Co-infection Of Ureaplasma urealyticum And Human Papilloma Virus In Asymptomatic Sexually Active Individuals.

This study aimed to determine the role of asymptomatic bacterial sexually transmitted infections (STIs), such as Chlamydia trachomatis (Ct), Mycoplasma genitalium (Mg), Mycoplasma hominis (Mh), and Ureaplasma urealyticum (Uu) in human papillomavirus (HPV) infection. In total, 264 asymptomatic outpatients aged between 21 and 80 years were prospectively enrolled in this study during routine gynecological screening tests. Specimens collected with a Cervex Brush were routinely analyzed with the Hybrid Capture 2 assay for HPV. Simultaneously, a specimen obtained with an endocervical swab was used to detect Ct and Mg with a monoplex real-time polymerase chain reaction (PCR) and to confirm Mh and Uu with a Mycoplasma IST 2 kit. The detection rates (%) of HPV, Ct, Mg, Mh, and Uu were 82/264 (31.1), 6/264 (2.3), 5/264 (1.9), 16/264 (6.1), and 95/264 (36.0), respectively. Of 95 Uu, 32 (33.7%) showed high density colonization (HDC, ≥104 color-changing units/mL). HDC-Uu was significantly associated with HPV infection (p=0.014, chi-square test). Mg infection and Mh infection were not associated with HPV infection (p=0.981 and p=0.931, chi-square test). Age was not associated with HPV infection or bacterial infection. Our data suggested that asymptomatic HDC-Uu was closely associated with HPV infection. Therefore, simultaneous evaluation for Uu and HPV should be performed during gynecological screening, even in asymptomatic individuals.

Inhibition of ERK activity enhances the cytotoxic effect of peroxisome proliferator-activated receptor γ (PPARγ) agonists in HeLa cells.

In this study, we examined whether the peroxisome proliferator-activated receptor γ (PPARγ) agonists, ciglitazone (CGZ) and troglitazone (TGZ), induce cell death in human cervical cancer HeLa cells. The cells were treated with a range of CGZ or TGZ doses for 24 or 48 h. Low concentrations of CGZ (≤10 µM) or TGZ (≤20 µM) had no effect on cell viability whereas higher doses induced cell death in a time- and dose-dependent manner as evidenced by the detection of activated caspase-3 and PARP cleavage. Treatment with the PPARγ antagonist GW9662 followed by PPARγ agonists did not increase CGZ- or TGZ-induced cell death, indicating that PPARγ agonists induced HeLa cell death independently of PPARγ. Moreover, ERK1/2 activation was observed at a CGZ concentration of 25 µM and a TGZ concentration of 35 µM, both of which induced cell death. To elucidate the role of ERK1/2 activated by the two PPARγ agonists, the effect of U0126, an inhibitor of ERK1/2, on PPARγ-agonist-induced cell death was examined. Treatment with 10 or 20 µM U0126 followed by CGZ or TGZ induced the down-regulation of ERK1/2 activity and a decrease in Bcl-2 expression accompanied by the collapse of mitochondrial membrane potential, which in turn significantly enhanced CGZ- or TGZ-induced apoptotic cell death. Our results suggest that PPARγ agonists are capable of inducing apoptotic cell death in HeLa cells independently of PPARγ and that inhibition of ERK1/2 activity offers a strategy to enhance the cytotoxicity of PPARγ agonists in the treatment of cervical cancer.

Conservative Chemotherapy in Gestational Trophoblastic Disease: Experience With Etoposide, Methotrexate, and Dactinomycin Chemotherapy.

