OBJECTIVE:To investigate whether the uterine artery pulsatility index (UtA PI) of hypertensive pregnancies is higher than that of normal pregnancies in the puerperium, as well as in the antepartum period.METHODS:The UtA PI was measured in hypertensive (group 1) and normal pregnancies (group 2) during antepartum, immediate postpartum or late postpartum periods. Using the transvaginal approach, the bilateral uterine artery indices were measured.RESULTS:One hundred twenty-two women were enrolled: group 1, hypertensive disease in pregnancy (11 cases in antepartum, 13 cases in immediate postpartum and 10 cases in late postpartum period); group 2, normal pregnancies (32 cases in antepartum, 29 cases in immediate postpartum and 27 cases in late postpartum). In antepartum and immediate postpartum periods, the mean UtA PI and the proportion of cases with an early diastolic notch were higher in group 1 than in group 2 (antepartum mean UtA PI, 1.14 in group 1 vs. 0.68 in group 2, P<0.001; early diastolic notch, 46% vs. 9%, P<0.05; immediate postpartum mean UtA PI, 1.30 vs. 1.08, P<0.05; early diastolic notch, 85% vs. 48%, P<0.05). In late postpartum period, the mean value of UtA PI of group 1 was still higher than that of group 2, although the proportion of cases with an early diastolic notch was not different (mean UtA PI, 1.43 vs. 1.20, P<0.05; early diastolic notch, 60% vs. 52%, P=0.73).CONCLUSION:The UtA PI in hypertensive pregnancies was still higher than normal pregnancies in puerperal periods, suggesting that more than several weeks are required to resolve increased uterine artery vascular impedance.

Objectives: This study investigated whether proteomic analysis of amniotic fluid (AF) in the early second trimester can be used to predict the development of preeclampsia. Methods: Amniotic fluid samples were collected at the time of genetic amniocentesis (15-19 weeks of gestation) from women who subsequently developed preeclampsia and from gestational age-matched normotensive controls (n = 10 for each). Amniotic fluid samples were subjected to proteomic analysis using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry, sodium dodecyl sulfate polyacrylamide gel coupled with in-gel tryptic digestion, electrospray ionization tandem mass spectrometry (MS/MS), immunodepletion assays, and enzyme-linke immunosorbent assay. Results: Five proteomic biomarkers were identified, which were differentially expressed in women who subsequently developed preeclampsia compared with those women who did not; four of these peaks were significantly upregulated (mass-to-charge ratio of 9080 [P = .006], 14 045 [P = .010], 14 345 [P = .049], and 28 087 [P = .006]) and one was significantly downregulated (mass-to-charge ratio of 4679 [P = .014]) in women who subsequently developed preeclampsia. Using electrospray ionization MS/MS and immunodepletion assays, two protein peaks were identified as albumin fragment and apolipoprotein A-I. Conclusions: Using proteomic technology, this study identified protein biomarkers that are differentially expressed in the early second trimester AF from women who subsequently develop preeclampsia compared with women who remained normotensive. Early identification of women at risk of developing preeclampsia will allow clinicians to better optimize maternal and perinatal outcomes.

Introduction: This study is designed to identify proteomic biomarkers that predict the subsequent development of gestational diabetes mellitus (GDM). Methods: Maternal blood was obtained prospectively from healthy pregnant women in the early second trimester (16-20 weeks). Twelve women subsequently diagnosed with GDM at 24 to 28 weeks were selected as cases; an equal number of normoglycemic women as controls. Proteomic analysis of the previously stored plasma was performed by surface-enhanced laser desorption/ionization time-of-flight (SELDI-TOF) mass spectrometry. Results: Three peaks (9122 Da, 9412 Da, and 9701 Da) that were increased in cases were characterized as isoforms of apolipoprotein CIII. Another discriminatory peak (17 105 Da) that was decreased in cases was matched to apolipoprotein AII. Enzyme-linked immunosorbent assay (ELISA) confirmed that women who subsequently developed GDM had significantly higher levels of apolipoprotein CIII than controls did. Levels of apolipoprotein AII failed to reach statistical significance. Conclusion: Our data suggest that there already exist biomarkers in the maternal circulation at 16 to 20 weeks in women who subsequently develop GDM.

