Hye Ri Hong

High-risk human papillomavirus infection is associated with premature rupture of membranes

BackgroundHuman papillomavirus (HPV) is known to be more prevalent in spontaneous abortions than in elective terminations of pregnancy. More recently, placental infection with HPV was shown to be associated with spontaneous preterm delivery. However, no study has evaluated the prevalence of HPV infection in pregnant Korean females and its association with adverse pregnancy outcomes.MethodsWe conducted a cross-sectional study of 311 females who gave birth at Korea University Medical Center. Our sample included 45 preterm deliveries, 50 cases of premature rupture of the membranes (PROM), 21 preeclampsia cases, and 8 gestational diabetes mellitus (GDM) patients. We used the Hybrid Capture II system to detect high-risk (HR)-HPV infection at six weeks postpartum.ResultsThe prevalence of HR-HPV infection was 14.1%. Women with HR-HPV infection had a higher incidence of PROM than those without HR-HPV. HR-HPV infection was associated with an increased risk of PROM (OR, 2.380; 95% CI, 1.103-5.134). The prevalence of preterm delivery, preeclampsia, or GDM was not different between the two groups.ConclusionsWe observed a high prevalence of HR-HPV infection in pregnant women. Moreover, HR-HPV infection was associated with a risk of PROM at term. Further studies are needed to evaluate mechanisms by which HR-HPV infection induces PROM.

Secular Trends of Gestational Diabetes Mellitus and Changes in Its Risk Factors

Objective The aim of this study was to evaluate the secular trends of incidence of gestational diabetes mellitus (GDM) and insulin treatment for GDM in a Korean population and to determine the factors that contribute to the trends in the incidence of GDM. Study Design We used data collected by the Health Insurance Review & Assessment Service of Korea and analyzed data from women who had given birth from 2006 to 2010. We evaluated the trends in the incidence of GDM and GDM requiring insulin treatment and the changes in risk factors. Results There were 1,824,913 births during the study period, which included 129,666 cases of GDM, an incidence of 7.11% over this period. The incidence of GDM increased from 3.86% in 2007 to 11.83% in 2010, with a continuous increase after adjustment for age. However, the number of GDM cases that required insulin treatment decreased significantly from 13.87% in 2007 to 5.94% in 2010. The proportion of patients who were at an older age and multiparity, 2 GDM risk factors, increased during the study period. Conclusions In Korea, the incidence of GDM, especially mild GDM, increased dramatically during the period from 2006 to 2010. Further efforts are needed to monitor this trend and to identify associated factors.

Trends in the rates of peripartum hysterectomy and uterine artery embolization.

The objective of this study was to determine the trends in national rates of peripartum hysterectomy (PH) and uterine arterial embolization (UAE) in Korea. We used data collected by the Health Insurance Review & Assessment Service of Korea and analyzed data from patients who gave birth during the period from 2005 to 2008. There were 1785,178 deliveries during the study period, including 2636 cases of PH (1.48 per 1000 deliveries). The PH rate in 2005 was 1.57 per 1000 deliveries and in 2008 it was 1.33 per 1000 deliveries. UAE was performed in 161 women (incidence, 0.38 per 1000 deliveries) and 447 women (incidence, 0.98 per 1000 deliveries) in 2005 and 2008, respectively. In Korea, the rate of PH decreased slightly, while the rate of UAE rate increased dramatically during the period from 2005 to 2008. Further studies are needed to evaluate the effects of UAE on the rate of PH performed.

Hepatitis A virus infection during pregnancy in Korea: Hepatitis A infection on pregnant women.