OBJECTIVE: The goal of this study was to evaluate the efficacy, toxicity, and survival of patients in our institution treated by EMA (etoposide, methotrexate [MTX], and dactinomycin) chemotherapy for 3 groups of patients: ones that had low-risk gestational trophoblastic disease (GTD) that was resistant to MTX (group A), those with high-risk GTD (group B), and the group having low-risk GTD but the cancer being metastatic (group C). METHODS: The medical records of 58 patients who received EMA chemotherapy in groups A, B, and C in the 2000 to 2012 period at St Mary's Hospital were examined. Clinical characteristics, chemotherapy responses, causes of treatment failure, and cases of drug toxicity were analyzed retrospectively. RESULTS: Treatment with the EMA regimen resulted in primary remission in 52 (96%) of 54 patients and resistance in 2 of the patients (3%). In the resistance group, one belonged to group B and was treated with etoposide, MTX, and actinomycin D with cyclophosphamide and vincristine (EMA-EP) and the other belonged to group A and died of refractory disease. World Health Organization (WHO) grade 4 leukocytopenia and thrombocytopenia with the EMA regimen occurred in 6% and 0.4% of the cycles, respectively; the other toxic effects were acceptable and manageable. Median cycles of EMA chemotherapy during the treatment were 7, 8, and 8 in groups A, B, and C, respectively. There was some reduction in total chemo cycle and toxicity, as compared with a previously reported study using the alternative cyclophosphamide and vincristine regimen. Among the EMA treated patients, 1 patient with a second malignancy of breast cancer was documented. In addition, 5 child births for the treated patients were recorded during the follow-up period of mostly 10 years. CONCLUSIONS: The EMA chemotherapy seemed to reduce treatment duration and the relapse rate without increasing the adverse effects in patients with MTX resistance and low-risk GTD, but having confirmed metastatic lesions. Although this study had some limitations regarding the high-risk GTD, our findings will provide a basis for the use of EMA chemotherapy when cyclophosphamide and vincristine is contraindicated due to toxicity.

Toll-like receptor 2 gene polymorphisms in Korean women with human papillomavirus-related cervical neoplasia.

INTRODUCTION: The aim of this study was to investigate the association between Toll-like receptor 2 (TLR2) gene polymorphisms and human papillomavirus (HPV)-related cervical neoplasia in Korean women. MATERIAL AND METHODS: Peripheral blood samples collected from 127 patients with HPV-related cervical neoplasia and 175 healthy women were genotyped for the TLR2 -16934, +1350, intron1, and 3' untranslated region (UTR) polymorphisms using the polymerase chain reaction and restriction fragment length polymorphism method. RESULTS: The TLR2 -16934 A/A, intron1 A/A, and +1350 T/C genotypes were more frequent in patients than in controls [odds ratio (OR) = 2.1, 95% CI = 1.302-3.475, p = 0.002; OR = 1.9, 95% CI = 1.168-3.169, p = 0.010; and OR = 1.9, 95% CI = 1.211-3.123, p = 0.006, respectively]. The frequencies of the TLR2 + 1350 C and 3'UTR G alleles were also higher in patients (OR = 2.0, 95% CI = 1.236-3.121, p = 0.004 and OR = 1.7, 95% CI = 1.005-3.076, p = 0.046, respectively). The genotype frequencies of TLR2 -16934 A/A and intron1 A/A increased with increasing oncogenic risk of the HPV genotype, as follows. low-risk type < high-risk type < HPV-16 and/or HPV-18 type (p = 0.008). CONCLUSIONS: Our study provides the first evidence that TLR2 gene polymorphisms are associated with high-risk type HPV-related cervical neoplasia and may play an important role in susceptibility to HPV infection. Further large-scale and functional studies are needed to confirm the role of TLR2 gene polymorphisms in HPV-related cervical neoplasia.

Relationship Between Gonadotropin-Releasing Hormone/Gonadotropin-Releasing Hormone Receptor Signaling and Progesterone Receptors in Human Trophoblasts.