This study investigates whether proteomic analysis of amniotic fluid (AF) in he mid-trimester can be used to predict the development of preeclampsia. AF samples collected at the time of genetic amniocentesis (15-19 weeks) were identified from women who subsequently developed preeclampsia (cases) and from gestational age-matched normotensive controls (n=10 for each) and subjected to proteomic analysis using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS). Proteomic biomarkers that were differentially expressed between cases and controls were identified, isolated, and characterized by fast protein liquid chromatography (FPLC), SDS-PAGE gel electrophoresis coupled with in-gel tryptic digestion and electrospray ionization tandem mass spectrometry (ESI-MS/MS), and immunodepletion assays. Five proteomic biomarkers were identified in mid-trimester AF that were differentially expressed in women who subsequently developed preeclampsia compared with those women who did not; four of these peaks were significantly up-regulated (m/z ratio 9080 [P=0.006], 14045 [P=0.010], 14345 [P=0.049], and 28087 [P=0.006]) and one was significantly down-regulated (m/z ratio 4679 [P=0.014]) in women who subsequently developed preeclampsia. Fractions containing the biomarkers of interest were then separated by FPLC and subjected to SDS-PAGE gel electrophoresis, in-gel tryptic digestion, immunodepletion assays, and ESI-MS/MS. Biomarkers with m/z ratios of 14045 and 14345 were identified as fragments of albumin. Using proteomic technology, this study has identified for the first time a series of protein biomarkers that are differentially expressed in AF collected in the mid-trimester (15-19 weeks) from women who subsequently developed preeclampsia as compared with women who remained normotensive. Additional studies are underway to determine the utility of this analysis to accurately predict the development of preeclampsia, and to determine the role of these differentially expressed proteins in the pathogenesis of this elusive disease.

Aplasia cutis congenita is a rare congenital disorder characterized by single or multiple skin defects at time of birth. After having diagnosed Human immunodeficiency virus infection, the mother took antiretroviral agents during pregnancy and all other antenatal test results were within normal range. Right after birth, a skin defect on the newborn‘s vertex scalp was detected which was diagnosed as Aplasia cutis congenita. We report a case with a literature review.

Unilateral pulmonary agenesis is a very rare developmental malformation that is often associated with other anomalies.The prognosis of pulmonary agenesis varies from stillbirth, to neonatal death, to survival without any symptoms depending on the presence of associated congenital malformations.Therefore, it is very important to perform a prenatal diagnosis of unilateral pulmonary agenesis.We describe a case of unilateral pulmonary agenesis diagnosed in the second trimester by transabdominal ultrasound.

The purpose of this study was to establish the safety of vaginal delivery in vertex-breech twins by estimating the success rate of vaginal delivery after trial of labor (TOL) and analyzing the neonatal outcome according to mode of delivery. We reviewed retrospectively the medical records of vertex-breech twins delivered at Seoul National University Hospital between January 1999 and July 2010. The patients were classified as TOL group and cesarean delivery (CD) group to compare neonatal morbidity and mortality of second twin. Neonatal composite morbidity included intraventricular hemorrhage, respiratory distress syndrome, bronchopulmonary dysplasia, pneumonia, sepsis, necrotizing enterocolitis, NICU admission, ventilator use, and birth trauma. 188 eligible cases were enrolled and analyzed. The proportion of TOL and CD group was 56.4% (n=106) and 43.6% (n=82), repectively. The success rate of vaginal delivery after TOL was 88.7% (94/106). The cesarean delivery rate of second twin after vaginal delivery of first twin in TOL group was 0.9% (1/106) (Table).TableMaternal characteristics and neonatal (second twin) outcomesTOL (n=106)CS (n=82)p-valueMaternal age (y)31.1 ± 3.233.4 ± 4.9NSMean gestational age (wks)36.8 ± 2.735.5 ± 2.8NSNulliparity (n)77 (72.6%)61 (74.4%)NSMonochorionicity (n)22 (20.8%)19 (23.2%)NSBirthweight (g)2374 ± 5512236 ± 622NSMaternal complication (n)14 (13.2%)13 (15.9%)NSComposite morbidity (n)22 (20.8%)29 (35.4%)NS⁎adjusted by gestational ageNeonatal mortality (n)3 (2.8%)2 (2.4%)NS adjusted by gestational age Open table in a new tab Our results showed no significant differences in composite neonatal morbidity and mortality. TOL is safe mode of delivery in vertex-breech twin and can reduce the rate of cesarean section without adverse effect on neonatal outcome of second twin.