Objective Although there is a large body of data on acute hepatitis A virus (HAV) worldwide, data regarding the occurrence of HAV during pregnancy is limited. It is commonly acknowledged that HAV is not associated with severe outcomes or complications during pregnancy. In contrast, there are several reported cases of vertical HAV transmission. Moreover, it has been recently reported that HAV infection during pregnancy is associated with gestational complications. In Korea, the incidence of HAV infection has increased from 317 cases in 2002 to 13,117 cases in 2009. However, HAV infection during pregnancy is rarely reported in Korea. Methods This study was conducted as a retrospective cohort series of pregnant women presenting to Korea University Medical Center between January 2000 and October 2009 in whom a diagnosis of HAV infection was made. Results During study period, there were 12 cases of HAV in pregnant women, including two cases with preterm contraction, two cases with cholestatic hepatitis, and one case with fetal ascites and intra-abdominal calcification. Conclusion HAV infection during pregnancy is associated with high prevalence of maternal and fetal complications. Because the incidence of HAV infection in women of reproductive age is increasing, a further focus on preventing HAV infection during pregnancy is warranted.

The neuroprotective effect of magnesium sulfate in preterm fetal mice.

Abstract Objective: To investigate the use of magnesium sulfate (MgSO4) as a neuroprotective agent in a mouse model of inflammation-associated and noninflammation-associated preterm birth. Methods: On embryonic day 15 of gestation, lipopolysaccharide (LPS) and mifepristone (RU486) were used, respectively, to create mouse models of inflammation and noninflammation-associated preterm birth. After intraperitoneal injection of LPS, RU486, or normal saline solution (NS), dams were randomized to intraperitoneal MgSO4 or NS injection. From the 6 treatment groups (NS+NS, LPS+NS, NS+MgSO4, LPS+MgSO4, RU486+NS and RU486+MgSO4), fetal brains were collected for Western blot analysis and neuronal cultures. Protein expression of S100B was assessed, and immunohistochemistry was performed to detect NeuN. The numbers of NeuN-labeled cells were counted using confocal laser scanning microscopy. Results: The expression of S100B significantly differed among the groups and was decreased in the LPS+MgSO4 group compared to the LPS+NS group. The expression of S100B did not differ between the RU486+NS and RU486+MgSO4 groups. NeuN-labeled cells were increased in the LPS+MgSO4 group compared with the LPS+NS group. NeuN-labeled cells were decreased in the RU486+MgSO4 group compared with the RU486+NS group. Conclusions: We observed that prenatal treatment with MgSO4 was associated with decreased expression of S100B and increased numbers of NeuN-labeled cells in an inflammation-associated preterm mouse model but not in a noninflammation-associated preterm mouse model. Our results suggest that prenatal treatment of MgSO4 reduces inflammation-associated brain injury in fetal mice.

Comparison of the Seeplex HPV4A ACE and the Cervista HPV assays for the detection of HPV in hybrid capture 2 positive media

Objective To validate the efficacy of Seeplex HPV4A ACE for the detection of high-risk (HR) human papillomavirus (HPV) and HPV 16 and/or HPV 18 genotypes as compared to the PCR method and the Cervista HPV assays in cervical swab samples. Methods Besides liquid-based cytology, additional 97 cervical swab samples were collected for HPV genotyping by HPV4A ACE, Cervista HPV assays, and PCR method. To check the statistical differences, we also conducted the paired proportion test, Cohens κ statistic, and a receiver operating characteristic curve. Results Seeplex HPV4A ACE and the Cervista HPV HR showed substantial agreement with PCR for detection of HR HPVs (88.3%, κ=0.767 and 81.7%, κ=0.636, respectively). Seeplex HPV4A ACE also showed substantial agreement with the Cervista HPV 16/18 test (89.5%, κ=0.628). Additionally, the sensitivity and specificity of Seeplex HPV4A ACE and Cervista HPV HR were 91.4% vs. 84.5% and 73.4%, vs. 72.7%, respectively, when those higher than low-grade squamous intraepithelial lesions were regarded as abnormalities. HPV genotyping for HPV 16/18 detected cervical intraepithelial neoplasias (CINs) better than HR HPV tests (66.7% vs. 24.6% by HPV4A ACE, 52.6% vs. 25.9% by Cervista HPV assays in CIN II or more, relatively). Conclusion Seeplex HPV4A ACE is an effective method as the PCR and the Cervista HPV assays for the detection of HR HPVs and for genotyping of HPV 16 and 18.

