Knowledge, attitudes, and acceptability about influenza vaccination in Korean women of childbearing age

OBJECTIVE: The aims of the present study were to investigate the women's perspective on influenza infection and vaccination and to evaluate how they influence vaccine acceptability, in Korean women of childbearing age. METHODS: This was a prospective study by random survey of women of childbearing age (20 to 45 years). They were asked to complete a questionnaire assessing their knowledge, attitudes and acceptability of influenza vaccination before and during pregnancy. This study utilized data from the Korea National Health and Nutrition Examination Survey (KNHANES) between 2008 and 2012, to analyze the recent influenza vaccination trends. RESULTS: According to KNHANES (2008-2012), influenza vaccination rates in women of childbearing age have increased up to 26.4%, after 2009. The questionnaire was completed by 308 women. Vaccination rate during pregnancy or planning a pregnancy was 38.6%. The immunization rate increased significantly with the mean number of correct answers (P<0.001). Women who received influenza vaccination were more likely to be previously informed of the recommendations concerning the influenza vaccination before or during pregnancy, received the influenza vaccination in the past, and of the opinion that influenza vaccination is not dangerous during pregnancy, with odds ratios of 14.6 (95% confidence interval [CI], 6.44 to 33.33; P<0.0001), 3.6 (95% CI, 1.84 to 6.97; P=0.0002) and 2.7 (95% CI, 1.34 to 5.47; P=0.0057). CONCLUSION: Influenza vaccination rate in women of childbearing age has increased in this study and national data. More information and recommendation by healthcare workers, especially obstetricians, including safety of vaccination, might be critical for improving vaccination rate in women of childbearing age.

Leg Weakness Caused by Bilateral Piriformis Syndrome: A Case Report

Piriformis syndrome (PS) is an uncommon neuromuscular disorder caused by the piriformis muscle (PM) compressing the sciatic nerve (SN). The main symptom of PS is sciatica, which worsens with certain triggering conditions. Because the pathophysiology is poorly understood, there are no definite diagnostic and therapeutic choices for PS. This case report presents a young woman who mainly complained of bilateral leg weakness. Electromyography revealed bilateral sciatic neuropathy and magnetic resonance imaging confirmed structural lesions causing entrapment of the bilateral SNs. After a laborious diagnosis of bilateral PS, she underwent PM releasing surgery. Few PS cases present with bilateral symptoms and leg weakness. Therefore, in such cases, a high level of suspicion is necessary for accurate and prompt diagnosis and treatment.

Knowledge and Acceptability about Adult Pertussis Immunization in Korean Women of Childbearing Age

PURPOSE: The adult tetanus, reduced diphtheria, and acellular pertussis (Tdap) vaccine has been introduced in order to provide individual protection and reduce the risk of transmitting pertussis to infants. We assessed the knowledge and acceptability of the Tdap vaccine around pregnancy. MATERIALS AND METHODS: This study was a cross-sectional survey of women of childbearing age (20-45 years) who visited obstetrics and gynecologic units of primary, secondary, or tertiary hospitals. They were asked to fill in a questionnaire assessing their knowledge, attitudes, and acceptability of Tdap. RESULTS: The questionnaire was completed by 308 women; 293 (95.1%) had not received information from doctors about Tdap, and 250 (81.2%) did not know about the need for vaccination. A significantly important factor related to subjects' intention to be vaccinated, identified by stepwise multiple logistic regression, was the knowledge (OR 13.5, CI 3.92-46.33) that adult Tdap is effective in preventing pertussis for infants aged 0-6 months. Additionally, 276 (89.6%) considered the recommendation of obstetric doctors as the most influencing factor about Tdap vaccination. CONCLUSION: In Korea, most women of childbearing age seem to be neither recommended nor adequately informed about the vaccination, although our population was not a nationwide representative sample. Information given by healthcare workers may be critical for improving awareness and preventing pertussis.

