Moon-Kyoung Cho

Hydrogen peroxide-producing Lactobacilli in the vaginal flora of pregnant women with preterm labor with intact membranes.

Objectives: To investigate the role of vaginal infection in preterm delivery, we studied characteristics of vaginal discharge related to hydrogen peroxide‐producing Lactobacilli. Methods: Vaginal specimens were obtained from 66 women with normal pregnancy and 30 women with preterm labor with intact membranes. pH, leukocyte counts on wet smear, and scores by Nugent criteria on Gram stain were measured. Lactobacilli were tested for their production of hydrogen peroxide. Results: Leukocyte levels in wet smears and Nugent scores of Gram‐stained smear of women with preterm labor with intact membranes were significantly higher than those of normal pregnant women (P < 0.01, P < 0.05). Hydrogen peroxide‐producing Lactobacilli levels in the vaginal flora of women with preterm labor with intact membranes were significantly lower (P < 0.01). Conclusion: Distribution of hydrogen peroxide‐producing Lactobacilli in vaginal flora as defense factors for infection may have an important role in the pathophysiology of preterm labor.

Cumulus Cell-Expressed Type I Interferons Induce Cumulus Expansion in Mice

ABSTRACT Ovulation resembles the inflammatory response. The purpose of the present study was to examine the expression and role of type I interferons (IFNs) Ifnalpha and Ifnbeta in mouse ovaries during the process of ovulation. An in vivo injection of equine chorionic gonadotropin (CG)-human CG (hCG) stimulated Ifnalpha and Ifnbeta mRNA in cumulus-oocyte complexes (COCs) within 6 h. Type I IFN receptor (Ifnar1 and Ifnar2) genes were also expressed in preovulatory follicles without a change by hCG. Immunofluorescent study revealed the expression of protein signals of Ifnalpha, Ifnbeta, and Ifnar1 in cumulus cells. Treatment of COCs with Ifnalpha or Ifnbeta in vitro induced cumulus expansion that was comparable to that mediated by epiregulin. In cultured COCs, the levels of Ifnalpha and Ifnbeta mRNA increased by epiregulin and follicle-stimulating hormone, but not by prostaglandin E2. Ifnalpha and Ifnbeta activated multiple signaling events (signal transducer and activator of transcription-1/3, Akt, and mitogen-activated protein kinase 1/2) and stimulated the expression of genes known to impact COC expansion (Has2, Ptx3, Tnfaip6, and Ptgs2). Interestingly, treatment of COCs with Toll-like receptor (TLR) 2 and TLR4 ligands (lipopolysaccharides, Pam3Cys, and hyaluronan fragments) increased Ifnalpha and Ifnbeta mRNA, while coculture with anti-TLR2/4 neutralizing antibody abolished these effects. Taken together, these results demonstrate that the type I IFN system is operating in mouse cumulus cells and plays a role in the induction of cumulus expansion during the ovulatory process in mice.

Expression of peroxiredoxin I regulated by gonadotropins in the rat ovary

Objective Peroxiredoxins (Prxs) play an important role in regulating cellular differentiation and proliferation in several types of mammalian cells. This report examined the expression of Prx isotype I in the rat ovary after hormone treatment. Methods Immature rats were injected with 10 IU of pregnant mares serum gonadotropin (PMSG) to induce the growth of multiple preovulatory follicles and 10 IU of human chorionic gonadotropin (hCG) to induce ovulation. Immature rats were also treated with diethylstilbestrol (DES), an estrogen analogue, to induce the growth of multiple immature follicles. Northern blot analysis was performed to detect gene expression. Cell-type specific localization of Prx I mRNA were detected by in situ hybridization analysis. Results During follicle development, ovarian Prx I gene expression was detected in 3-day-old rats and had increased in 21-day-old rats. The levels of Prx I mRNA slightly declined one to two days following treatment with DES. A gradual increase in Prx I gene expression was observed in ovaries obtained from PMSG-treated immature rats. Furthermore, hCG treatment of PMSG-primed rats resulted in a gradual stimulation of Prx I mRNA levels by 24 hours (2.1-fold increase) following treatment, which remained high until 72 hours following treatment. In situ hybridization analysis revealed the expression of the Prx I gene in the granulosa cells of PMSG-primed ovaries and in the corpora lutea of ovaries stimulated with hCG for 72 hours. Conclusion These results demonstrate the gonadotropin and granulosa cell-specific stimulation of Prx I gene expression, suggesting its role as a local regulator of follicle development.

