Joong-Sik Shin

Maternal Serum Levels of VCAM-1, ICAM-1 and E-selectin in Preeclampsia

Endothelial dysfunction is thought to be a central pathogenic feature in preeclampsia on the basis of elevated adhesion molecules. The aim of the present study was to compare the levels of soluble vascular cell adhesion molecule-1 (sVCAM-1), intercellular adhesion molecule-1 (sICAM-1) and E-selectin (sE-selectin) in sera of normal and preeclamptic pregnancies. We studied the serum levels of sVCAM-1, sICAM-1 and sE-selectin in normal pregnant women (n=63), mild preeclampsia (n=33) and severe preeclampsia (n=82). Concentrations of soluble adhesion molecules were determined with enzyme-linked immunoassay (ELISA). Serum concentrations of sVCAM-1 were significantly higher in both mild (p=0.004) and severe preeclampsia (p=0.000) than normal pregnancy. There were also significant differences in sVCAM-1 levels between mild and severe preeclampsia (p=0.002). sICAM-1 levels of severe preeclampsia were statistically different from those of normal pregnancy (p=0.038). Levels of sE-selectin were elevated in both mild (p=0.011) and severe preeclampsia (p=0.000) compared to normal pregnancy, but no statistical difference between the mild and severe preeclampsia (p=0.345). These results suggest that all three soluble adhesion molecules are increased in severe preeclampsia, and sVCAM-1 among them may be useful in predicting the severity of preeclampsia.

Maternal Serum and Amniotic Fluid Inhibin A Levels in Women who Subsequently Develop Severe Preeclampsia

The purpose of this study was to evaluate whether maternal serum (MS) and amniotic fluid (AF) inhibin A levels are elevated in patients who subsequently develop severe preecalmpsia, and to investigate the correlation between MS and AF inhibin A levels in the second trimester. The study included 40 patients who subsequently developed severe preecalmpsia and 80 normal pregnant women. Inhibin A levels in MS and AF were measured with enzyme-linked immunosorbent assay (ELISA). The MS and AF inhibin A levels in patients who developed severe preeclampsia were significantly higher than those in the control group (both for p<0.001). There was a positive correlation between MS and AF inhibin A levels in patients who developed severe preeclampsia (r=0.397, p=0.011), but not in the control group (r=0.185, p=0.126). The best cutoff values of MS and AF inhibin A levels for the prediction of severe preeclampsia were 427 pg/mL and 599 pg/mL, respectively; the estimated ORs that were associated with these cut-off values were 9.95 (95% CI 3.8-25.9, p<0.001) and 6.0 (95% CI 2.3-15.8, p<0.001). An elevated level of inhibin A in MS and AF at the time of second trimester amniocentesis may be a risk factor for the subsequent development of severe preeclampsia.

Exposure to Rosiglitazone and Fluoxetine in the First Trimester of Pregnancy

Rosiglitazone is a thiazolidinedione oral hypoglycemic drug that seems to be a promising alternative not only as an oral hypoglycemic agent but also for women with polycystic ovary syndrome. However, information regarding exposure to rosiglitazone in pregnancy is limited to two previous case reports. In the first case, a 35-year-old woman was exposed until the 8th week of pregnancy to 4 mg/day rosiglitazone and to glicazide, acarbose, atorvastatin, spironolactone, hydrochlorothiazide, carbamazepine, thiridazine, amitryptiline, chlordiazepoxide, and pipenzolate bromide (1). The second case was a woman exposed to 4 mg/day rosiglitazone between gestational weeks 13 and 17 (2). The two cases delivered normal babies at gestational weeks 36 and 37, …

OP23.05: Procedure outcomes of embryo reduction and selective feticide with multifetal pregnancy to twin or singleton pregnancy: a retrospective study

the use of intracardiac potassium chloride and fetal reduction must be performed using cord occlusion techniques such as bipolar cord coagulation, interstitial laser or by radiofrequency ablation. We present our series of selective reduction in complex triplet pregnancy with an MC pair using radiofrequency ablation (RFA). Methods: This was a retrospective study of the procedures in our unit for the period between 2010 and 2016. We had 25 cases of complex triplets (19 Dichorionic and 6 Monochorionic triplets). The indications for fetal reduction include 14 of multifetal pregnancy reduction, 9 cases of TTTs in the Monochorionic pair, 1 of fetal anomaly in co twin and 1 of discordant growth in the MC pair. Results: Outcome data was available in 24 cases. Median GA at procedure was 15.4 weeks (range 12.1-21.7) and at delivery was 32.9 weeks (range 17.4-41). We had 3 miscarriages; 2 cases occurred within 2 weeks of procedure. IUD of the co-twin occurred in 3 cases (2 in DCTA and 1 in MCTA). The median GA at delivery following MFPR in complex triplets was 34.6 weeks and in the TTTS group was 32.3 weeks. Complications included complex thermal injury to the co twin in 1 case resulting in the subsequent termination of the co twin. There were no cases of neurological impairment in the survivors post procedure. Conclusions: This is the largest case series of fetal reduction in complex triplets by RFA. Selective reduction by RFA in complex triplet pregnancies resulted in a total pregnancy loss in 12.5% of the cases with an 87.5% favourable outcome, in other words two live babies at discharge from hospital. The gestational age was higher at delivery in the MFPR group compared to other indications for selective fetal reduction. This data is useful in appropriate counselling of complex triplex pregnancies.

OP05.13: Fetal loss rate after midtrimester amniocentesis in twin pregnancies

Objective: To assess the fetal loss rate among dichorionic twin gestations undergoing genetic amniocentesis compared with singletons undergoing the procedure and untested twins. Methods: From January 2002 through December 2004, total 132 pregnant women with dichorionic twin gestation with mid-trimester amniocentesis at Hospital were included in this study. In control group, 595 women with untested dichorionic twins during the same period and 402 women with singleton pregnancies with amniocentesis performed by the same physician at the same date of study group were selected. Excluded were fetuses with known structural anomalies, cases in which amniocentesis was done in only one fetus, and cases of which pregnancies were terminated due to fetal chromosomal abnormalities. Fetal loss was defined as the loss of both fetuses and subdivided into two categories: within 4 weeks after amniocentesis and before 28 gestational weeks. Results: Up to 4 weeks after the procedure, one case (0.75%) in the tested twin group, two cases in post-procedure singleton group (0.49%, P=.729), and eight cases in the untested twin control group (1.34%, P=.581) were aborted spontaneously. Up to 28 gestational weeks, four fetal losses occurred in post-amniocentesis twins (3.03%), sixteen cases in untested twins (2.69%, P=.83), and two cases in the singleton pregnancies with amniocentesis (0.49%, P=.017). Conclusion: The risk of fetal loss in twin underwent mid-trimester amniocentesis appears to be higher than that of tested singletons in this study. However, there was no significant difference in the fetal loss rates between amniocentesis twin group and untested twin group.