In-Sook Sohn

Rupture of a pseudoaneurysm as a rare cause of severe postpartum hemorrhage: analysis of 11 cases and a review of the literature

OBJECTIVE To clarify the clinical features of severe postpartum hemorrhage (PPH) resulting from a ruptured pseudoaneurysm and to determine the efficacy of selective arterial embolization as a method of management. STUDY DESIGN Eleven women who underwent selective arterial embolization for treatment of severe hemorrhage due to a ruptured pseudoaneurysm were identified from 2 hospitals within the past 5 years. A retrospective analysis was performed to identify the clinical characteristics of the hemorrhage and to evaluate the efficacy of arterial embolization. RESULTS Nine women delivered by cesarean delivery. Eight of the 11 women had late PPH with onset of bleeding occurring 6-100 days (median, 11.5) after delivery. The average volume of transfusion was 3196 ml of packed red blood cells (range, 1600-8980 ml). Uterine atony occurred in only one patient and was accompanied by an intrauterine abscess. Administration of uterotonic agents did not diminish the bleeding. Only one patient out of 11 underwent re-embolization. CONCLUSION If late PPH without uterine infection or retained placenta occurs after cesarean delivery, one should suspect the possibility of a ruptured pseudoaneurysm. Selective arterial embolization may be considered as a primary means of treatment.

Intercellular adhesion molecule‐1 K469E polymorphism in Korean patients with spontaneous preterm delivery

To investigate the association between intercellular adhesion molecule‐1 (ICAM‐1) gene K469E polymorphism and spontaneous preterm delivery in a Korean population.

Nationwide cervical cancer screening in Korea: data from the National Health Insurance Service Cancer Screening Program and National Cancer Screening Program, 2009–2014

Objective The rates of participation in the Korean nationwide cervical cancer screening program and the rates of abnormal test results were determined. Methods The database of the National Health Insurance Service (NHIS) was used during the study period (2009–2014). Results The participation rate increased from 41.10% in 2009 to 51.52% in 2014 (annual percentage change, 4.126%; 95% confidence interval [CI]=2.253–6.034). During the study period, women ≥70 years of age had the lowest rate of participation (range, 21.7%–31.9%) and those 30–39 years of age the second-lowest (27.7%–44.9%). The participation rates of National Health Insurance beneficiaries (range, 48.6%–52.5%) were higher than those of Medical Aid Program (MAP) recipients (29.6%–33.2%). The rates of abnormal results were 0.65% in 2009 and 0.52% in 2014, with a decreasing tendency in all age groups except the youngest (30–39 years). Every year the abnormal result rates tended to decrease with age, from the age groups of 30–39 years to 60–69 years but increased in women ≥70 years of age. The ratio of patients with atypical squamous cells of undetermined significance compared with those with squamous intraepithelial lesions increased from 2.71 in 2009 to 4.91 in 2014. Conclusion Differences related to age and occurring over time were found in the rates of participation and abnormal results. Further efforts are needed to encourage participation in cervical cancer screening, especially for MAP recipients, elderly women and women 30–39 years of age. Quality control measures for cervical cancer screening programs should be enforced consistently.

Interventional management for complications following caesarean section

OBJECTIVES This study aimed to evaluate the efficacy and safety of interventional management for various intractable complications following caesarean section. METHODS Between August 2005 and September 2009, 18 consecutive women were referred to interventional radiology for treatment of complications developing after caesarean section. Complications included vaginal bleeding (n = 14), haemoperitoneum with abdominal wall haematoma (n = 2), caesarean scar pregnancy (CSP) (n = 1) and post-caesarean fluid collection (n = 1). RESULTS 17 women underwent transcatheter arterial embolisation (TAE) with a variety of embolic materials, and two women underwent percutaneous drainage (PCD) for fluid collection and haemoperitoneum. 5 of the 14 women with vaginal bleeding had extravasation of contrast media on angiography; the other 9 had no visible bleeding foci. The two women with haemoperitoneum with abdominal wall haematoma had injury to the inferior epigastric artery from angiography. TAE and PCD were successfully performed in both women. The CSP was successfully managed and the serum β-human chorionic gonadotropin (β-hCG) level finally normalised. Hysterectomy or dilatation and curretage was required in women with placenta accrete and undetectable bleeding foci. CONCLUSION Interventional management including TAE and PCD is effective and safe in controlling complications following caesarean section. Use of these procedures can help avoid high-risk surgery, but subsequent procedures including hysterectomy may be required in cases of placental abnormalities and undetectable bleeding foci.

Expression of DJ-1 proteins in placentas from women with severe preeclampsia

OBJECTIVE Lately, DJ-1 has been identified as a novel mediator of hypoxia-induced cellular responses. The aim of this study was to determine the difference of DJ-1 expression in the placentas of women with normal and preeclamptic pregnancies. STUDY DESIGN DJ-1 mRNA expression was quantified by quantitative reverse transcription polymerase chain reaction (RT-PCR). Also, immunoperoxidase and immunofluorescent staining for DJ-1 was performed on 11 normal and 12 preeclamptic placental tissues. RESULTS The expression of mRNA of DJ-1 was significantly higher in the study group than in the control group. The immunoreactivity was especially higher in the syncytiotrophoblast of preeclamptic placentas compared to the control group. CONCLUSION Overexpression of the DJ-1 protein in the placentas of severe PE patients is thought to be a causative or compensatory mechanism in response to hypoxia, and this finding might contribute to a better understanding of the pathophysiology of preeclampsia.