Use of the angle of progression on ultrasonography to predict spontaneous onset of labor within 7 days

Abstract Objective: To investigate the relationship between angle of progression (AoP) on ultrasonography at 37–40 weeks’ gestation and delivery within 7 days. Methods: This prospective study was conducted between January 2013 and May 2013 at Korea University Guro Hospital, Korea. Nulliparous women between 37/0 and 40/3 weeks’ gestation with a singleton fetus, intact membrane, and cephalic presentation from January 2013 to May 2013 were enrolled. To evaluate the cervical parameters of cervical length and AoP, transvaginal and transperineal ultrasonography were performed, respectively. We then assessed the relationship between cervical parameters and onset of labor within 7 days by multivariate logistic regression analysis. Results: Women who underwent spontaneous onset of labor within 7 days had a significantly shorter cervical length and AoP than those who underwent labor after 7 days. Logistic regression analysis showed that a larger AoP was an independent predictor of spontaneous labor within 7 days. Conclusions: A larger AoP was significantly associated with spontaneous onset of labor within 7 days. These findings may be useful for counseling patients regarding the management of term pregnancies.

Decreased umbilical orexin-A level is associated with idiopathic polyhydramnios.

To evaluate the association between orexin‐A level and idiopathic polyhydramnios.

Analysis of Pregnancy Outcomes among Interracial Couples in Korea

Although the prevalence of interracial marriages in Korea is increasing, little is known regarding the pregnancy outcomes of interracial couples. The aim of this study was to investigate the differences in pregnancy outcomes between Korean and interracial Korean-foreign couples. Data for infants born in 2011 and 2012 were obtained from the national birth registry of the Korean Statistical Office. The couples were subdivided into Korean father-Korean mother, Korean father-foreign mother, and foreign father-Korean mother groups. Pregnancy outcomes included neonates with low birth weight (< 2,500 g) and those with high birth weight (> 4,000 g). In 2010 and 2011, 888,447 Korean father-Korean mother, 36,024 Korean father-foreign mother, and 4,955 foreign father-Korean mother neonates were delivered in Korea. After adjustment for parental age, educational level, parity, gestational age at delivery, and neonatal sex, the birth weights were found to be different between groups, with the highest number of foreign father-Korean mother and lowest number of Korean father-foreign mother pregnancies. Based on multivariate logistic regression analysis, the risk of low and large birth weights was higher in the Korean father-foreign mother and foreign father-Korean mother groups, respectively, compared with that in the Korean father-Korean mother group. There are significant differences in pregnancy outcomes including birth weights between Korean and interracial Korean-foreign couples.

Muscle weakness and myalgia as the initial presentation of serous ovarian carcinoma: A case report

IntroductionEpithelial ovarian cancer (EOC) has one of the worst prognoses among gynecologic cancers. An appropriate screening method is not available for EOC, and the initial symptoms such as abdominal pain or bloating, anorexia, and urinary urgency are vague. As a result, most cases of EOC are diagnosed at an advanced stage.Case presentationWe report novel insights gained from the case of a 45-year-old, gravida 0, para 0 woman who presented to the emergency department with complaints of general weakness, fatigue, and myalgia over the previous two months. She reported progressive muscle weakness of the upper and lower extremities leading to difficulty walking. Serum muscle enzymes, such as creatine phosphokinase, were markedly elevated. No evidence of malignancy was detected upon imaging. A biopsy of the left vastus medialis muscle was performed, and the results were consistent with primary myopathy with myofibrillar disarray, suggesting paraneoplastic necrotizing myopathy. Explorative laparotomy was performed to evaluate these results, and histopathological analysis of the full specimen revealed a grade 3 ovarian serous adenocarcinoma with direct invasion to the rectum.ConclusionsBecause of the lack of screening tools for EOC, any clinical findings suggesting its presence are valuable, and the possibility of EOC should be considered in unknown primary malignancies with initial complaints of muscle weakness or myalgia.