No abstract available.
Extraembryonic Membranes* ; Placenta*

Embryology is essential for the undergraduate students of medical college to understand the process and mechanisms related to both normal and abnormal development. In almost all medical colleges, anatomy class precedes embryology or at least begin simultaneously with embryology even when the anatomy related subjects including embryology are operated as integrated process during the course of basic medical science curriculum. However in the medical college of Dankook University, embryology begins in premedical course and also precedes anatomy and other anatomy related subjects. This pattern of curriculum might have its own merit and there shouldn't be any problem or difficulty in learning general embryology contents such as fertilization process, early weeks of development, congenital malformations, and fetal membranes. However, the situation is somewhat different in learning system based embryology which is focused on the development of each human system during the embryonic period. As an attempt of prerequisite learning of anatomical knowledge before beginning each chapter of system based embryology, group presentation method was newly introduced to the embryology class. In this study, a survey analysis was performed in both presentation and non-presentation group. Common survey questionnaire for both presentation and non-presentation group was composed of previous experiences on embryology related subjects, necessities of knowledge on anatomy in learner's aspect, and free comments on embryology class at large. For the presentation group, preferred methods and contents for the prerequisite learning of anatomy, relevances in the level of difficulty and length of presentation class, and preferred level of prerequisite learning of anatomy were added to survey questionnaire. In the results, necessities of knowledge on anatomy in learner's aspect between presentation and non-presentation group was different with statistical significance. In non-presentation group, it was revealed that the students themselves hardly recognize the necessities of prerequisite learning because originally they had no experience on anatomy class. Therefore, the results revealed that the precedent effort of lecturer to supply diverse chances in prerequisite learning of anatomy is a high priority especially when embryology precedes anatomy or other anatomy related subjects.
Curriculum ; Embryology* ; Extraembryonic Membranes ; Fertilization ; Humans ; Learning* ; Methods ; Teaching*

OBJECTIVE: The aim of our study was to compare the thickness and histopathologic changes in the fetal membrane between premature rupture of membranes (PROM) and intact membrane after delivery. METHODS: In a prospective study involving 31 patients who were divided into 4 groups such as <37 weeks without PROM, <37 weeks with PROM, >or=37 weeks without PROM, and >or=37 weeks with PROM, we measured the thickness of membrane and studied the histopathologic findings in vitro by light microscopy of histological sections. RESULTS: The membrane thickness of <37 weeks with PROM group was thinner (35.9 micrometer) than that (42.3 micrometer) of <37 weeks without PROM group, but there was no statistical significance. The membrane thickness of >or=37 weeks with PROM and >or=37 weeks without PROM were similar (25.6 micrometer, 26.0 micrometer). But the membrane thickness of >or=37 weeks with/without PROM was significantly thinner (25.8 micrometer) compared with that (38.9 micrometer) of <37 weeks with/without PROM. The histopathologic features of PROM positive group was amnionitis with neutrophilic infiltration, focally or diffusely necrotic change of amniotic membrane, separation of amniotic membrane and degeneration of chorionic villi. CONCLUSION: The thickness of fetal membrane between PROM group and intact membrane group was not different but the thickness of fetal membrane between <37 weeks and >or=37 weeks was statistically significant. The histopathologic change of PROM positive group was prominent as amnionitis. Further evaluation will be needed about the relationship between membrane thickness and PROM.
Amnion ; Chorioamnionitis ; Chorionic Villi ; Extraembryonic Membranes ; Female ; Humans ; Membranes* ; Microscopy ; Neutrophils ; Pregnancy ; Prospective Studies ; Rupture*

