Hai-Joong Kim

The levels of circulating vascular endothelial growth factor and soluble Flt-1 in pregnancies complicated by preeclampsia

To evaluate the role of vascular endothelial growth factor (VEGF) in the pathogenesis of preeclampsia, we measured total VEGF, free VEGF and soluble Flt-1 (sFlt-1) concentrations and determined their relationships. Maternal serum samples were collected from 20 patients with preeclampsia and 20 normotensive women with uncomplicated pregnancies matched with the patients with preeclampsia for gestational age and parity. The serum concentrations of total VEGF (2.39±0.75 vs. 0.28±0.14) and sFlt-1 (934.5±235.5 vs. 298.0±161.2) were significantly increased in the patients with preeclampsia compared to the women with uncomplicated pregnancies. However the serum concentration of free VEGF (21.5±6.3 vs. 134.0±16.3) was lower in patients with preeclampsia. There was a positive correlation between the serum concentrations of total VEGF and sFlt-1 with systolic and diastolic blood pressure, respectively. There was a negative correlation between the serum concentration of free VEGF and systolic and diastolic blood pressure. There was a strong negative correlation between free VEGF and sFlt-1 concentrations. In conclusion, we found VEGF and sFlt-1 were related to the pathogenesis of preeclampsia. Although reduced concentrations of free VEGF might interfere with endothelial cell function and survival, further studies are required to clarify its specific role in the pathogenesis of preeclampsia.

Retinol-binding protein-4 is decreased in patients with preeclampsia in comparison with normal pregnant women.

Abstract Aims: The aim of this study was to investigate retinol-binding protein-4 (RBP4) levels in maternal and umbilical cord serum in patients in the third trimester of pregnancy with preeclampsia in comparison to levels in normal pregnant women. Methods: The RBP4 levels in maternal and umbilical cord serum were measured and compared by enzyme-linked immunosorbent assay in 16 normal pregnant and 16 patients with preeclampsia. Results: Both maternal and umbilical cord serum RBP4 levels were significantly decreased in patients with preeclampsia, as compared to normal pregnant women (maternal serum, median 168.0 μg/mL vs. 202.0 μg/mL, P<0.001; umbilical cord serum, median 147.9 μg/mL vs. 193.0 μg/mL, P<0.001). Preeclampsia was independently related to RBP4 levels of maternal and umbilical cord serum. Conclusion: Both maternal and umbilical cord serum RBP4 levels were lower in patients with preeclampsia than in normal pregnant women in the third trimester of pregnancy.

Prior cesarean section is associated with increased preeclampsia risk in a subsequent pregnancy

BackgroundTo evaluate the impact of a prior cesarean section on preeclampsia risk in a subsequent pregnancy.MethodsStudy data were collected from the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service for 2006–2010. Patients who had their first delivery in 2006 and subsequent delivery between 2007 and 2010 in Korea were enrolled. The overall incidence of preeclampsia during the second pregnancy was estimated and to evaluate the risk of preeclampsia in the second pregnancy, a model of multivariate logistic regression analysis was performed with preeclampsia as the final outcomeResultsThe risk of preeclampsia in any pregnancy was 2.17%; the risk in the first pregnancy was 2.76%, and that in the second pregnancy was 1.15%. During the second pregnancy, the risk of preeclampsia was 13.30% for women who had developed preeclampsia in their first pregnancy and 0.85% for those who had not. In the entire population, prior cesarean section was associated with preeclampsia risk in their subsequent pregnancy (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.13–1.41). Among women with and without preeclampsia in their first pregnancy, a prior cesarean section was associated with preeclampsia risk in their second pregnancy (OR, 1.35; 95% CI, 1.09–1.67; OR, 1.23; 95% CI, 1.08–1.40, respectively).ConclusionsOur study showed that cesarean section in a first pregnancy was associated with increased preeclampsia risk in the second pregnancy. These results provide physicians with a preeclampsia risk evaluation method for a second pregnancy that they may aid counseling in patients.

