Plasma pH can be altered during pregnancy and at labor. Membrane excitability of smooth muscle including uterine muscle is suppressed by the activation of K+ channels. Because contractility of uterine muscle is regulated by extracellular pH and humoral factors, K+ conductance could be connected to factors regulating uterine contractility during pregnancy. Here, we showed that TASK-2 inhibitors such as quinidine, lidocaine, and extracellular acidosis produced contraction in uterine circular muscle of mouse. Furthermore, contractility was significantly increased in pregnant uterine circular muscle than that of non-pregnant muscle. These patterns were not changed even in the presence of tetraetylammonium (TEA) and 4-aminopyridine (4-AP). Finally, TASK-2 inhibitors induced strong myometrial contraction even in the presence of L-methionine, a known inhibitor of stretchactivated channels in myometrium. When compared to non-pregnant myometrium, pregnant myometrium showed increased immunohistochemical expression of TASK-2. Therefore, TASK-2, seems to play a key role during regulation of myometrial contractility in the pregnancy and provides new insight into preventing preterm delivery.
4-Aminopyridine ; Acidosis ; Animals ; Contracts ; Female ; Hydrogen-Ion Concentration ; Lidocaine ; Membranes ; Methionine ; Mice ; Muscle, Smooth ; Muscles ; Myometrium ; Plasma ; Pregnancy ; Quinidine ; Relaxation ; Uterine Contraction ; Uterus

OBJECTIVE: The purpose of the present study was to determine whether a relationship exists between the clinical symptoms (dysmenorrhea and infertility) and prostaglandin (PG) concentrations in follicular and peritoneal fluid in the women with endometriosis during the late follicular phase of the menstrual cycle. METHODS: Thirty patients with pelvic endometriosis diagnosed by pelvic surgery were enrolled. Eight patients were suffering from severe dysmenorrhea and 11 had history of primary or secondary infertility among them. Endometriosis patients were grouped by the presence of each symptom and compared with 33 control patients without endometriosis. Peritoneal fluid was collected in the beginning of peritoneal opening and dominant follicular fluid was aspirated by syringe needle at the time of operation. Then PGE2 and PGF2a concentration were measured at each tube. RESULTS: Follicular fluid PGF2a levels were increased in 30 endometriosis patients (P=0.003), and the levels were significantly higher in 11 patients with infertility compared with the control (P=0.001). Peritoneal fluid PGF2a levels were significantly higher in 8 patients with severe dysmenorrhea compared with the others or the control (P=0.028). Follicular or peritoneal fluid PGE2 levels were not different between any group and the control. There was no significant correlation between size of endometrioma and each PG levels. CONCLUSION: Severe dysmenorrhea in endometriosis patients would be related with the high level of peritoneal fluid PGF2a concentration, and infertility in endometriosis would be related with the high level of follicular fluid PGF2a concentration.
Ascitic Fluid* ; Dinoprostone* ; Dysmenorrhea ; Endometriosis* ; Female ; Follicular Fluid ; Follicular Phase ; Humans ; Infertility ; Menstrual Cycle ; Needles ; Prostaglandins ; Syringes

OBJECTIVE:The purpose of this study was to determine the factors associated with successful vaginal birth after cesarean section (VBAC), and to analyze the causes of failed VBAC. METHODS:This study was performed based on 193 pregnant women who tried vaginal delivery after cesarean section in Chungbuk National University Hospital from January 1997 to December 2005. Maternal age, gestational age, cervical dilatation at admisson, maternal body mass index (BMI), neonatal bodyweight, history of prior vaginal delivery, and indication of prior cesarean section were retrospectively analyzed between the successful group and the failed group of women who tried labor. The causes of the failed trial were analyzed. RESULTS:Seventy nine percent (153/193) was successful in the trial of VBAC and 21% (40/193) failed. There were no difference in maternal age or gestational age between two groups. The success rate was significantly higher when cervical dilatation at admission was more extended, BMI of pregnant women before pregnancy and birth was lower, and birthweight of newborn was lower. Maternal request was the major cause of failure (47.5%), and others were failure to progress, non-reassuring fetal monitoring and failed induction. CONCLUSION:The factors that had significant differences in this study can be used as predictor of successful VBAC. And failed trial of VBAC due to maternal request can be decreased by adequate explanation regarding the complication of emergency operation, and enough pain control during labor.
Body Mass Index ; Cesarean Section ; Chungcheongbuk-do ; Emergencies ; Female ; Fetal Monitoring ; Gestational Age ; Humans ; Infant, Newborn ; Labor Stage, First ; Maternal Age ; Parturition ; Pregnancy ; Pregnant Women ; Retrospective Studies ; Vaginal Birth after Cesarean*