Regulation of interleukin-11 expression in ovulatory follicles of the rat ovary

The aim of the present study was to examine the regulation of interleukin (IL)-11 expression, as well as the role of IL-11, during ovulation in gonadotropin-primed immature rats. Injection of equine chorionic gonadotropin (eCG), followed by human CG (hCG) to induce superovulation stimulated expression of the Il11 gene in theca cells within 6h, as revealed by northern blot and in situ hybridisation analyses. Real-time reverse transcription-polymerase chain reaction analysis showed that the IL-11 receptor, α subunit gene was expressed in granulosa and theca cells and that injection of hCG had no effect on its expression. IL-11 protein expression was stimulated in theca cells by hCG. LH-stimulated increases in Il11 mRNA levels in cultured preovulatory follicles were inhibited by protein kinase A and mitogen-activated protein kinase kinase inhibitors. Toll-like receptor (TLR) 2 and TLR4 were detected in preovulatory follicles, and the TLR4 ligand lipopolysaccharide, but not the TLR2 ligand Pam3Cys, increased Il11 mRNA levels in theca cells, but not in granulosa cells. Treatment of preovulatory follicles with IL-11 stimulated progesterone production and steroidogenic acute regulatory protein (Star) gene expression. Together, these results indicate that IL-11 in theca cells is stimulated by mitogen-activated protein kinase signalling and TLR4 activation, and increases progesterone production during ovulation.

P05.06: Antenatal diagnosed occipital calcification: a case of craniosynostosis

Premature ossification and closure of the cranial sutures results in the abnormal shape and size of the skull. This can cause compression on cranial nerves and increased pressure on growing brain. In most cases, only one suture is affected and the condition is isolated and sporadic. However, in a minority of cases, closure of multiple sutures is possible and associated anomalies are present. The most frequent craniosynostosis is due to closure of the sagittal suture, which is responsible for about half of the cases, resulting in an elongated head (scaphocephaly). The second most frequent type is due to closure of the coronal suture that results in a very flat, recessed forehead (brachycephaly). We report a rare case of craniosynostosis in the sagittal and bilateral lambdoid sutures. Ultrasound examinations were performed in the ACCUVIX XQ (Medison, Seoul, Korea). Antenatal sonographic finding was normal except occipital calcification. Fetus occipital area was calcified and protrudent. Fetal brain MRI was checked and it was not detected any pathology finding. Cesarean section was performed at 37 weeks gestation. 2990g, male was born. He had abnormal scalp shape and small head. Craniosynostosis with sagittal and both lambdoid sutures and small cranial volume was detected in brain 3 dimensional CT. But brain MRI was not any evidence of brain anomaly. So we report our experience with a brief review of literature.

OP19.01: Atosiban, magnesium sulfate and ritodrine therapy for preterm labor: effects on uterine, fetal umbilical and middle cerebral artery Doppler parameters in the first 24 hours

Background: Cardiovascular abnormalities are common in the recipient twin in TTTS. In the donor, except for altered umbilical arterial flow, no gross cardiovascular changes are typically seen. Selective laser photocoagulation therapy (SLPT) improves outcome and can reverse many of the cardiovascular abnormalities noted in the recipient, however its impact on the donor twin heart has not been extensively studied. Objective: To investigate the effects of SLPT for TTTS on the cardiovascular status of the donor twin. Methods: Pre and post-operative fetal echos from 54 patients who underwent SLPT for TTTS Stage 2 or higher from June 2007 to February 2009 were reviewed. Cardiothoracic ratio (CTR), Doppler tricuspid and mitral E and A peak inflow velocities, umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PI), and myocardial performance indices (MPI) of the donor twin, were compared before and after SLPT. Presence or absence of pericardial effusion (PE) and tricuspid or mitral regurgitation were also noted. Results: CTR increased significantly as did mitral and tricuspid valve velocities, suggesting an increase in volume load. UA PI increased, but MCA PI remained unchanged. In select donors RV MPI increased substantially, however there was no difference for the group as a whole. Postoperatively, over 20% of donors developed a significant PE; nearly 50% developed tricuspid or mitral regurgitation. Conclusions: Important cardiovascular abnormalities develop in the donor twin following SLPT. The origin of these findings are unclear, but may be related to the insult of acute, rapid volume load in a previously volume depleted fetus. Serial fetal echo follow up of both donor and recipient for cardiovascular abnormalities after SLPT is warranted.

Predictive factors for vaginal birth after cesarean delivery

The dictum ‘once a cesarean always a cesarean’ dominated obstetric practice for nearly 70 years in the United States. The concept began to change approximately 30 years ago and reports have documented the relative safety of a trial of labor. The purpose of this study was to determine predictive factors associated with a successful trial of labor in women attempting a vaginal delivery after a cesarean delivery. The study was carried out from 1 January 1998 through 31 December 2001 at the Chonnam National University Hospital in Gwangju Korea. All pregnant women who satisfied the inclusion criterion of attempting a vaginal delivery after a cesarean delivery were invited to participate. They were counseled and their informed consent was obtained. A retrospective review of their charts and operative records was then performed and data for potential predictors were abstracted. These predictors were prior successful vaginal birth after cesarean delivery reasons for prior cesarean delivery and gestational age and birth weight at prior cesarean delivery. At the time of admission for labor we added data such as maternal age height body mass index and Bishop score gravity gestational age estimated fetal body weight and labor management techniques adopted such as induction or augmentation of labor. (excerpt)