OBJECTIVE: To investigate the relationship between gonadotropin-releasing hormone (GnRH)/gonadotropin-releasing hormone receptor (GnRHR) signaling and progesterone receptors (PGRs). STUDY DESIGN: HTR-8/SV neo cells and JEG-3 cells were incubated for 24 hours with GnRH-I or -II. The expression of PGRs was measured by quantitative real-time reverse transcriptase-polymerase chain reaction and Western blotting. RESULTS: In both cells lines after incubation with 1-1,000 nM/L GnRH-I or -II the ratio of PGR-B to PGR-AB mRNA level did not differ in any of the groups as compared to the control. Relatively higher expression of PGR-B than PGR-A mRNA and expression of only PGR-B protein without PGR-A protein were observed in all specimens. There were no significant differences in the expression of PGR-B protein in each group when compared to the control group after incubation with GnRH-I or -II at 0.001-1,000 mM/L in both cell lines. CONCLUSION: PGRs are expressed regardless of GnRH/GnRHR signaling in human trophoblasts, in which PGR-B expression is more dominant than PGR-A expression.

A Pilot Study to Investigate the Efficacy of Fibrin Sealant (Tisseel®) in the Loop Electrosurgical Excision Procedure.

AIMS: The objective of the current study was to evaluate the efficacy and feasibility of fibrin sealant (Tisseel®) in the loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN 2 or 3). METHODS: We designed a single-blind, prospective, randomized study in 40 consecutive women undergoing LEEP for CIN 2 or 3 at our institute. Two milliliters of fibrin sealant (Tisseel) was applied to the uterine cervix of 20 women immediately after LEEP surgery (treatment group). We evaluated abdominal pain, vaginal bleeding, vaginal discharge and impairment in daily living after 1 week using visual analogue scale questionnaires and compared the results with those of 20 women who did not receive fibrin sealant (control group). RESULTS: Among 40 women who returned for a follow-up 1 week after LEEP, 25 women (62.5%) reported at least one moderate to severe postprocedural symptom. The mean duration of moderate to severe vaginal bleeding and impairment in daily living during postoperative week 1 for the treatment group and the control group was 0.3 ± 0.80 versus 1.7 ± 2.36 days (p = 0.015) and 0.9 ± 1.37 versus 3.00 ± 2.62 days (p = 0.060), respectively. CONCLUSION: Intraoperative application of fibrin sealant (Tisseel) in LEEP can decrease postoperative vaginal bleeding and impairment in daily living.

Association between fetal abdominal circumference and birthweight in maternal hyperglycemia.

OBJECTIVES: To compare fetal abdominal circumference and its relationship with birthweight at increasing gestational ages in the context of maternal hyperglycemia of varying severity. DESIGN: Retrospective cohort study. SETTING: Two centers participated in building one database. POPULATION: A total of 1538 Korean pregnant women were subjected to a two-step approach to diagnose gestational diabetes mellitus. METHODS: Pregnant women were classified into gestational diabetes mellitus, borderline gestational diabetes mellitus, and normal groups. Fetal abdominal circumferences, which were measured with ultrasound at 4-week intervals starting at 16 weeks of gestation and ending prior to delivery, were evaluated in the groups. MAIN OUTCOME MEASURE: The significance of fetal abdominal circumferences as predictors or risk factors of macrosomia/large-for-gestational age. RESULTS: Fetal abdominal circumferences measured from 16 weeks of gestation until prior to delivery predicted birthweight in all groups with some exceptions. Fetal abdominal circumferences measured from 32 weeks of gestation until prior to delivery were predictive of macrosomia in all groups. Fetal abdominal circumferences measured from 28 weeks of gestation until prior to delivery were predictive of neonates being large-for-gestational age in all groups. Fetal abdominal circumferences measured at 16 and 24 weeks of gestation were also predictive of large-for-gestational age in the borderline gestational diabetes mellitus group. Fetal abdominal circumference measured at 24 weeks of gestation was also a predictor of macrosomia/large-for-gestational age in normal women. CONCLUSIONS: Fetal abdominal circumferences measured during the second and especially third trimesters were significantly associated with excessive birthweight, irrespective of the severity of maternal glucose intolerance.

Pregnancy coexisting with uterus didelphys with a blind hemivagina complicated by pyocolpos due to Pediococcus infection: a case report and review of the published reports.

