Purpose: The purpose of this study was to investigate the clinical practice patterns of Korean obstetricians and gynecologists the diagnosis and management of hypertensive disease in pregnant women. Methods: From April 2015 to October 2015, questionnaire was distributed via email to obstetricians who were members of the Society for Maternal and Fetal Medicine. The survey consisted of 37 questions in 6 categories. Responses to the questions on the management of hypertensive disorders of pregnancy, from diagnosis to treatment, were evaluated. Results: A total of 93 obstetricians and gynecologists responded to the survey. High blood pressure was allocated the highest priority as an index mainly used when deciding to hospitalize patients with hypertensive disease during pregnancy, followed by pregnancy symptoms, proteinuria, and blood test results. Calcium channel blocker (CCB) for oral administration and hydralazine for injection were preferred as antihypertensive drugs mainly used to control severe hypertension. Regarding the delivery method for hypertensive disease during pregnancy, in cases of preeclampsia, 63% of the respondents chose the delivery method according to the cervical status, and in cases of hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and eclampsia, which increased in severity, 52% and 31% responded that the delivery method was determined according to the cervical status, respectively. In cases of mild preeclampsia, the 70% of respondents preferred 37–38 weeks of gestation for the delivery time. Regarding the use of aspirin in patient with hypertension during pregnancy, 52% of the respondents occasionally administered aspirin, and in patients with a history of hypertensive disease during pregnancy, only 43% were administered prophylactic aspirin. Conclusion Domestic obstetricians regarded blood pressure as the most meaningful factor when treating women with hypertension during pregnancy and considered blood pressure control as important. The preferred antihypertensive agents were oral CCB and hydralazine injections, and the choice of delivery method was determined according to the condition of the cervix and severity of the disease. Even in women with high risk factors for preeclampsia, prophylactic aspirin was administered in as low as 50%, of patients, possibly may due to the absence of domestic guidelines for aspirin use during pregnancy. Korean guidelines for prophylactic aspirin administration during pregnancy is needed based on additional research on the efficacy of aspirin for domestic women in the future.

Purpose: The purpose of this study was to investigate the clinical practice patterns of Korean obstetricians and gynecologists the diagnosis and management of hypertensive disease in pregnant women. Methods: From April 2015 to October 2015, questionnaire was distributed via email to obstetricians who were members of the Society for Maternal and Fetal Medicine. The survey consisted of 37 questions in 6 categories. Responses to the questions on the management of hypertensive disorders of pregnancy, from diagnosis to treatment, were evaluated. Results: A total of 93 obstetricians and gynecologists responded to the survey. High blood pressure was allocated the highest priority as an index mainly used when deciding to hospitalize patients with hypertensive disease during pregnancy, followed by pregnancy symptoms, proteinuria, and blood test results. Calcium channel blocker (CCB) for oral administration and hydralazine for injection were preferred as antihypertensive drugs mainly used to control severe hypertension. Regarding the delivery method for hypertensive disease during pregnancy, in cases of preeclampsia, 63% of the respondents chose the delivery method according to the cervical status, and in cases of hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and eclampsia, which increased in severity, 52% and 31% responded that the delivery method was determined according to the cervical status, respectively. In cases of mild preeclampsia, the 70% of respondents preferred 37–38 weeks of gestation for the delivery time. Regarding the use of aspirin in patient with hypertension during pregnancy, 52% of the respondents occasionally administered aspirin, and in patients with a history of hypertensive disease during pregnancy, only 43% were administered prophylactic aspirin. Conclusion Domestic obstetricians regarded blood pressure as the most meaningful factor when treating women with hypertension during pregnancy and considered blood pressure control as important. The preferred antihypertensive agents were oral CCB and hydralazine injections, and the choice of delivery method was determined according to the condition of the cervix and severity of the disease. Even in women with high risk factors for preeclampsia, prophylactic aspirin was administered in as low as 50%, of patients, possibly may due to the absence of domestic guidelines for aspirin use during pregnancy. Korean guidelines for prophylactic aspirin administration during pregnancy is needed based on additional research on the efficacy of aspirin for domestic women in the future.

