No abstract available.
Placentation*

In diamnionic dichorionic twins, the type of placenta consists of fused and separate types. The expansion of one twin placenta often occurs in the direction of the other implantation site in fused type. Placental development often leads to collision, and the growth of one or both placentas may be hindered, which can cause intrauterine growth restriction (IUGR). We represent a single case of one placental implantation above the another which caused IUFD in one fetus in diamnionic dichorionic twin pregnancy with a brief review of literatures.
Fetal Death* ; Fetus ; Humans ; Placenta ; Placentation ; Pregnancy, Twin ; Twins*

OBJECTIVE: This study was to investigate the expression of CDK inhibitors, p27kip1 and p57kip2 during the growth and differentiation of mouse placenta. METHODS: Total RNA and protein were extracted from placenta of mouse sacrificed at day 12, 14, 16, 18 post-coitum (p.c.), then semi-quantitative RT-PCR and western blotting of p27kip1 and p57kip2 was carried out, respectively. RESULTS: p27kip1 mRNA was highly expressed in 18 days p.c. then other groups. But, p57kip2 mRNA expression was high in 12, 14, and 16 days p.c., then decreased in 18 days p.c. p27kip1 expression pattern was similar with mRNA. But, p57kip2 was higher in 14 days p.c. than other groups. CONCLUSION: This result shows that p27kip1 may play a role in late period of mouse placental development, and p57kip2 may play a role in middle period of mouse placental development.
Animals ; Blotting, Western ; Mice* ; Placenta* ; Placentation ; Pregnancy* ; RNA ; RNA, Messenger

Virtually all monochorionic twin placentas contain vascular connections between the circulatory domains of each twin. In contrast, vascular anastomoses are generally thought not to occur in fused, dichorionic placentation. In the twin-to-twin transfusion syndrome (TTTS) one twin is preferentially perfused by blood from the cotwin via unbalanced placental vascular anastomoses. This vascular shunting results in twins born with discrepant weights, colors and hemoglobins. When one of the TTTS criteria was not present, the pregnancy was defined as "pseudo" TTTS. In pregnancies complicated by "pseudo" TTTS indicate that small twins have abnormal cord insertion more frequently than large twins. We present a case of vascular anastomoses in dichorionic diamniotic-fused placentas resulting in "pseudo" TTTS with a brief review of the literatures concerned.
Female ; Fetofetal Transfusion* ; Humans ; Placenta* ; Placentation ; Pregnancy ; Weights and Measures

OBJECTIVE: To investigate what factors are associated with a failed arterial embolization for postpartum hemorrhage (PPH) and to attempt to estimate efficacy of arterial embolization. METHODS: Between 2004 and 2008, 60 patients at Korea University Medical Cencter underwent arterial embolization to control obstetrical hemorrhage. In all cases, arterial embolization was performed because of intractable hemorrhage unresponsive to conservative management. Medical records and angiographic results were reviewed. Arterial embolization failure was defined as the requirement for subsequent surgical procedure to control PPH with the procedure, and its results. RESULTS: Arterial embolization was attempted in 60 of deliveries. Failures occurred in 7 of 60 cases (11.7%) and in 4 of 7 cases (57.1%) of abnormal placentation (placenta previa totalis with or without placenta accrete or increta). Comparison of the failed and successful arterial embolization groups showed no differences in maternal characteristics, clinical status, and angiographic finding. Amount of total transfusion in failed arterial embolization group were larger than successful group although hemoglobin before embolization was not different. CONCLUSION: The only factor significantly associated with failed arterial embolization was an abnormal placentation. Arterial embolization is a safe and highly effective method to control PPH.
Hemoglobins ; Hemorrhage ; Humans ; Korea ; Medical Records ; Placenta ; Placentation ; Postpartum Hemorrhage ; Postpartum Period