A woman in early pregnancy was referred due to severe pelvic pain. Vaginal examination showed a severely protruding left vaginal wall with severe tenderness. A transvaginal ultrasound showed a double uterus and a mixed echogenic mass next to the cervix of the left uterus. After creating an opening in the left vaginal wall and inserting a Foley catheter through the opening into the vaginal wall for drainage with antibiotic therapy, the patient's condition rapidly improved. A culture of the pus drained from the vaginal wall showed Pediococcus species. The patient delivered a healthy infant by cesarean section at term gestation without recurrence of pyocolpos. Ten months after delivery, resection of the vaginal septum was performed and the left cervix was exposed. Ultrasound revealed normal kidneys.

Incidence and risk factors of lower-extremity lymphedema after radical surgery with or without adjuvant radiotherapy in patients with FIGO stage I to stage IIA cervical cancer.

OBJECTIVE: This study aimed to determine the incidence and risk factors of lower-extremity lymphedema (LEL) in women who had radical surgery with or without adjuvant radiotherapy for International Federation of Gynecology and Obstetrics (FIGO) stage I to stage IIA cervical cancer. METHODS: The medical records were reviewed retrospectively on patients with histologically confirmed FIGO stage I to IIA cervical cancer. Lower-extremity lymphedema-related medical problems such as peripheral vascular disease, congestive heart failure, or chronic renal disease were excluded. A logistic regression analysis was used to examine the relationship between variable clinical characteristics and development of LEL. RESULTS: We evaluated 707 patients. Of the 707 patients evaluated, we excluded 92 patients who had received radiotherapy as the initial therapy and 19 patients with LEL related to medical problems. Seventy-five patients (12.6%) developed LEL. The incidence was high in patients with adjuvant radiotherapy (odds ratio, 3.47; 95% confidence interval, 2.086-5.788; P = 0.000), with 78.7% of the patients with LEL having developed the condition within 3 years after initial treatment. CONCLUSIONS: Adjuvant radiotherapy was significantly associated with development of LEL in women who had undergone radical surgery with lymphadenectomy for FIGO stage I to stage IIA cervical cancer. The possibility for the occurrence of LEL must be fully explained before treatment and patients should be provided with the appropriate preventive education. Further prospective studies are needed to confirm the incidence and risk factors for LEL.

A pilot study to investigate the treatment of cervical human papillomavirus infection with zinc-citrate compound (CIZAR®).

OBJECTIVE: In the present study the potential therapeutic effects of zinc-citrate compound (CIZAR®) in women infected with high-risk human papillomavirus (HR-HPV) was investigated. METHODS: A total of 194 women diagnosed with HR-HPV infection using the Hybrid capture (HC) II assay with no evidence of high grade squamous intraepithelial lesions (HSIL) or worse by Pap smear and colposcopy were enrolled. Among them, 76 women were treated by twice weekly self administered intra-vaginal infusion of 0.5 mM zinc citrate solution containing CIZAR® for 12 weeks and were evaluated for clearance of the HR-HPV infection compared to 118 women without treatment (Control group). RESULTS: The 12 weeks zinc citrate solution treatment resulted in the elimination of HR-HPV in 49/76 (64.47%) patients compared to the spontaneous clearance of 15.25% (18/118) in the control group (p=0.000). By logistic regression analysis, the 12 week zinc citrate solution treatment reduced the risk of persistent HR-HPV infection significantly (OR 0.079; 95% CI 0.039-0.165; p=0.000). CONCLUSION: The results of this study showed for the first time that treatment with intra-vaginal infusion of a zinc-citrate compound (CIZAR®) can result in elimination of HR-HPV infection from the uterine cervix.

Cell-mediated immune response to human papillomavirus 16 E7 peptide pools in patients with cervical neoplasia.