PURPOSE: To determine the means, medians and reference intervals for TSH (thyroid-stimulating hormone) and fT4 (free thyroxine) for each month of gestation and for three trimesters in Korean pregnant women. METHODS: Serum samples were collected from 265 pregnant women with singleton gestation. Levels of TSH, fT4 were measured by immunoassay. After exclusion of subjects with positive antimicrosomal autoantibodies, the means, medians and reference intervals based on 2.5th and 97.5th percentiles for TSH, fT4 were determined. RESULTS: The study population consisted of 94 women in first trimester, 49 women in second trimester, and 122 women in third trimester. The trimester-specific reference intervals were: TSH (1st trimester: 0.03~2.72, 2nd: 0.27~2.29, and 3rd: 0.03~2.88 mIU/L), fT4 (1st trimester 4.50~19.75, 2nd: 4.70~12.98 and 3rd: 5.07~11.84 pg/mL). fT4 levels were significantly lower in the second and third trimesters. TSH levels were lower in the first trimester than second and third trimester, with gradual elevation in the second and third trimester. CONCLUSION: Levels of TSH, fT4 during pregnancy differ from those in non-pregnant women. Gestational age specific reference intervals will play a cental role in screening and diagnosis of thyroid disorders. Further studies for normal reference ranges during pregnancy are needed to create reference intervals in Korean pregnant women.
Autoantibodies ; Female ; Gestational Age ; Humans ; Immunoassay ; Mass Screening ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Pregnant Women ; Reference Values ; Thyroid Function Tests ; Thyroid Gland ; Thyrotropin

OBJECTIVE: To determine which compartments of placenta in the term pregnancy express the embryonic stem cell markers. METHODS: We have used immunohistochemical methods with antibodies to embryonic stem cell surface antigens, TRA 1-60 (Tumor rejection antigen 1-60), TRA 1-81 (Tumor rejection antigen 1-81), SSEA-3 (stage-specific embryonic antigen-3) and SSEA-4 (stage-specific embryonic antigen-4), to identify and localize stem cells in the term placenta. RESULTS: Stem cell marker-positive cells were found in all layer of placenta. Amnionic epithelial cells was immunoreactive with TRA 1-60, TRA 1-81. Amnionic mesenchymal stromal cells was immunoreactive with TRA 1-81. Chorionic mesenchymal stromal cells was immunoreactive with TRA 1-60 and TRA 1-81. SSEA-3 and SSEA-4 were not stained at any compartment of the term placenta. Compartment that was stained most strongly by TRA 1-60 was the amnionic epithelial cells layer. Compartment that was stained most strongly by TRA 1-81 was the chorionic mesenchymal stromal cells layer. CONCLUSION: The mesenchymal stroma cells of the amnion and chorion as well as amnionic epithelial cells may be useful source of pluripotent stem cells in the term placenta.
Amnion ; Antibodies ; Antigens, Surface ; Antigens, Tumor-Associated, Carbohydrate ; Chorion ; Embryonic Stem Cells ; Epithelial Cells ; Humans ; Mesenchymal Stromal Cells ; Placenta ; Pluripotent Stem Cells ; Pregnancy ; Rejection (Psychology) ; Stage-Specific Embryonic Antigens ; Stem Cells

OBJECTIVE: This study was performed to prove the significance of the oligohydramnios in the intrauterine growth restriction. METHODS: Eighty two patients were identified to have intrauterine growth restriction with oligohydramnios (Group of IUGR+Oligihydramnios) and fifty six patients were identified to have intrauterine growth restriction without oligohydramnios (Group of IUGR) on ultrasound examination from January 1st, 2005 to December 31st, 2007 at St. Vincent Hospital of Catholic University of Korea. Perinatal outcomes were compared between two groups. RESULTS: Statistically significant differences were not shown between two groups in the maternal characteristics and fetal clinical features except amniotic fluid index and the duration between diagnosis and delivery. The incidence of hyperbilirubinemia and complications in the urogenital system were significantly increased in the group of IUGR+ Oligihydramnios. The other complications were not shown significant difference between two groups. CONCLUSION: Oligohydramnios may not seem to be significant predictor of adverse neonatal outcome of IUGR except the development of hyperbilirubinemia and urogenital complications.
Amniotic Fluid ; Female ; Fetal Growth Retardation ; Humans ; Hyperbilirubinemia ; Incidence ; Korea ; Oligohydramnios ; Pregnancy ; Urogenital System

