and hMLH1 genes in spontaneously aborted embryos (SAEs) with normal chromosomal integrity. DESIGN: Retrospectively analyzed, prospectively obtained database. SETTING: Bundang CHA General Hospital in South Korea. PATIENT(S): Fifty-nine SAEs (<20 wk of gestational age) with normal chromosomal integrity. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Genotype frequency of MTHFR, TSER polymorphisms, and methylation status of p16(INK4A) and hMLH1 genes in SAEs with normal chromosomal integrity. RESULT(S): The distribution of the MTHFR 677C>T polymorphism differed significantly between SAEs with normal chromosomal integrity and the two control groups. Also, the frequency of combined MTHFR 677 and TSER genotypes was significantly different between the aborted embryos and the adult control group. However, the MTHFR 677C>T and 1298A>C and TSER polymorphisms were not associated with the methylation status of p16(INK4A) and hMLH1 genes in SAEs with normal chromosomal integrity. CONCLUSION(S): Association between the MTHFR 677C>T polymorphism and the risk of SAEs with normal chromosomal integrity in the Korean population.

[Abnormal liver function tests in pregnancy: a single institution experience].

BACKGROUND/AIMS: Elevated transaminase levels are often detected during pregnancy. Causes are variable and difficult to differentiate. Furthermore, there is no practical guideline for abnormal transaminase levels in pregnancy. The aim of this study was to suggest a strategy for managing elevated transaminase level during pregnancy. METHODS: One hundred and fifty-five women with elevated transaminase level were included from an antenatal care center between January 1, 2003 and December 31, 2004. Another 221 women with normal transaminase levels were enrolled as control group. We analyzed documented causes, changes in laboratory tests, and pregnancy outcomes. RESULTS: Two groups showed no difference in baseline characteristics except the duration of pregnancy, parity, and albumin level. Of abnormal results, 39.4% occurred between 30 and 40 gestational weeks while 29% occurred between 10 and 20 gestational weeks. Common causes were hyperemesis gravidarum followed by pre-eclampsia, viral hepatitis, and HELLP syndrome. Excluding viral hepatitis, 69 patients showed abnormal results in the first two trimesters and the results were normalized during the follow-up period. AST and ALT levels were 52.9 (+/-49.6) IU/L and 83.3 (+/-77.0) IU/L during the first two trimesters in the patient group. Abnormal results during the third trimester were associated with shorter duration of pregnancy. CONCLUSIONS: Elevated transaminase levels up to 3 to 4 times of the upper normal limit during the first two trimesters could be safely observed with careful history taking and hepatitis viral antigen tests. However, abnormal results in the third trimester were associated with a shorter duration of pregnancy and should be managed carefully.