OBJECTIVE: To identify characteristics of the cell-mediated immune (CMI) response to human papillomavirus-16 (HPV) E7 viral peptide pools to help the formulation of therapeutic vaccines. DESIGN: Prospective study. Population. Korean women. SETTING: University hospital. METHODS: From December 2008 to August 2010, 33 HPV-16-positive patients, seven patients exhibiting a high-risk HPV infection other than HPV-16 with grade 2/3 cervical intraepithelial neoplasm (CIN2/3), and nine healthy control donors were enrolled. MAIN OUTCOME MEASURES: CMI response to synthetic HPV-16 E7 overlapping peptide pools using the IFN-γ ELISPOT assay. RESULTS: The E7 sequence comprising amino acids 16-55 was a major immunogenic region. The CMI response to HPV-16 E7 is highly type-specific. The follow-up CMI response may last longer than expected after the lesion is resected. CONCLUSIONS: We found that the E7 sequence comprising amino acids 16-55 is a major immunogenic region that is critical for the T-cell-mediated immune response with CIN2/3 or cervical cancer. The identification of CMI responses to HPV-16 E7 peptide pools may provide insight into therapeutic vaccine trials for the control of HPV-associated diseases.

Specific human papillomavirus types and other factors on the risk of cervical intraepithelial neoplasia: a case-control study in Korea.

OBJECTIVE: Cervical neoplasia is attributed to a persistent human papillomavirus (HPV) infection. We performed a hospital-based, case-control study to evaluate the associations of HPV genotypes and other cofactors with cervical intraepithelial neoplasia (CIN). METHODS: A total of 158 women were enrolled after we received their informed consent, and the control group (the non-CIN group; n = 80) was selected from women at St Paul's Health Promotion Center. The CIN group (n = 78) was enrolled from the outpatient clinics at Kangnam St Mary's Hospital. Cervical intraepithelial neoplasia was confirmed with colposcopic-guided biopsy or loop electrosurgical excision procedure-conization. A structured questionnaire, Papanicolaou test, and HPV testing were completed. We compared each risk factor using chi2 tests and simple logistic regression analysis between the CIN and non-CIN groups. Finally, odds ratios (ORs) were calculated again by multiple logistic regression analysis. RESULTS: The most frequent HPV types in CIN were HPV-16, HPV-58, HPV-31/-33, and HPV-35/-56. The OR of the A9 group (HPV-16, HPV-31, HPV-33, HPV-35, HPV-52, HPV-58) was 22.7 (95% confidence interval [CI], 8.3-62.5), that of the A6 group (HPV-53, HPV-56, HPV-66) was 2.9 (95% CI, 1.1-7.5), and that of the A7 group (HPV-18, HPV-39, HPV-45, HPV-59, HPV-68) was 1.5. Sexual debut before 20 years old had significantly higher OR than did a sexual debut after 30 years (OR, 32.9; 95% CI, 2.8-364.7). The OR for CIN in single women versus married women was 6.2 (95% CI, 2.5-15.2). Compared with parous women (parity >3), nonparous women had a higher OR (95% CI, 1.4-16.7). On the multiple logistic regression analysis including the sexual debut age, the marital status, parity, cytology, and the HPV groups, the A9 group had a significant OR for CIN (6.1; 95% CI, 1.6-23.6). CONCLUSIONS: The risk of CIN was higher for women infected with the HPV-A9 group after multiple logistic regression analysis. The other clinical risk factors were not significant factors of CIN.

Does the type of hysterectomy affect the prognosis in clinical stage I endometrial cancer?