Maternal Smoke during Pregnancy Programs for Bone Disturbance in Offspring

Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul; Department of Obstetrics and Gynecology, Sungae Hospital, Seoul, Korea Objective: A number of epidemiological studies have reported that smoking causes a decrease in bone mineral density (BMD) and an increase in the risk of bone fracture, and is a risk factor for osteoxad porosis. Maternal smoking during pregnancy results in a variety of adverse developmental outcomes associated with intrauterine growth restriction. However, little is known about the effect of maternal smoking during pregnancy on BMD in the offspring. Methods: Pregnant CDxad1 mice were exposed to cigarette smoke (1 or 2 cigarettes/day, 5 days/week) (smoke group) or sham exposed (control group) throughout pregnancy. After delivery, nursing dams and offspring were kept together in individual cages. At 4 weeks, the fourth lumbar vertebral body of each offspring was scanned with a microxad computed tomography apparatus. Trabecular parameters including bone volume fraction (bone volume/total volume, %), thickness (mm), number (1/mm), and separation (mm) were evaluated. The BMD was also measured. Results: No differences in the trabecular bone volume fraction, thickness, separation, and number and the BMD were observed between the offspring of the control and 1 cigarette smoking dams. However, trabecular bone volume fraction, thickness, number, and the BMD were significantly lower, whereas trabecular separation was higher in the offspring of 2 cigarette smoking dams compared with those of the offspring from control dams. Conclusion: Maternal smoking during pregnancy decreased BMD and altered bone microarchitecture in the offspring. These results will become a great source to inform the importance of quitting smoking during pregnancy.

Prepregnancy Factors Are Associated with Development of Hypertension Later in Life in Women with Pre-Eclampsia

BACKGROUNDnThe aim of our study was to investigate the prepregnancy characteristics that are risk factors for the development of hypertension (HTN) and identify prepregnancy factors for the development of HTN in women affected by pre-eclampsia in their first pregnancy.nnnMETHODSnWe enrolled 1910 women who had undergone a National Health Screening Examination through the National Health Insurance Corporation between 2002 and 2003, and who had their first delivery affected by pre-eclampsia in 2004. Women were classified as having HTN if they were newly diagnosed with HTN from 2005 through 2012.nnnRESULTSnAfter 8 years of follow-up, 7.7% (148/1910) of pre-eclamptic women developed HTN. Using the Cox proportional hazards model, old age (hazard ratio [HR] 3.92, 95% confidence interval [CI] 2.47-6.23), a family history of HTN (HR 2.28, 95% CI 1.46-3.58), prepregnancy obesity (HR 3.74, 95% CI 2.50-5.59), and high blood pressure (BP) (HR 2.78, 95% CI 1.85-4.19) were independently associated with the development of HTN.nnnCONCLUSIONSnThe results show that the development of HTN in pre-eclamptic women is related to prepregnancy factors. Recognizing who subsequently develops HTN postpartum in pre-eclamptic women with these prepregnancy factors could lead to early identification and lifestyle interventions, which could reduce the burden of cardiovascular disease.

Adaptive responses of cardiac function to fetal postural change as gestational age increases

Objective The cardiovascular system maintains homeostasis through a series of adaptive responses to physiological requirements. However, little is known about the adaptation of fetal cardiac function to gravity, according to gestational age. In the present study, we aimed to evaluate the adaptive responses of cardiac function to postural changes, using Tei index measurements. Methods Fetal echocardiography and Doppler examination were performed on 114 women with vertex singleton pregnancies at 19 to 40 weeks gestation. Participants were placed in an upright seated position, and the Tei index for fetal left ventricular cardiac function was measured. The women were then moved into a supine position and the Tei index was re-measured. Results The mean Tei index when measured in an upright seated position was significantly lower than that measured in a supine positioning for all fetuses (0.528±0.103 vs. 0.555±0.106, P=0.014, respectively). This difference was also noted in fetuses with a gestational age of 28–40 weeks (0.539±0.107 vs. 0.574±0.102, P=0.011, respectively). However, there was no difference in the Tei index between an upright seated and a supine position among fetuses with a gestational age of <28 weeks (0.505±0.091 vs. 0.516±0.103, P=0.571, respectively). Conclusion Postural changes from an upright seated to a supine position result in an increased Tei index after a gestational age of 28 weeks. This appears to reflect maturation in the adaptive responses of the fetal cardiovascular system to postural changes.