Most chemotherapeutic drugs are known to possess signifi cant teratogenic effects.Although several agents have been proven to be safe for the fetus after organogenesis period, there is limited information on their use during pregnancy and it is very diffi cult to establish researches on the effect to human.We report a very unique case of unrecognized pregnancy in lung cancer patient who had been treated with variable agents of chemotherapy.A 25-year-old woman (gravida 0) who had been diagnosed as non-small cell lung cancer 6 years ago and received multiple regimens of chemotherapy presented at full term pregnancy with unknown gestational period.Without knowledge of pregnancy, she received a palliative chemotherapy with Docetaxel during fi rst and second trimesters.Vaginal delivery with induction of labor due to postterm pregnancy was performed after evaluation of her medical condition and fetal surveillance.A 2,450 g female newborn was delivered with no evidence of congenital malformations.

Sialorrhea in pregnant women is of unknown origin.Sialorrhea in pregnant women is defi ned as an excessive secretion of saliva, common in pregnant women with hyperemesis gravidarum who might have diffi culty in swallowing their saliva.Sialorrhea usually begins with hyperemesis gravidarum and ceases after delivery.We have experienced three cases Sialorrhea in pregnant women which started from the early pregnant period and then ceased after delivery.So we report three cases with a brief review of the literature.

Abstract Objective: To analyze the proteomic pattern in urine for distinguishing severe preeclampsia from mild preeclampsia and normotensive controls using surface-enhanced laser desorption ionization time-of-flight mass spectrometry (SELDI-TOF-MS). Study design: Urine samples were collected from women with severe preeclampsia (n=11 [sPE]), mild preeclampsia (n=7 [mPE]), and normotensive controls (n=8) and analyzed by SELDI-TOF-MS to identify discriminatory protein peaks in the sPE cohort. A scoring system was constructed – designated as Preeclampsia Proteomic Score of Urine (PPSU) – to differentiate sPE from mPE and normotensive controls. Results: Four discriminatory protein peaks were identified (m/z ratio: 4155, 6044, 6663, and 7971), all of which were down-regulated in women with sPE. PPSU scores in women with sPE were significantly lower than that in both mPE and controls (sPE 0 [0–4] vs. mPE 3 [0–4] vs. controls 4 [2–4]; median [range]; P<0.05). PPSU<2 had a sensitivity of 90.9% and specificity of 93.3% in discriminating patients with sPE from mPE and controls. Conclusion: Proteomic analysis of urine can accurately distinguish sPE from mPE and normotensive controls.

Congenital intracranial teratoma is a very rare kind of tumor.A fetus was diagnosed with a congenital intracranial teratoma and hydrocephalus at 20 weeks' gestation.On prenatal ultrasonography, the fetus showed a severe macrocephalic hydrocephalus, along with a huge, heterogenous intracranial mass in the posterior fossa.After fetal cephalocentesis was performed at 21 weeks' gestation, the pregnancy was terminated vaginally without any complication.On the postmortem examination, the pathologic report revealed an intracranial immature teratoma.We report a case with a brief review of the literature.