We present an unusual case in which a patient was diagnosed with the preeclampsia associated with a partial hydatidiform mole and bilateral theca-lutein cysts. The patient newly developed proteinuric hypertension at 16 weeks' gestation. Ultrasound findings showed small multiple cystic spaces in the placenta and a live singleton fetus. Triploid 69, XXX was confirmed at karyotype analysis. Intrauterine fetal death was found at 18 weeks' gestation and termination of pregnancy was performed, and a partial hydatidiform mole was confirmed at pathologic examination. Torsion of bilateral theca-lutein cysts was developed at postpartum one week. Detorsion and aspiration of the bilateral theca-lutein cysts were performed under the laparoscopy.
Female ; Fetal Death ; Fetus ; Humans ; Hydatidiform Mole ; Hypertension ; Karyotype ; Laparoscopy ; Placenta ; Postpartum Period ; Pre-Eclampsia ; Pregnancy ; Triploidy

OBJECTIVE: This study was designed to detect genes specifically expressed in severe preeclamptic placentas. METHODS: Placenta tissues were collected immediately after delivery from 5 preeclamptic patients and 5 normal pregnant women. Total RNAs of each placenta were extracted and hybridized for a cDNA microarray. Of the microarray data, four up-regulated genes (DSCR4, GPA, PCDHGB1, Hemogen) and four down-regulated genes (IL1R2, MGST1, GAS1 GREB1) were selected and reverse transcriptase-polymerase chain reaction was used to confirm the results of cDNA microarray. RESULTS: The expression fold for each up-regulated gene was 2.2 times for DSCR4, 2.7 times for PCDHGB1, 3.5 times for Hemogen, 5.2 times for GPA on the cDNA microarray. The expression fold for each down-regulated gene was 3.3 times for IL1R2, 4.2 times for MGST1, 4.9 times for GAS1 and 2.3 times for GREB1 on the cDNA microarray. The expression fold for each up- regulated gene was 5.21 times for DSCR4, 3.01 times for PCDHGB1, and 4,53 times for Hemogen and 2.2 times for GPA on RT-PCR. The expression fold for each down-regulated gene was 2.7 times for IL1R2, 2.22 times for MGST1, 2.53 times for GAS1 and 1.83 times for GREB1 on the RT-PCR. CONCLUSION: DSCR4, PCDHGB1, Hemogen and GPA as the up-regulated genes and IL1R2, MGST1, GAS1 and GREB1 as the down-regulated genes, which were found and selected by the cDNA microarray, might be considered to be novel biomarkers for preeclampsia.
Biomarkers ; Chimera ; Female ; Gene Expression ; Humans ; Microarray Analysis ; Oligonucleotide Array Sequence Analysis ; Placenta ; Pre-Eclampsia ; Pregnant Women ; RNA

OBJECTIVE: The purpose of this study was to examine the association between intrapair birth weight discordance and perinatal outcomes according to the chorionicity. METHODS: Twin births in St. Vincent's Hospital of Catholic University of Korea for the period 2000~2007 were retrospectively studied. Discordance was defined as an intertwin birth weight difference > or =20% and concordance was defined as weight difference <20% calculated from the larger newborn. Perinatal outcomes were compared between discordant and concordant pairs in monochorio-diamnionic and dichorionic twins. RESULTS: Among 38 monochorionic twin births, 34.2% was discordant and 66.8% was concordant. Among 144 dichorionic twin birth, 9.9% was discordant and 91.9% was concordant. The incidences of intrauterine fetal death (FDIU), twin-to-twin transfusion syndrome (TTTS), intrauterine growth restriction (IUGR) and neonatal hypoglycemia of discordant group of monochorionic twins were statistically increased compared with concordant group of monochorionic twins. The incidences of IUGR and neonatal hypoglycemia were statistically increased in the discordant group of dichorionic twins compared with concordant group of dichorionic twins. The others were not shown statistically significant between two groups in the both chorionic twins. CONCLUSIONS: Birth weight discordance in monochorionicity seems to predict fetal death, TTTS, IUGR and newborn hypoglycemia. Birth weight discordance in dichorionicity does not seem to be good predictor of adverse perinatal outcomes except IUGR and neonatal hypoglycemia.
Birth Weight ; Chorion ; Female ; Fetal Death ; Fetal Growth Retardation ; Fetofetal Transfusion ; Humans ; Hypoglycemia ; Incidence ; Infant, Newborn ; Korea ; Parturition ; Pregnancy ; Retrospective Studies ; Twins