Effect of DJ-1 Downregulation on the Functions of the First Trimester Extravillous Trophoblasts

DJ-1 (PARK7) has been reported to be causative gene of Parkinson disease and also an oncogene. A loss in DJ-1 function can lead to cell death in neurodegenerative disease, or a gain of it can cause unregulated cell survival in cancer, respectively. DJ-1 protein is known to be expressed mainly in trophoblastic cells in the placenta with increased expression in the first trimester compared to later in term. However, its role in trophoblast regulation remains unknown. This study aimed to investigate the effect of DJ-1 regulation on a first trimester extravillous trophoblast cell line, HTR-8/SVneo. The effect of DJ-1 downregulation induced by small-interfering RNA on cell apoptosis, migration, and the pathway to regulate the cell function was assessed. Data of this study showed that DJ-1 downregulation increased apoptosis and reduced migration by regulating matrix metalloproteinase 2 and matrix metalloproteinase 9 in HTR-8/SVneo cells under both ambient and oxidative stress. Changes in cell function were demonstrated to be at least partly dependent on the AKT/S6 kinase beta-1 (S6K1) pathway. In summary, DJ-1 might play a protective role in maintaining trophoblastic cell functions through the AKT/S6K1-based pathway.

Evaluation of ABX Pentra DX 120 and Sysmex XE‐2100 in umbilical cord blood

Cord blood (CB) is an important source of hematopoietic stem cells and reflects the hematologic status of neonates. ABX Pentra DX 120 (Horiba Medical, Montpellier, France) and Sysmex XE‐2100 (Sysmex, Kobe, Japan) were compared in 200 CB specimens.

Incarceration of early gravid uterus with adenomyosis and myoma: report of two patients managed with uterine reduction

Although gravid uterine incarceration is typically diagnosed during the early second trimester, we encountered two unusual cases in early pregnancy. A 34-year-old multiparous woman with adenomyosis presented at 7 + 2 weeks of gestation with increased urinary frequency and a sensation of incomplete bladder emptying. The uterine incarceration was successfully reduced by manual reduction and pessary insertion, and she delivered a normal infant at term. In the second case, a 31-year-old nulliparous woman with a large myoma complained of dysuria, acute urinary retention, and intense back pain at 6 weeks of gestation. Manual reduction was successful in the knee-chest position. Subsequent pessary insertion failed; however, a slight reduction in pain was achieved. After a week, the fetus spontaneously aborted. In summary, gravid uterine incarceration is a rare but potentially fatal condition for the fetus, and a suspicion of this condition in patients with urinary symptoms, especially urinary retention and pelvic pain, is important in the early gestation period.

A comparative analysis of maternal and fetal 25-hydroxyvitamin D in pregnant women with and without gestational diabetes mellitus

Abstract Objective: This study aimed to compare maternal 25-hydroxyvitamin D (25(OH)D) serum levels during pregnancy in women with and without gestational diabetes mellitus (GDM) with neonatal 25(OH)D serum levels and to evaluate the relationship between maternal and fetal 25(OH)D in the two groups. Methods: Between May 2014 and March 2015, 87 pregnant women were enrolled. The study population was divided into two groups, those with and without GDM (n = 32 and 55). All participants were surveyed about lifestyle and behavior. Maternal and umbilical venous blood samples were obtained. Serum from maternal blood was analyzed for 25(OH)D2 and 25(OH)D3, and umbilical venous blood for 25(OH)D2, 25(OH)D3, and 3-epi-25(OH)D3. Results: The maternal serum level of 25(OH)D3 and the 25(OH)D3 and 3-epi-25(OH)D3 levels in umbilical venous blood were significantly lower in women with GDM (p < .01 for all comparisons). The maternal blood levels of 25(OH)D2, 25(OH)D3, and total 25(OH)D were positively correlated with their levels in umbilical venous blood in the total, normal, and GDM groups. Conclusions: The serum 25(OH)D3 and 3-epi-25(OH)D3 levels of babies from mothers with GDM are lower than in pregnant women without GDM.

Perinatal Outcomes according to Screening Timing in Gestational Diabetic Women with Family History of Diabetes

Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea Objective: To compare perinatal outcomes of gestational diabetic women with a family history of type 2 diabetes mellitus (DM), who were diagnosed through early or late screening. Methods: After 2010, women with a family history of DM underwent 2-step screening at the initial visit, mostly before 16 weeks of gestation. The perinatal outcomes were compared with those of historical cohort screened at 24-28 weeks of gestation between 2005 and 2009. The primary outcomes were complications associated with maternal hyperglycemia such as primary cesarean delivery, large for gestational age (LGA), neonatal hypoglycemia, and fetal anomaly. Results: The risk of gestational diabetes mellitus (GDM) was 20.8% (67/322) in women with a history of DM in a first-degree relative. Women who were screened before 16 weeks of gestation were more likely to have a high level of hemoglobin A1C at diagnosis and receive insulin therapy for glycemic control than the Late-screen group. But odds ratios of LGA, primary cesarean delivery and fetal anomalies compared with normal control were highest in the Late-screen group than in the Early screen group and the Low risk GDM group. Conclusion: Some perinatal outcomes may be more favorable in women with GDM and a family history of DM who were screened before 16 weeks of gestation rather than routinely.