OBJECTIVE: This study was to determine whether aquaporin-4, which plays role as a transcellular water channel, is expressed in human placenta, and to compare the degree of its expression between preeclamptic women and normal pregnant women. METHODS: Placentas were obtained from severely preeclamptic women and normal pregnant women who were delivered neonates by cesarean section before the onset of labor in the Chungbuk National University Hospital. Immunohistochemistry with aquaporin-4 antibody was performed using paraffin-embedded tissue section. Signal of aquaporin-4 expression was observed with light microscope. RESULTS: Immunohistochemistry demonstrated expression of aquaporin-4 in the placentas of both preeclamptic women and normal pregnant women. The degree of expression was not different in both group. CONCLUSION: Aquaporin-4 was expressed in the human placenta, but may not be related to the pathogenesis of preeclampsia.
Cesarean Section ; Chungcheongbuk-do ; Female ; Humans ; Immunohistochemistry ; Infant, Newborn ; Placenta* ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women

Large cell neuroendocrine carcinoma of the uterine cervix is a rare and highly aggressive cervical neoplasm. Metastases and recurrences of the tumor are common. Cervical large cell neuroendocrine carcinomas are distinctive cervical carcinomas that are frequently misdiagnosed and have unfavorable prognosis. So prudential care must be considered for proper diagnosis and multimodal treatment may be required for better survival. We experienced one case of large cell neuroendocrine carcinoma accompanied with adenocarcinoma of the uterine cervix in 52 year old woman. The uterine cervix covered and infiltrated with adenocarcinoma cells and attached polypoid mass (3.2 x 2.1 cm) composed of large cell neuroendocrine carcinoma cells. The diagnosis was confirmed by immuno-staining using cytokeratin (+), synaptophysin (+), chromogranin (+), neuron-specific enolase (+), CD 56 (+), and vimentin (-). So we report the case with brief review of the literature.
Adenocarcinoma* ; Carcinoma, Neuroendocrine* ; Cervix Uteri* ; Combined Modality Therapy ; Diagnosis ; Female ; Humans ; Keratins ; Middle Aged ; Neoplasm Metastasis ; Phosphopyruvate Hydratase ; Prognosis ; Recurrence ; Synaptophysin ; Uterine Cervical Neoplasms ; Vimentin

OBJECTIVE: The purpose of this study was to compare the efficacy of intravaginal misoprostol and that of intravenous sulprostone for termination of second-trimester pregnancy. METHODS: Fouty-six patients were randomly assigned to misoprostol and sulprostone group, and the misoprostol group was further divided into two groups according to gestational age. In the misoprostol group, the patients at or before 20 weeks of gestation received 400 microgram of intravaginal misoprostol every 4 hours until labor pain was established, 200 microgram every 6 hours after 20 weeks of gestation. In the sulprostone group, intravenous sulprostone was infused at the speed of 100 microgram/hr regardless of gestational age. RESULTS: At or before 20 weeks of gestation, the mean time from induction to completion of termination was shorter, and the success rate within 24 hours was higher in the misoprostol group than in the sulprostone group (9.0 vs. 20.2 hours; 86% vs 50%). After 20 weeks, the mean induction time was longer at misoprostol group than sulprostol group but, there was no significant difference in success rate within 24 hours (14.7 vs. 7.1 hours; 83% vs. 86%). There was no significant difference in the prevalence of complication between two groups. CONCLUSION: Misoprostol is superior to sulprostone for termination of pregnancy at or before 20 weeks of gestation, but both have almost equal effectiveness after 20 weeks of gestation. Considering less cost and complication, the efficacy of misoprostol should be further investigated for termination of second-trimester pregnancy.
Female ; Gestational Age ; Humans ; Labor Pain ; Misoprostol* ; Pregnancy* ; Prevalence