This study examined urinary cotinine levels and self-reported smoking among pregnant women in Korea and the factors associated with smoking during pregnancy. The subjects were selected from pregnant women who visited 30 randomly sampled obstetric clinics and prenatal care hospitals in Korea in 2006. Smoking status was determined by self-reporting and urinary cotinine measurement. A total of 1,090 self-administered questionnaires and 1,057 urine samples were analyzed. The percentage of smoking revealed by self-reporting was 0.55% (95% confidence interval [CI], 0.11-0.99) and that revealed by urinary cotinine measurement (>100 ng/mL) was 3.03% (95% CI, 1.99-4.06). The kappa coefficient of agreement between self-reported smoking status and urinary cotinine measurement was 0.20 (95% CI, 0.03-0.37). Multiple logistic regression analysis revealed that early gestational period, low educational level, and being married to a smoker were significant risk factors for smoking during pregnancy. Smoking among pregnant women in Korea is not negligible, and those who are concerned to maternal and child health should be aware of this possibility among pregnant women in countries with similar cultural background.

OBJECTIVE:We sought to examine changes in the intraamniotic proteomic environment after the administration of antenatal corticosteroids to women with impending preterm delivery.STUDY DESIGN:Amniotic fluid samples were collected at the time of clinically indicated amniocentesis before and within 7 days of administration of antenatal corticosteroids for impending preterm delivery (n = 12). Proteins differentially expressed before and after corticosteroids were identified by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry. They were isolated, characterized, and quantified by fast protein liquid chromatography, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, in-gel tryptic digestion, immunodepletion assays, enzyme-linked immunosorbent assay, and electrospray ionization tandem mass spectrometry.RESULTS:Five protein peaks of interest were identified and characterized, all of which were significantly decreased after antenatal corticosteroid administration. These included 2 isoforms of transthyretin, albumin, prothrombin fragment 2, and lumican.CONCLUSION:Four proteins, identified and characterized in amniotic fluid, were differentially expressed with antenatal corticosteroid administration. These data may provide additional insight into the molecular mechanisms by which antenatal corticosteroids prevent neonatal complications.

Listeriosis is an infectious disease caused by Listeria monocytogenes, a gram positive, facultatively anaerobic bacterium.Listeriosis occurs primarily in newborn infants, elderly patients, immunocompromised patients and pregnant women.One third of the patients are pregnant women, and complications of this disease include miscarriage, stillbirth and preterm labor.We experienced a case of listeriosis in a singleton pregnancy at 23 rd week of gestation that presented with fever, chill, lower abdominal pain, backache, and eventually resulted in fetal death in utero.Autopsy results of the stillborn baby, as well as blood and amniotic fluid culture of the mother confirmed Listeria monocytogenes infection.Proper antibiotics therapy thereafter led to clear recovery of the infected mother.We report this case with a brief review of literature.

Cantrell's Pentalogy is a rare condition that consists of defects involving the abdominal wall, lower sternum, anterior diaphragm, pericardium, and heart. In the literature to date, pregnant women with Cantrell's Pentalogy have not been discussed. We performed successful vaginal delivery of a 23-yr-old nulliparous, primigravid woman who had been diagnosed with this condition. Diagnosis was based on cardiac catheterization, angiography, and echocardiogram, and abdominopelvic CT. Vaginal delivery may be an option for women with Cantrell's Pentalogy and may be attempted with caution.

BACKGROUND:The known connection between placental hypoxia and the development of preeclampsia suggests that angiogenic factors in the placenta would be changed and affect the maternal and/or umbilical cord plasma levels in patients with preeclampsia.OBJECTIVE:The aim of this study was to determine the difference and correlation of placental mRNA expression and maternal/umbilical cord plasma concentrations of vascular endothelial growth factor A (VEGF-A), angiopoietin-1, and angiopoietin-2 between women with severe preeclampsia and normal pregnancies.METHODS:Sixteen patients with severe preeclampsia and 29 normotensive pregnant women were studied. The placental mRNA expression was assessed using real-time quantitative RT-PCR analysis. Maternal/umbilical cord plasma levels were measured using an enzyme-linked immunoassay. Nonparametric methods were applied for statistical analysis.RESULTS:. Placental mRNA expression of angiopoietin-2 was significantly increased in patients with severe preeclampsia (p < 0.001). The maternal plasma angiopoietin-2 protein level was also significantly increased in women with severe preeclampsia (p < 0.05) and showed a positive correlation with the placental mRNA expression of angiopoietin-2 (r = 0.54, p < 0.005). For VEGF-A and angiopoietin-1, there were no significant differences between the two groups. A maternal plasma angiopoietin-2 concentration of 8.4 ng/mL had a sensitivity of 63% and a specificity of 83% for predicting severe preeclampsia.CONCLUSION:Placental angiopoietin-2 mRNA expression was increased and correlated with the maternal plasma angiopoietin-2 protein concentration in women with severe preeclampsia. This suggests that the plasma angiopoietin-2 protein level may be a candidate marker for severe preeclampsia.