The amniotic membrane is the innermost layer of fetal membrane and is attached to the chorion in the placenta. This membrane has been used for nearly a century in varied fields such as ophthalmology, reconstructive surgery, and burn treatment. In this case report, we used a human amniotic membrane to repair an iatrogenic oroantral communication that occurred during the extraction of the patient's right upper second molar. A splint was given after the perforation was covered with human amniotic membrane and healing was clinically evaluated at various intervals. The outcome of the study revealed that the human amniotic membrane was an efficient graft material for repairing the defect caused by an iatrogenic oroantral communication following tooth extraction.
Amnion* ; Burns ; Chorion ; Extraembryonic Membranes ; Humans* ; Membranes ; Molar ; Ophthalmology ; Patient Rights ; Placenta ; Splints ; Tooth Extraction ; Transplants

Incompetent internal os of cervix is treated with McDonald or Shirodkar cerclage after 14 weeks of gestation. In rare case, after 20 weeks of gestation fetal membrane is bulging into vaginal cavity, but cerclage in that period is risk factor for preterm labor and preterm premature rupture of membranes. So many complications are reported in that period. So many experiences for reducing fetal membranes into uterine cavity were performed. We report a case of amnioreduction in prolapsed fetal membranes after McDonald cerclage, and delivered in 33 weeks of gestation with brief review of literature.
Cervix Uteri ; Extraembryonic Membranes ; Female ; Membranes* ; Obstetric Labor, Premature ; Pregnancy ; Risk Factors ; Rupture

Cervical incompetence is one of the main contributors to repeated pregnancy loss and preterm delivery. Typically it results in progressive cervical dilatation, leading to a painless second or early third trimester abortion. Emergency cerclage can be used in the setting of advanced cervical incompetence, even when fetal membranes bulge through the dilated cervix. To facilitate the procedure, various techniques have been developed to replace the fetal membranes into the uterine cavity. We performed six successful cases of emergency cerclage combined with amnioreduction in advanced incompetent internal os of cervix (IIOC). Interval from emergency cerclage to delivery was 8.1 +/- 2.4 weeks (range 4-10 weeks) and we delivered viable fetuses in all but one. Hereby we report our experiences with a brief review of literature.
Cervix Uteri ; Emergencies* ; Extraembryonic Membranes ; Female ; Fetus ; Humans ; Labor Stage, First ; Pregnancy ; Pregnancy Trimester, Third

Two patients, bulging fetal membrane accompanied with cervical dilatation & effacement in the late second-trimester, were treated by modified Shirodkar method. Pregnancies were prolonged effectively and viable fetuses were delivered in both cases. Our cases may help make objective decision prior to attempting cerclage placement when cervix is markedly dilated and something should be done to save pregnancy.
Cervix Uteri ; Extraembryonic Membranes* ; Female ; Fetus ; Humans ; Labor Stage, First ; Pregnancy ; Uterine Cervical Incompetence*

Premature rupture of membranes(PROM) means the rupture of amniotic membranes at any time prior to labor during the gestational period. The dilemma of correctly diagnosing rupture of the fetal membranes is well known as the consequences of management based on an incorrect diagnosis. This study was undertaken to determine if the measurement of B-hCG levels in the vaginal fluid is useful for the diagnosis of premature rupture of membranes. HCG is synthesized and secreted by the placental syncytiotrophoblast and it is normally found in amniotic fluid, maternal urine and blood. We used B-hCG for diagnosis of PROM to exclude the cross reaction with other hormones. After irrigating the posterior vaginal fornix with 3 ml of sterile saline and obtaining vaginal washings, we measured B-hCG levels. The groups were classified normal group(group I), confirmed PROM group(group II ), and suspicious PROM group(groupIII) during the third trimester. The median and 95% confidence intervals(CIS) of vaginal fluid B-hCG in each group(normal, confirmed PROM, suspicious PROM group) were 30.99mIU/ml(range: 0.32-209.89mIU/ml), 188.61mIU/ml(range: 9.65-2095.00mIU/ml), 69.63mIU/ml(range 4.76-349.56mIU/ml). There was significant difference between normal and confirmed PROM group(p<0.05), sensitivity was 95.00%, specificity 80.00%, positive predictive value 82.60%, negative predictive value 94.12%, and accuracy 87.50%, using threshold value of 60mIU/ml. There was significant difference between normal and suspicious PROM group(p<0.05) but the result of the B-hCG was not used in the obstetric decision. In terms of these results, the B-hCG level in vaginal fluid is a useful marker of PROM during the third trimester. A new technic is proposed to confirm the diagnosis of rupture of the membranes based on the introduction of B-hCG in vaginal fluid.
Amnion ; Amniotic Fluid ; Cross Reactions ; Diagnosis ; Extraembryonic Membranes ; Female ; Humans ; Membranes* ; Pregnancy ; Pregnancy Trimester, Third ; Rupture* ; Sensitivity and Specificity ; Trophoblasts