Three-dimensional volumetric gray-scale uterine cervix histogram prediction of days to delivery in full term pregnancy

Objective Our aim was to figure out whether volumetric gray-scale histogram difference between anterior and posterior cervix can indicate the extent of cervical consistency. Methods We collected data of 95 patients who were appropriate for vaginal delivery with 36th to 37th weeks of gestational age from September 2010 to October 2011 in the Department of Obstetrics and Gynecology, Korea University Ansan Hospital. Patients were excluded who had one of the followings: Cesarean section, labor induction, premature rupture of membrane. Thirty-four patients were finally enrolled. The patients underwent evaluation of the cervix through Bishop score, cervical length, cervical volume, three-dimensional (3D) cervical volumetric gray-scale histogram. The interval days from the cervix evaluation to the delivery day were counted. We compared to 3D cervical volumetric gray-scale histogram, Bishop score, cervical length, cervical volume with interval days from the evaluation of the cervix to the delivery. Results Gray-scale histogram difference between anterior and posterior cervix was significantly correlated to days to delivery. Its correlation coefficient (R) was 0.500 (P = 0.003). The cervical length was significantly related to the days to delivery. The correlation coefficient (R) and P-value between them were 0.421 and 0.013. However, anterior lip histogram, posterior lip histogram, total cervical volume, Bishop score were not associated with days to delivery (P >0.05). Conclusion By using gray-scale histogram difference between anterior and posterior cervix and cervical length correlated with the days to delivery. These methods can be utilized to better help predict a cervical consistency.

TWO PLACENTAS IN SINGLETON PREGNANCY WITH FUSED UMBILICAL CORD: A CASE REPORT

Two placentas in singleton pregnancy with fused umbilical cord which has its own placental insertion site forming 3-vessel cord at fetal end is an extremely rare case. This present case describes two placentas with fused umbilical cord with an episode of vanishing twin syndrome and there seems to be a strong relationship between these two events. A 37-year-old woman, gravid 0, para 0, visited emergency room with an episode of vaginal bleeding without pelvic cramps at 8 weeks and 5 days of gestation and repeated ultrasonic exams revealed reabsorption of vanishing twin and two separate placentas on anterior and posterior body of uterus. At 40 weeks and 4 days, the patient delivered a viable female infant weighing 3,900 g via Cesarean section and postpartum examination of the placentas and membranes confirmed two placentas with fused umbilical cord. Two placentas were almost equal in size and there were 2 cord insertions, 1 into each placenta. The cord at each of the placental disc had marginal insertion site and main placental disc cord had 2 arteries with one vein (3 vessel-cord) whereas side placental disc cord had one artery with one vein (2 vessel-cord). Several hypothesis for this two placentas with fused umbilical cord in singleton pregnancy, were proposed including placenta abnormalities after in vitro fertilization-embryo transfer procedure, succenturiate lobes and fetus in fetus, however, further evaluation is need.

OP09.11: Three‐dimensional gestational sac volumetry as the new biometric parameter and the intraobsever and interobserver reproducibility

Cervical length by 2DUS 11.50 mm 69.2% 82.5% 45.0% 92.9% 80.3% 0.817 (0.687–0.947) Cervical length by 3DUS 13.35 mm 76.9% 84.1% 50.0% 94.6% 82.9% 0.812 (0.676–0.948) Cervical volume (VOCAL) 24.31 cc 69.2% 79.4% 40.9% 92.6% 77.6% 0.809 (0.671–0.947) Cervical volume (Ellipsoid) 15.87 cc 69.2% 84.1% 47.4% 93.0% 81.6% 0.815 (0.694–0.936) Cervical volume 21.32 cc 69.2% 82.5% 45.0% 92.9% 80.3% 0.803 (0.664–0.942)