저자들은 양수천자에서 염색체 핵형이 모자이시즘 (mosaicism)이면서 제대천자에서는 정상핵형을 보이는 2예의 태아를 경험하였다. 첫 번째 태아는 터너 증후군 모자이시즘이고 두 번째 태아는 20번 삼염색체성 모자이시즘 (trisomy 20 mosaicism)이었다. 이러한 증례가 산전에 진단된 경우 예후에 관해서는 확실히 밝혀진 것이 없다. 터너 증후군 모자이시즘 증례는 임신 23+3주에 부모가 원하여 임신 종결하였고 부검 결과에서 터너 증후군의 특징적인 소견은 관찰되지 않았다. 이후 시행된 세포유전학 검사결과는 피부조직에서 45,X[4]/46,XX[52], 폐조직에서는 46,XX였다. 두 번째 증례는 임신 38+2주에 정상 분만하였으며, 출생 당시와 출생 후 3개월에 시행한 검진상 선천성 기형이나 발달 장애 소견은 없었다. 태아 여러 조직에서 염색체 핵형의 불일치는 매우 드문 경우로 문헌 검토와 함께 보고하는 바이다.

목적: 산전진단된 선천성 낭종성선종양폐기형의 진단 정확도와 임신결과 및 예후에 영향을 미치는 인자를 확인하고자 하였다. 연구 방법: 1999년 1월부터 2008년 6월까지 서울대학교병원에서 산전초음파를 통해 선천성 낭종성선종양폐기형으로 진단된 32예를 대상으로 산모 및 신생아의 의무기록을 후향적으로 조사하였다. 결과: 산전초음파검사를 통해 선천성 낭종성선종양폐기형으로 진단된 32예 중 24예에서 추적관찰이 이루어 졌다. 출생 후 조직검사나 영상의학검사를 통해 3예는 폐분리증으로, 1예는 선천성 대엽성폐기종으로 진단되어 선천성 낭종성선종양폐기형의 산전진단의 정확도는 83.3% (20/24)였다. 선천성 낭종성선종양폐기형으로 최종 진단이 확인된 20예 중 태아수종이나 복수가 동반된 경우는 2예 (10%)였다. 태아수종이나 복수가 동반된 2예 중 한 예는 흉강-양막강단락술을 시행하였고, 다른 한 예는 산모가 원하여 임신을 종결하였다. 임신을 유지한 15예 중 흉강-양막강단락술을 시행한 1예를 제외하면 모두 만삭분만 하였으며 (평균 분만 주수: 39.6±2.2주, 평균체중: 3,200±500 gram), 15예 모두 출생 후 다른 합병증 없이 생존 퇴원하였다. 산전초음파 분류에 의해 대낭성으로 확인된 13예 중 출생 후 조직학적 분류에서 미세낭이나 고형성 병변인 III형은 없었으며, 소낭성으로 진단된 7예의 경우 III형이 5예(83%)로 산전초음파 분류와 출생 후 분류간의 연관성을 확인할 수 있었다(P<0.01). 결론: 산전진단된 선천성 낭종성선종양폐기형에서 태아수종이나 복수와 같은 합병증의 빈도는 10%였으며, 이러한 합병증이 없이 임신을 지속한 경우 임신결과는 매우 양호하였다.