OBJECTIVE: Our purpose was to investigate transglutaminase 2 (TGM2) mRNA and protein expressions in term placentas and fetal membranes delivered with labor compared to no labor. METHODS: Samples were obtained from five cases delivered with labor and five cases delivered without labor after 38 weeks of gestation. Each sample was collected from amnion, chorion, central and peripheral portion of the basal plate of placenta. Real time polymerase chain reaction (RT-PCR) was done to analyze mRNA expression of TGM2. Western blot was done and TGM2 protein level was detected. Mann-Whitney U test was used for statistic analysis. RESULTS: In labor group, TGM2 mRNA expressions were decreased compared to no labor group in 3 sampling sites except chorion (0.66+/-0.10 vs 1.29+/-0.12 in peripheral placenta, 0.67+/-0.23 vs 1.02+/-0.02 in central placenta, 0.70+/-0.16 vs 1.04+/-0.05 in amnion in contrast with 1.62+/-0.64 vs 1.56+/-0.21 in chorion). TGM2 protein expressions of four differential portions were decreased in all labor groups (1.05+/-0.35 vs 1.27+/-0.19 in peripheral placenta, 0.69+/-0.84 vs 0.84+/-0.31 in central placenta, 0.33+/-0.15 vs 0.39+/-0.33 in amnion, 0.96+/-0.18 vs 1.77+/-0.61 in chorion). CONCLUSIONS: This result suggests that TGM2 might involve in labor progress of term pregnancy.
Amnion ; Blotting, Western ; Chorion ; Extraembryonic Membranes ; Gene Expression ; GTP-Binding Proteins ; Placenta ; Pregnancy ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Transglutaminases

OBJECTIVES: The purpose of this study is to investigate the clinical risk factors of emergency cesarean hysterectomy in patients with pregnancies complicated by placenta previa and whether the third trimester transvaginal ultrasonographic findings of placenta previa would predict emergency cesarean hysterectomy. MATERIALS AND METHODS: Between January 1995 and March 2005, we retrospectively reviewed the records and compared between patients with pregnancies complicated by placenta previa who underwent cesarean hysterectomy and patients with pregnancies complicated by placenta previa who did not undergo cesarean hysterectomy. RESULTS: There were 314 had placenta previa and 34 patients were performed cesarean hysterectomy (10.83%). There were significant differences on the basis of maternal age (31.53+/-4.41 vs 34.06+/-4.12, p<0.05), parity (0.81+/-0.70 vs 1.29+/-0.63, p<0.05) , the number of cesarean section (0.36+/-0.56 vs 0.91+/-0.75, p<0.05), previous history of placenta previa and presence of placenta accreta, but not on the basis of gestational age, the number of antenatal vaginal bleeding, the number of abortions and emergency operation between two groups. On the basis of third trimester transvaginal ultrasonographic findings, significant differences were found on the distances from the internal os of cervix (1.18+/-3.66 vs 2.67+/-2.94, p<0.05) and thickness of lower placental edge. However, the presence of lacuna in the lower placenta was not associated with emergency hysterectomy. CONCLUSIONS: Patients with placenta previa are at a higher risk of undergoing cesarean hysterectomy when they are associated with placenta accreta, thick lower placenta edge, and positively longer distance to the internal os of cervix. The other clinical factors such as maternal age, parity, the number of cesarean section and previous history of placenta previa might be associated the risk of cesarean hysterectomy.
Cervix Uteri ; Cesarean Section ; Emergencies* ; Female ; Gestational Age ; Humans ; Hysterectomy* ; Maternal Age ; Parity ; Placenta Accreta ; Placenta Previa* ; Placenta* ; Pregnancy ; Pregnancy Trimester, Third ; Retrospective Studies ; Risk Factors* ; Ultrasonography ; Uterine Hemorrhage