Effectiveness of sacrospinous colpopexy in vault prolapse patients / 대한산부인과학회지

OBJECTIVE: To evaluate the effectiveness of sacrospinous colpopexy in vault prolapse patients. METHODS: It is the retrospective study including 10 vault prolapse patients who received sacrospinous colpopexy at St. Paul Hospital, the Catholic University from July 1999 to April 2004. RESULTS: The 10 patients receiving sacrospinous colpopexy had the average age of 58.9 years, and the parity of 3.4. They were moderately overweighted with average BMI of 24.5. The average period from hysterectomy to diagnosis of vault prolapse was 11.1 years. Hypertension was noted on most of patients (70.0%). The average operation time was 68.5 minutes and postoperative hemoglobin decrement was 2.4 on average. During 2-month period of postoperative follow-up, there were no significant complications noted except one case of wound infection associated with diabetes and one case of transfusion due to anemia. After sacrospinous colpopexy, protruding mass out of vagina was resolved on 100% and urologic and other complications were improved over 50% of cases. CONCLUSION: Considering that several underlying medical conditions such as hypertension, obesity are associated with vault prolapse patients, sacrospinous colpopexy in case of vault prolapse is an excellent operative approach with low complication and recurrence rates.

The differences of fetal heart rate according to fetal sex / 대한산부인과학회잡지

OBJECTIVES: The purpose of this study is to analyze the previously unreported effect of fetal sex on the fetal heart rate and to measure its magnitude in relation to the effects of other independent clinical variables. METHODS: Three hundred and seventeen pregnant women who were able to provide electronic fetal heart rate monitoring were evaluated. On the basis of fetal sex after birth, 167 pregnant women who delivered male neonate were for males group and 146 examples who delivered female neonate were for female group. We analyzed fetal heart rate data using the Catholic Computer Assisted Obstetric Diagnosis System(CCAOD). RESULTS: Female fetuses had significantly faster basal heart rate(140.51+/-12.43bpm) than male fetuses(137.64+/-13.68 bpm).(P=0.007) Percent acceleration time(PAT) increased significantly for males(6.10+/-4.00bpm), comparing to females(4.90+/-3.34bpm).(P=0.001) Also percent deceleration time(PDT) was significantly higher in male fetuses(7.50+/-8.70bpm) than female fetuses(6.18+/-7.70bpm).(P=0.039) But there was no differences in standard deviation(SD)(8.84+/-10.11bpm, 8.11+/-3.56bpm), long term variation(LTV)(80.38+/-62.79msec, 73.65+/-54.60msec), and short term variation(STV)(14.06+/-9.79msec, 13.33+/-12.32msec) between male and female fetuses. CONCLUSION: The fetal heart rate of female fetuses differ from that of male fetuses. Computerized linear analysis and nonlinear analysis of antepartum fetal heart rate will need to take into account the multiple factors that influence the fetal heart rate to identify precisely which pattern predict clinical outcome.

Serum Concentration of CA-125 during the First Trimester of Normal and Abnormal Pregnancies / 대한산부인과학회잡지

A prospective study was initiated to compare maternal serum concentration of CA-125 during the first trimester of normal and abnormal pregnancies. Serum specimens were obtained from 87 women with a normal intrauterine pregnancy and 47 women with abnormal pregnancies which were ended in spontaneo abortion or pathologically confirmed to be missed abortion. In normal pregnancies, the mean serum CA-125 concentrations were increased significantly from amenorhea 6 weeks (139.838.7 IU/ml), and were higher statistically than the values tested in the same weeks of abnormal pregnancies. In abnormal pregnancies serum CA-125 concentations were relatively lower than those of normal pregnancies. But these differences were not statistically significant except the values tested in amenorhea 6weeks. So serum levels of CA-125 may not be proved useful in monitoring of early pregnancies outcome.