OBJECTIVE: To investigated whether lowering oxygen tension affects invasion of cultured trophoblast. METHODS: Trophoblasts were isolated from the normal placenta in early pregnancy(6-10 weeks in gestation). Isolated trophoblasts were cultured under normoxic(5% CO2, 95% humid air in incubator) and hypoxic(MERCK, 1% O2, 99% CO2) conditions for 24, 48 and 72 hours, respectively. The proliferation ability was measured using [H3] thymidine assay. Total RNA was extracted from the cultured trophoblasts. The expressions of matrix metalloproteinase(MMP-2) and tissue inhibitor of metallo- proteinase(TIMP-2) were determined by reverse transcription- polymerase chain reaction(RT-PCR) and Northern blot analysis. The invasiveness of cultured trophoblast was observed using in vitro invasion assay. RESULTS: [H] thymidine assay indicated that cellular DNA synthesis was not affected by the culture condition. The expression of MMP-2 mRNA was decreased at 24 hours and then progressively increased in the time-dependent manner in each culture condition. The expression of TIMP-2 was decreased in the time-dependent manner under hypoxic condition. In vitro invasion assay revealed that the cultured trophoblasts under hypoxic condition has more invasive ability than them under normoxic condition. CONCLUSION: These data suggests that hypoxic condition may stimulates the invasion of trophoblast in the human placentation. And MMP-2 and TIMP-2 may be related to control their invasiveness under hypoxic condition.
Blotting, Northern ; DNA ; Humans ; Oxygen ; Placenta ; Placentation ; RNA ; RNA, Messenger ; Thymidine ; Tissue Inhibitor of Metalloproteinase-2 ; Trophoblasts*

Sphingosine-1-phosphate (S1P), a bioactive sphingolipid metabolite, has various functions to affect many signalling pathways leading to cellular proliferation and differentiation and to regulate of cell migration, invasion, and angiogenesis. However, there are little reports about the relation between trophoblast stem cells and S1P. Thus, the physiologic effects of S1P on trophoblast stem (TS) cells were investigated in this study. S1P was involved in early stage development of trophoblast via upregulation of Eomesodermine mRNA expression and suppressed differentiation of TS cells through activation of extracellular-signal regulated kinase (ERK) activation. Other actions of S1P were the activation of p38 and the induction of Dlx-3 mRNA expression for angiogenesis in TS cells. Interestingly, TS cells cultured with S1P for 4 days in thrombin-fibrinogen gel culture system, specific culture system for endothelial cells, showed good healthy appearance, but TS cells cultured without S1P got severe damages. Taken together, we suggest that S1P has very important roles on placenta such as development of early stage trophoblast, suppression of differentiation, and angiogenesis on placenta.
Cell Movement ; Cell Proliferation ; Endothelial Cells ; Phosphotransferases ; Placenta ; Placentation* ; RNA, Messenger ; Stem Cells ; Trophoblasts ; Up-Regulation

OBJECTIVE: To observe the difference in telomerase activity (TA) expression in the placenta between fetal growth restriction (FGR) with preeclampsia and those without and to evaluate the effect of oxygen concentration on the TA expression in the trophoblastic cells. METHODS: Telomerase activity was measured in 48 (normal pregnancies, 16; preeclampsia with FGR, 15; normotensive FGR, 17) placentas which were obtained between 32 and 41 weeks' gestations. Trophoblastic cells were extracted from 8 chorionic villi samples obtained from 8-10 weeks' placenta and were cultured in either 2%, 8%, and 20% oxygen atmosphere. Then TA was examined by using telomeric repeat amplification protocol (TRAP) assay. RESULTS: During 3rd trimester of pregnancy, exhibited TA expression in normal pregnancy, FGR complicated by preeclampsia, and normotensive FGR groups were 11 of 16 (68.8%), 4 of 15 (26.7%), and 4 of 17 (23.5%), respectively. Significantly lower level of TA was detected in the FGR group compared to the normal pregnancies (p=0.009), whereas within FGR pregnancies, presence of preeclampsia did not seem to have statistically significant effect on TA expression. TA expression levels were measured by optical density in trophoblasts cultured under various oxygen concentration which revealed that significantly higher TA was exhibited in the cells cultured in 2% oxygen compared to 8% and 20% (p<0.001). However no significant difference was noted in TA between cells cultured in 8% and 20% oxygen. CONCLUSION: Decreased TA in the placenta from pregnancies with FGR was noted regardless of presence of preeclampsia indicating a probable correlation between FGR and placental senescence. Since increased TA was noted in trophoblastic cells that were cultured in hypoxic condition, we could speculate that the intervillous oxygen tension during early-stage placental development plays a certain role in the placental degeneration in pregnancies complicated by FGR and preeclampsia.
Aging ; Anoxia* ; Atmosphere ; Chorionic Villi ; Fetal Development* ; Oxygen ; Placenta ; Placentation ; Pre-Eclampsia ; Pregnancy* ; Telomerase* ; Trophoblasts