PURPOSE: To compare clinical outcomes after management with bed rest versus cerclage for treatment of amniotic sac bulging in the second trimester. METHODS: Women with cervical incompetence with membranes at or beyond a dilated external cervical os, before 27weeks of gestation, were treated with bed rest or emergency cerclage. We analyzed the pregnancy outcome retrospectively. 25 women underwent an emergency cerclege and 35 women underwent the bed rest. RESULTS: Gestational age at time of diagnosis was 22.40 weeks in the emergency cerclage and 22.39 weeks in the bed rest group. Mean interval from diagnosis until delivery was 8.65 weeks in the emergency cerclage group and 1.18 weeks in the bed rest group (p<0.001). Mean gestational age at delivery was 31 weeks in emergency cerclage group and 23.74 weeks in the bed rest group (p<0.001). Preterm delivery before 26 weeks and 34 weeks of gestation were significantly lower in the emergency cerclage group (p<0.001). Perinatal mortality was 17.4% in the emergency cerclage group and 48.6% in bed rest group (P=0.026). CONCLUSION: Emergency cerclage reduced preterm delivery before 26 and 34 weeks and improved perinatal outcome compared with bed rest treatment.
Bed Rest ; Emergencies ; Extraembryonic Membranes ; Female ; Gestational Age ; Humans ; Membranes ; Perinatal Mortality ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second ; Retrospective Studies

BACKGROUND: Preterm labor accounts for one third of preterm deliveries. However, the causes and the mechanism of preterm labor are still under investigation. The purpose of this study was to investigate the changes of tissue transglutaminase 2 (TGM2) and cyclo-oxigenase I,II in the fetal membrane of patients with preterm birth compared with patients with term delivery. METHODS: Fetal membrane were obtained from women with preterm birth due to preterm labor (n=3) and from the women with term delivery (n=3) after each vaginal birth. The expression of TGM2, COX I & II were assessed by RT-PCR and immunoblotting analysis of the amnion and chorion. Nonparametric statistics were used for analysis. RESULTS: In the amnion in patients with preterm delivery, the expression of TGM2, COX I and COX II mRNA were increased by 2.3-fold, 2.7-fold, 1.3-fold, respectively, compared to term delivery with labor. The protein expression of TGM2 and COX I in these patients was increased in 1.9-fold and 2.1-fold but COX II protein expression showed no significant change, compared to term delivery with labor. In the chorion in patients with preterm delivery, the expression of TGM2, COX I and COX II mRNA showed no significant change, compared to term delivery with labor, but the protein concentration was significantly increased in 14.6-fold, 1.4-fold and 1.3-fold respectively, compared to term delivery with labor. CONCLUSION: This study shows that TMG2 and COX I are expressed more in the fetal membrane at preterm delivery caused by preterm labor, compared to term delivery with labor. These data suggests that the mechanism of preterm labor might be different form term labor.
Amnion ; Chorion ; Extraembryonic Membranes* ; Female ; Humans ; Immunoblotting ; Obstetric Labor, Premature ; Parturition ; Pregnancy ; Premature Birth* ; Prostaglandin-Endoperoxide Synthases* ; RNA, Messenger