ATP and Adenosine Induce Growth Inhibition and Apoptosis in Human Trophoblast-like (TL) Cell Line / 대한산부인과학회잡지

BACKGROUND: Although nucleotides -like Adenosine Triphosphate (ATP) and its derivatives Adenosine, were known to induce growth inhibition and apoptosis in diverse cell lines, little is known about their effects on trophoblast. OBJECTIVE: To elucidate the effects of extracellular ATP and adenosine on trophoblast cell growth and to delineate if apoptosis is involved in this mechanism. MATERIALS AND METHODS: We used TL cell line, derived from human term placenta. The cells were cultured for 24, 48, and 72 hours after being treated with ATP and adenosine, each. Also, cell growth according to different concentrations of ATP and adenosine was evaluated. To test whether apoptosis was induced by each nucleotide, DNA fragmentation and nuclear condensation by Hoechst 33258 stain and P53 protein expression were evaluated. RESULTS: Cell growth was inhibited by ATP and adenosine in time and dose-dependent manner. Furthermore, the growth inhibitory effect of adenosine was stronger than ATP, whereas signs of DNA fragmentation and nuclear condensation were observed in ATP treated cells, but not in adenosine treated ones. CONCLUSION: Our results shows that ATP and adenosine exert inhibitory effect on growth in TL cell line. These findings suggest that pathological production of ATP or its metabolites, adenosine, may lead to a pathologic status such as preeclampsia or intrauterine growth restriction.

A case of false positive amniotic acetylcholinesterase in a normal pregnancy / 대한산부인과학회잡지

Maternal serum alpha-fetoprotein (AFP) has been used for a long time for the prenatal diagnosis of neural tube defects in women at midtrimester of gestation. But AFP is elevated not only in cases of neural tube defects, but also in fetus with congenital nephrosis, abdominal wall defects, fetal demise, low birth weight or simply erroneously calculated gestational age. So, when maternal serum AFP is increased, gestational age of the fetus must be re-evaluated and targeted ultrasonographic evaluation is indicated to rule out neural tube defects. If NTDs are suspected or ultrasound is non-diagnostic, amniotic fluid AFP are measured and when AF-AFP is elevated, the presence or absence of acetylcholinesterase should be evaluated. The detection rate of open neural tube defects using amniotic acetylcholiesterase is reported to be as high as 96 to 99% with a 0.06% and 0.14% of false positive rate in amniotic fluids non-contaminated and contaminated by blood, respectively. We report a case with elevated mid-trimester MS-AFP, AF-AFP and positive amniotic acetylcholin-esterase, but in which repeated sonographic findings were normal, and result in delivery of a heathy baby without anomalies.

A case of false positive amniotic acetylcholinesterase in a normal pregnancy / 대한산부인과학회잡지

Maternal serum alpha-fetoprotein (AFP) has been used for a long time for the prenatal diagnosis of neural tube defects in women at midtrimester of gestation. But AFP is elevated not only in cases of neural tube defects, but also in fetus with congenital nephrosis, abdominal wall defects, fetal demise, low birth weight or simply erroneously calculated gestational age. So, when maternal serum AFP is increased, gestational age of the fetus must be re-evaluated and targeted ultrasonographic evaluation is indicated to rule out neural tube defects. If NTDs are suspected or ultrasound is non-diagnostic, amniotic fluid AFP are measured and when AF-AFP is elevated, the presence or absence of acetylcholinesterase should be evaluated. The detection rate of open neural tube defects using amniotic acetylcholiesterase is reported to be as high as 96 to 99% with a 0.06% and 0.14% of false positive rate in amniotic fluids non-contaminated and contaminated by blood, respectively. We report a case with elevated mid-trimester MS-AFP, AF-AFP and positive amniotic acetylcholin-esterase, but in which repeated sonographic findings were normal, and result in delivery of a heathy baby without anomalies.