AIM: To determine whether clinical outcomes show a benefit from extended hysterectomy in patients with early endometrial cancer. METHODS: We reviewed the medical records of 101 patients who had endometrial cancer with clinical stage I disease. All the patients were surgically staged, and two types of hysterectomy, simple hysterectomy (SH) or extended hysterectomy (EH), were performed by surgeon's preference. The postoperative pathology findings, recurrence rate and disease-free survivals (DFS) between the two groups were compared. RESULTS: Sixty-six patients and thirty-five patients underwent SH and EH, respectively. At subsequent surgical staging, seven patients (10.6%) in the SH and four (11.4%) in EH group were upgraded to stage II or III disease. The surgical and pathological features were not different between the groups. Though the recurrence rate was lower in the EH group (9.09% for SH vs 2.86% for EH), it showed no statistical significance (P = 0.241). The 5-year DFS (88.2% for SH vs 96.0% for EH) showed no statistically significant difference between the groups either (P = 0.242). CONCLUSION: Compared to SH, EH did not have any prognostic benefit in clinical stage I endometrial cancer. Until the therapeutic role of the EH is determined by further studies using a larger sample size, SH remains the treatment of choice in patients with early endometrial cancer, and surgeons should not perform extended operation without definite evidence of the disease.

A prospective comparison of vaginal stump suturing techniques during total laparoscopic hysterectomy.

PURPOSE: We compared the incidence of vaginal cuff dehiscence and other surgical complications after different modes of suturing during total laparoscopic hysterectomy (TLH), and reviewed the characteristics of patients with complications. METHODS: We enrolled 248 patients undergoing TLH for benign diseases at Daejeon St Mary's Hospital of Korea from March 2007 through February 2009. We evaluated the clinical outcomes of different vaginal cuff suture techniques during TLH: the widely used interrupted figure-of-eight suture and a two-layer running suture. RESULTS: All operations were completed successfully by laparoscopy. Three of 248 hysterectomies (1.2%) were complicated by vaginal cuff dehiscence. One of them belonged to the two-layer running suture group, and the others belonged to the interrupted figure-of-eight suture group. However, there was no statistically significant difference in outcomes between the suture methods. One case of trocar site incisional herniation occurred. No ureteral, bladder, or major vascular injury occurred. The overall major complication rate including vaginal bleeding was 2.0% (5/248). CONCLUSIONS: The two-layer running suture technique was safe and effective for vaginal cuff suture during TLH, but there was no statistically significant advantage over the widely used figure-of-eight suture method. Diabetes, cigarette smoking and pelvic adhesions produced statistically significant increased risks of complication.

The Influence of Oral Dydrogesterone and Vaginal Progesterone on Threatened Abortion: A Systematic Review and Meta-Analysis.

OBJECTIVE: To conduct systematic analyses to evaluate the efficacy of progesterone therapy for the prevention of miscarriages in pregnant women experiencing threatened abortion. METHODS: In November 2016, we performed a systematic literature search and identified 51 articles in PubMed, Embase, and Cochrane databases. We identified nine randomized trials that included 913 pregnant women (including 322 treated with oral dydrogesterone, 213 treated with vaginal progesterone, and 378 control subjects) who met the selection criteria. RESULTS: The incidence of miscarriage was significantly lower in the total progesterone group than in the control group (13.0% versus 21.7%; odds ratio, 0.53; 95% confidence interval (CI), 0.36 to 0.78; P = 0.001; I2, 0%). Moreover, the incidence of miscarriage was significantly lower in the oral dydrogesterone group than in the control group (11.7% versus 22.6%; odds ratio, 0.43; 95% CI, 0.26 to 0.71; P = 0.001; I2, 0%) and was lower in the vaginal progesterone group than in the control group, although this difference was nonsignificant (15.4% versus 20.3%; odds ratio, 0.72; 95% CI, 0.39 to 1.34; P = 0.30; I2, 0%). However, the incidence of miscarriage was not different between the oral dydrogesterone and vaginal progesterone groups. CONCLUSION: Progesterone therapy, especially oral dydrogesterone, can effectively prevent miscarriage in pregnant women experiencing threatened abortion.

Factors associated with participation in cervical cancer screening among young Koreans: a nationwide cross-sectional study.