Prognosis of placental abruption depends on gestational age and the status of the mother and the fetus, and perinatal mortality was almost entirely attributable to prematurity. A midtrimester women with placental abruption was successfully treated by expectant management including fetal surveillance, serial ultrasonography and maternal hematologic examination, and delivered a healthy baby 11 weeks later. We suggest that expectant management may be considered as a good treatment option until fetal lung maturation is documented in preterm pregnancy with placental abruption if there is no maternal or fetal compromise.
Abruptio Placentae* ; Female ; Fetus ; Gestational Age ; Humans ; Live Birth* ; Lung ; Mothers ; Perinatal Mortality ; Pregnancy ; Pregnancy Trimester, Second* ; Prognosis ; Ultrasonography

Fetal posterior urethral valve syndrome results in potentially lethal complications including renal dysplasia, pulmonary hypoplasia. Antenatal fetal vesicocentesis and amniotic fluid infusion may be useful to improve neonatal pulmonary function, however rapid recurrence of urinary retention and oligohydramnios usually required repetitive invasive procedures. We successfully treated a posterior urethral valve syndrome with vesico-amniotic shunt. Under ultrasonographic guidence, we inserted a Double-Basket Catheter into fetal urinary bladder through lower abdominal wall at second trimester. Shunt remained in place until the fetus was delivered at 35th gestational week. The vesico-amniotic shunt can improve fetal outcome and avoid repeated vesicocentesis before delivery.
Abdominal Wall ; Amniotic Fluid ; Catheters ; Female ; Fetus ; Humans ; Oligohydramnios ; Pregnancy ; Pregnancy Trimester, Second ; Recurrence ; Urinary Bladder ; Urinary Retention

Although sporadic cases of transient fetal ascites have been described, pulmonary hypoplasia or hydrops fetalis may occur as potentially lethal complications of isolated fetal ascites. Antenatal fetal paracentesis may be useful in improving neonatal pulmonary function, however rapid accumulation of fluid after paracentesis usually required repetitive invasive procedures. We successfully treated an isolated fetal ascites with peritoneo- amniotic shunt. Under the ultrasonographic guidence, we inserted a Double-Basket Catheter into the left lower quadrant of fetal abdominal wall at the end of second trimester. Shunt remained in place until the fetus was delivered at term. The peritoneo-amniotic shunt can improve fetal outcome and avoid repeated paracentesis before delivery.
Abdominal Wall ; Ascites* ; Catheters ; Female ; Fetus ; Humans ; Hydrops Fetalis ; Paracentesis ; Pregnancy ; Pregnancy Trimester, Second

OBJECTIVE: Since the accuracy of Pap smear for cervical neoplasm has been questioned, a number of adjunctive tests have been developed. The purpose of this study was to evaluate the accuracy of speculoscopy, a magnified chemiluminescent examination, as compared with that of the Pap smear in the screening of cervical neoplasm. METHODS: A total of 41 women were included in the study. We conducted Pap smear, speculoscopy, and punch biopsy to all subjects. Targeted biopsies were obtained from any suspicious lesions that were found with positive speculoscopy. Women with negative speculoscopy underwent random biopsies. The data were analysed using McNemar's test. RESULTS: Thirty-one out of 41 biopsy specimen were found to have cervical lesion that were worse than CIN I, including 8 cases of invasive cancer. The sensitivity and specificity of Pap smear were 74.2% and 70.0%, respectively. Those of speculoscopy were 93.5% and 60.0%, respectively. When these two tests were combined, the sensitivity was raised to 96.8%, but the specificity declined to 50.0%. Among 9 cases of ASCUS on Pap smear, 6 cases were found to have cervical pathology worse than CIN II, and these were positive on speculoscopy. CONCLUSION: Speculoscopy combined with a Pap smear can increase the detection of cervical lesions compared with the Pap smear alone. In the cases of ASCUS on Pap smear, speculoscopy may be more useful to detect significant pathology.
Biopsy ; Female ; Humans ; Mass Screening* ; Pathology ; Sensitivity and Specificity ; Uterine Cervical Neoplasms*