Successful Delivery In Women With Advanced Liver Cirrhosis: Report Of 3 Cases / 대한산부인과학회잡지

There is high prevalence of HBV infection in Asian countries including South Korea. In fact, 8% of Koreans are HBV carriers, and 20-25% of them progress to liver cirrhosis. Liver cirrhosis, known to be the last stage of chronic liver diseases, is the most prominent cause of death in Korean males in their forties. However, women participation to social activities increased and also increased psychological stress that changed life style now days, and due to increased alcohol consumption liver disease has become a serious problem in korean women population. But as liver cirrhosis usually occurs after the menopause, and decreased fertility in cirrhotic patients, pregnancy in women with liver cirrhosis is rare. However, improved general care increased pregnancy rates and reports of pregnancy in women with liver disease worldwide. Studies on the effect of liver cirrhosis on pregnancy and the effect of pregnancy on the clinical progression of liver cirrhosis have not been well established, and the continuation of pregnancy in a patient with liver cirrhosis has been controversial. Recently, it has become favorable for the argument that pregnancy can be kept as long as liver function is maintained at certain level and portal hypertension is mild. The most common and fatal maternal complication is gastrointestinal hemorrhage. It increases maternal mortality and intrauterine developmental defect resulting in neonatal morbidity. Although South Korea is an area of high prevalence of HBV infection, there are few reports of pregnancies in women with liver cirrhosis. Recently, we have experienced the 3 cases of pregnancies in women with progressive liver cirrhosis who became pregnant. Although thrombocytopenia and increased coagulopathy complicated the pregnancy course, all women delivered healthy babies and were discharged in good condition.

Successful Delivery In Women With Advanced Liver Cirrhosis: Report Of 3 Cases / 대한산부인과학회잡지

There is high prevalence of HBV infection in Asian countries including South Korea. In fact, 8% of Koreans are HBV carriers, and 20-25% of them progress to liver cirrhosis. Liver cirrhosis, known to be the last stage of chronic liver diseases, is the most prominent cause of death in Korean males in their forties. However, women participation to social activities increased and also increased psychological stress that changed life style now days, and due to increased alcohol consumption liver disease has become a serious problem in korean women population. But as liver cirrhosis usually occurs after the menopause, and decreased fertility in cirrhotic patients, pregnancy in women with liver cirrhosis is rare. However, improved general care increased pregnancy rates and reports of pregnancy in women with liver disease worldwide. Studies on the effect of liver cirrhosis on pregnancy and the effect of pregnancy on the clinical progression of liver cirrhosis have not been well established, and the continuation of pregnancy in a patient with liver cirrhosis has been controversial. Recently, it has become favorable for the argument that pregnancy can be kept as long as liver function is maintained at certain level and portal hypertension is mild. The most common and fatal maternal complication is gastrointestinal hemorrhage. It increases maternal mortality and intrauterine developmental defect resulting in neonatal morbidity. Although South Korea is an area of high prevalence of HBV infection, there are few reports of pregnancies in women with liver cirrhosis. Recently, we have experienced the 3 cases of pregnancies in women with progressive liver cirrhosis who became pregnant. Although thrombocytopenia and increased coagulopathy complicated the pregnancy course, all women delivered healthy babies and were discharged in good condition.

Influence of Hepatocyte Growth Factor on Matrix Metalloproteinase Expression in HT cell line / 대한산부인과학회잡지