OBJECTIVES: Despite the possibility of early detection of cervical cancer, participation in screening programmes among young Koreans is low. We sought to identify associations between risk factors and participation in screening for cervical cancer among young Koreans. DESIGN: Nationwide cross-sectional study. SETTING: Republic of Korea. PARTICIPANTS: 3734. MAIN OUTCOME MEASURES: The Korea National Health and Nutrition Examination Survey (KNHANES V: 2010-2012) was used to evaluate factors associated with attendance for cervical cancer screening among women aged 15-39. After excluding those who were previously diagnosed with cervical cancer and those with incomplete responses to questionnaires, a total of 3734 subjects were eligible. Multi-dimensional covariates as potential predictors of cervical cancer screening were adjusted in multiple logistic regression analysis. RESULTS: The participation rate for cervical cancer screening was 46% among women aged 40 or younger. The logistic analyses showed that age, education, total household income, smoking and job status among women aged 15-39 were associated with participation in cervical cancer screening (p<0.05). After age stratification, the associated factors differed by age groups. Moreover, a dose-response between participation in cervical cancer screening and high total household income in the 30-39 age group was seen. CONCLUSIONS: Predictive factors differed among young women (aged 15-29 vs 30-39). Thus, age-specific tailored interventions and policies are needed to increase the participation rate in screening for cervical cancer.

Barbed versus conventional 2-layer continuous running sutures for laparoscopic vaginal cuff closure.

We compared results using unidirectional barbed sutures and conventional sutures for vaginal cuff closure during total laparoscopic hysterectomy (TLH).The electronic medical records and surgical videos of 170 patients who underwent TLH between January 2013 and March 2015 at Uijeong-bu St. Mary's Hospital of Catholic University of Korea were reviewed. Vaginal cuffs were closed using the 2-layer continuous running technique with unidirectional barbed sutures (V-Loc; Covidien, Mansfield, MA) in 64 patients and with polycolic acid Vicryl; Ethicon, Somerville, NJ sutures in 106 patients. Procedure time, clinical characteristics, and postoperative complications were compared between the 2 study groups. There were no differences in clinical characteristics (age, body mass index, and demographic data) between groups. The mean suturing time was significantly reduced in the barbed group (7.2 vs 12.2 minutes; P < 0.001), although the mean number of stitches was greater than in the Vicryl group (14.1 vs 12.3, P < 0.001). Perioperative complications, including episodes of vaginal bleeding, vaginal cuff cellulitis, and postoperative fever, did not differ between groups. There were no instances of vaginal cuff dehiscence in either group. Unidirectional barbed sutures can be used safely to reduce procedure time and surgical difficulty relative to conventional sutures in laparoscopic vaginal cuff closure.

Maternal hyperglycemia and the 100-g oral glucose tolerance test.

OBJECTIVES: To compare the characteristics of pregnant women with hyperglycemia according to the severity of glucose intolerance using the 100-g oral glucose tolerance test (OGTT) and to demonstrate the need to manage the condition of women with mild hyperglycemia. MATERIALS AND METHODS: In this retrospective cohort study, a total of 258 women at high risk of gestational diabetes (GDM) based on a positive 50-g oral glucose challenge test (OGCT) were classified into 0+, 1+, 2+, 3+, and 4+ groups according to the number of abnormal plasma glucose values on the 100-g OGTT. The clinical characteristics of the groups were compared. RESULTS: The rates of advanced maternal age (≥ 35 years), multiparity, prior history of GDM, preterm birth, cesarean delivery, and elevated body mass index were all positively correlated with the number of abnormal plasma glucose values on the OGTT (p < 0.05 for all variables). After adjusting for confounding factors, the fasting plasma glucose levels predicted birth weight in 44.4%, 48.4%, and 58.6% of the women in the positive 50-g OGCT group, the 0+ group, and the 1+ group, respectively. Weight gain during pregnancy predicted birth weight in 42%, 44.6%, and 37.6% of the women in the positive 50-g OGCT group, the 0+ group, and the 2+ group, respectively (p < 0.001 in each case). CONCLUSIONS: These data demonstrate that the detection and management of mild hyperglycemia below the current diagnostic criteria of GDM as well as GDM diagnosed using the 100-g OGTT are necessary for improving pregnancy outcomes.