OBJECTIVE: The objective of this study is to investigate whether the amniotic fluid 8-isoprostane levels at the time of genetic amniocentesis is a marker for severe preeclampsia. METHODS: A case-control study was conducted to compare mid-trimester concentrations of amniotic fluid 8-isoprostane in women with normal pregnancies (n=22) and in those who subsequently developed severe preeclampsia (n=22). Amniotic fluid was also obtained by amniocentesis from another women who already developed severe preeclampsia (n=22) after 20 weeks of gestation. The 8-isoprostane levels were measured by enzyme-linked immunoassay. For statistical analysis, nonparametric tests and receiver-operating characteristic curves were used where appropriate. Statistical significance was considered when probability was <0.05. RESULTS: The levels of midtrimester amniotic fluid 8-isoprostane were found to be significantly decreased in the women who subsequently developed severe preeclampsia in comparison with those who underwent normal pregnancies (P<0.05). The levels of 8-isoprostane in preeclamptic amniotic fluid were found to be significantly decreased with respect to that in midtrimester amniotic fluid (P<0.05). No relationship was found between the midtrimester amniotic fluid 8-isoprostane levels and preeclampsia with small-for- gestational-age. After the onset of severe preeclampsia, however, the amniotic fluid 8-isoprostane levels were significantly decreased in women with small-for-gestational-age. The midtrimester amniotic fluid 8-isoprostane level of 170 pg/ml had a sensitivity of 72.7% and a specificity of 63.6% in the prediction of severe preeclampsia. CONCLUSION: The midtrimester amniotic fluid 8-isoprostane levels may predict the later occurrence of severe preeclampsia. This study not only presents a new information that 8-isoprostane is detected in human amniotic fluid, but also provides a convincing evidence that a subclinical process from faulty placentation in early gestation is important for the occurrence of preeclampsia. Further studies are warranted to determine which mechanism causes such decrease in amniotic fluid 8-isoprostane in preeclampsia.
Amniocentesis ; Amniotic Fluid* ; Case-Control Studies ; Female ; Humans ; Immunoassay ; Placentation ; Pre-Eclampsia* ; Pregnancy ; Pregnancy Trimester, Second* ; Sensitivity and Specificity

OBJECTIVE: To evaluate the clinical indications and incidence of emergency peripartum hysterectomy by dermographic characteristics by a retrospective review based on hospital data of 98 patients over 8 years. METHODS: We reviewed their medical records of the 98 cases of peripartum hysterectomy among 50,338 deliveries, from January. 1992 to December. 1999, at St Mary, Kang Nam St Mary, and Holy Family hospital of Catholic University. RESULTS: The total incidence of peripartum hysterectomy was 98/50,338 (0.19%), Cesarean hysterectomy was performed in 96 of 22,561 Cesarean sections (0.43%) and in 2 of 27,777 vaginal deliveries (0.01%). The higher the age, the higher incidence of peripartum hysterectomy was noted and the most common indication for hysterectomy was abnormal adherent placentation (45.48%) followed by uterine atony (39.80%). During peripartum hysterectomy, patients were transfused with mean 10.04 pints. Although one maternal death occurred, maternal morbidity remained high (51.02%), including postoperative febrile condition in 15 (15.3%), intraoperative urologic injury in 11 patients (11.2%). CONCLUSION: There is a strong association between advancing age and incidence of peripartum hysterectomy. The data identify abnormal adherent placentation as the primary cause for peripartum hysterectomy and then considering the mean volume of blood loss more than 10 pints of blood should be prepared before emergency hysterectomy.
Cesarean Section ; Emergencies* ; Female ; Humans ; Hysterectomy* ; Incidence ; Maternal Death ; Medical Records ; Peripartum Period* ; Placentation ; Pregnancy ; Retrospective Studies ; Uterine Inertia