OBJECTIVE: This study was performed to investigate the influence of hepatocyte growth factor (HGF) on matrix metalloproteinase (MMP), which are related in the lysis process of tissue during the invasion of trophoblasts. METHOD: HT cell line was treated with recombinant HGF (rHGF) of different concentration (0, 10, 50 and 100 ng/mL) and was cultured for 24 hours to check the changes in the expression of MMP-2 and MMP-9. Also, HT cell line was treated with recombinant HGF 50 ng/mL and was cultured for 24, 36, 48, and 72 hours to check the changes in the expression of MMPs according to the different time span. Total RNA were extracted from each cultured sample and RT-PCR and Western blotting were used to analyze the expression of MMP-2 and MMP-9. RESULTS: MMP-2 mRNA expression with treated rHGF showed increase of 2, 2.5 and 2.2 times with the increase of concentration level of 10, 50 and 100 ng/mL accordingly, while MMP-2 protein expression were increased 1.4 and 1.5 times in 50 ng/mL and 100 ng/mL of rHGF respectively compared with that of normal control. MMP-9 mRNA showed no significant changes in its expression with all different levels of concentration, while MMP-9 protein showed 1.5 times increase with 10 ng/mL rHGF but 0.4 times decrease with 100 ng/mL. MMP-2 mRNA expression treated with recombinat HGF were increased 1.6 times with 24 hour culture and 2.3 times with 36 hour culture. MMP-2 protein showed 1.9 times increase only for the case of 24 hour culture. MMP-9 mRNA expression of recombinant HGF-treated groups was decreased 0.7 times compared with that of control group in 36 hours. MMP-9 protein expression were increased by 1.2, 1.6 and 1.9 times as culture time increase to 36, 48, and 72 hours accordingly, compared with that of normal control. CONCLUSION: This result suggests that the HGF might partially regulate the invasion of trophoblasts through MMP-2 and MMP-9.

Influence of Hepatocyte Growth Factor on Matrix Metalloproteinase Expression in HT cell line / 대한산부인과학회잡지

OBJECTIVE: This study was performed to investigate the influence of hepatocyte growth factor (HGF) on matrix metalloproteinase (MMP), which are related in the lysis process of tissue during the invasion of trophoblasts. METHOD: HT cell line was treated with recombinant HGF (rHGF) of different concentration (0, 10, 50 and 100 ng/mL) and was cultured for 24 hours to check the changes in the expression of MMP-2 and MMP-9. Also, HT cell line was treated with recombinant HGF 50 ng/mL and was cultured for 24, 36, 48, and 72 hours to check the changes in the expression of MMPs according to the different time span. Total RNA were extracted from each cultured sample and RT-PCR and Western blotting were used to analyze the expression of MMP-2 and MMP-9. RESULTS: MMP-2 mRNA expression with treated rHGF showed increase of 2, 2.5 and 2.2 times with the increase of concentration level of 10, 50 and 100 ng/mL accordingly, while MMP-2 protein expression were increased 1.4 and 1.5 times in 50 ng/mL and 100 ng/mL of rHGF respectively compared with that of normal control. MMP-9 mRNA showed no significant changes in its expression with all different levels of concentration, while MMP-9 protein showed 1.5 times increase with 10 ng/mL rHGF but 0.4 times decrease with 100 ng/mL. MMP-2 mRNA expression treated with recombinat HGF were increased 1.6 times with 24 hour culture and 2.3 times with 36 hour culture. MMP-2 protein showed 1.9 times increase only for the case of 24 hour culture. MMP-9 mRNA expression of recombinant HGF-treated groups was decreased 0.7 times compared with that of control group in 36 hours. MMP-9 protein expression were increased by 1.2, 1.6 and 1.9 times as culture time increase to 36, 48, and 72 hours accordingly, compared with that of normal control. CONCLUSION: This result suggests that the HGF might partially regulate the invasion of trophoblasts through MMP-2 and MMP-9.

A Case of Retroperitoneal Teratoma Antenatally Diagnosed / 대한주산의학회잡지

No abstract available.

A Case of preofpregnancy combined with Primary Pulmonary Hypertension / 대한산부인과학회잡지

No abstract available.

A Case of Primary Choriocarcinoma of the Fallopian Tube / 대한산부인과학회잡지

Primary choriocarcinoma of the fallopian tube has been known for 4% of choriocarcinoma also 1.7% of gestational trophoblastic disease. Its symptom and sign in presentation are similar to the ectopic pregnancy or adnexal mass, thus it is confirmed through histopathological descriptions after explolaparotomy or laparoscopy. Mostly it is common in younger women who are reproductive, we have done conservative surgery followed by chemotherapy. After that, the prognosis was good. We have experienced a case of primary choriocarcinoma of the fallopian tube and reported with a brief review.

A Case of Prenatally Diagnosed Fetal Retroperitoneal Cystic Lymphangioma / 대한산부인과학회잡지

Lymphangiomas are congenital malformations of lymphatic vessels that have the potential to infiltrate surrounding structures. In 95% of cases, they are located in the neck (cystic hygroma), head and axilla. But they can occur in a variety of anatomical locations, such as the abdominal cavity, extremities and urinary bladder. Pathologically they can be classified into three group: lymphangioma simplex; carvenous lymphangioma; and cystic lymphangiomas or hygromas. Mixed lesions may coexist in different areas of the same lymphangioma. Although these lesions are benign, they have a propensity for rapid growth and invasion into the underlying muscles and connective tissues. A extensive mass can compress adjacent vital organs, which determines the severity of the lesion. Accurate prenatal diagnosis and anatomical evaluation are important as they permit planned delivery and prompt postnatal resuscitation, and allow the option of terminating the pregnancy if a poor outcome is predicted. Prenatal MRI can confirm ultrasonographic findings, provide detailed fetal anatomical evaluation, and demonstrate the extent and character of lymphangiomas. We present a case of a huge retroperitoneal cystic lymphangioma diagnosed prenatally using ultrasound and MRI at 26 weeks gestation.

A Case of Prenatally Diagnosed Fetal Unilateral Renal Agenesis with Contralateral Renal Hypoplasia / 대한산부인과학회잡지

Renal agenesis is a disorder characterized by the congenital absence of one or both kidneys due to complete failure of the kidney to form. The syndrome of renal agenesis is severe oligohydramnios, amnion nodosum, flattened face, low-set and floppy ears, and bilateral pulmonary hypoplasia. Bilateral renal agenesis occurs in 0.1 to 0.3 per 1000 births and unilateral involvement occurs in 1 in 500 to 1 in 1300 live births.1,2 Bilateral renal agenesis is an invariably lethal condition, and is associated in more than half of the affected individuals with malformations of the genitourinary tract, cardiovascular system, vertebral bodies or imperforated anus.2 Accurate diagnosis in the mid-trimester permits the parents to allow elective termination. However, the nearly absent amniotic fluid makes an accurate assessment of fetal kidney difficult. We present a case of unilateral renal agenesis with contralateral renal hypoplasia, diagnosed by ultrasonography after amnioinfusion at 21 weeks gestation.

A case of Necrotizing Fascitis after Cesarean Section / 대한산부인과학회잡지

The necrotizing fascitis, that develops after a Cesarean section, is acknowledged as a rare complication due to the development of antibiotics. Having a very high mortality rate, the only way to prevent the septic shock and the impairment of the cardiopulomary function is the use of adequate antibiotics, the infusion of IV fluids, a radical section of the necrotized fascia and a through cleansing. We have an experience in treating a primipara who had a necrotic fascitis after Cesarean section, and therefore, report this case with the review of articles enclosed.

A case of Edward syndrome with radius aplasia / 대한산부인과학회잡지

Trisomy 18 is the second most common chromosomal anomaly that reach to live birth after Down syndrome. Several methods were proposed to screen patients on the risk of Edward syndrome like maternal serum levels using total human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and unconjugated estriol (uE3), or free beta hCG with AFP, but the serum screening has only 50-60% detection rate with a 1-2% of false positive rate. So to cover the limitations that serum marker has, detailed ultrasound examination is also necessary and sensitivities of 65-70% were reported. We report a case of trisomy 18 fetus in which second trimester triple markers of maternal serum was normal, but by detailed ultrasound examination, unilateral radius aplasia was diagnosed cytogenetic study confirmed the fetus as trisomy 18.