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Objective: To determine the contribution of maternal lipids in predicting large-for-gestational age (LGA) newborns born to women with gestational diabetes mellitus (GDM). Design: Retrospective study. Setting: Yonsei University Health System, Korea. Population: A total of 104 women diagnosed with GDM between January 2000 and June 2008. Methods: Women who were positive on the 50 g oral glucose challenge test (24-28 weeks' gestation) and who were referred patients suspected of GDM underwent a 3 hours, 100 g oral glucose tolerance test for GDM diagnosis. Maternal fasting serum triglycerides and total, high-density lipoprotein (HDL), and low-density lipoprotein cholesterol levels were determined at 24-32 weeks' gestation. Logistic regression analysis was performed to determine maternal parameters independently associated with delivering LGA newborns at term. Main Outcome Measures: Risk contributions for LGA newborns. Results: Maternal fasting serum triglyceride levels were significantly higher in mothers of LGA newborns compared with other mothers; however, no significant correlations were found between newborn birthweight and maternal fasting glucose, total cholesterol, or HDL cholesterol levels. After adjusting for confounding variables including prepregnancy body mass index, weight gain during pregnancy, age, and parity, maternal hypertriglyceridemia at 24-32 weeks' gestation remained an independent parameter for identifying term LGA newborns. Conclusions: In GDM pregnancies, determining maternal serum triglyceride levels during midpregnancy may help identify women likely to give birth to LGA newborns. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effect of nicotine on the production of soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng) in human umbilical vein endothelial cells (HUVECs) and trophoblast cells, and to assess the involvement of alpha 7 nicotinic acetylcholine receptor (alpha7 nAChR) in this process.Methods: Commercially available full-term placental trophoblasts and HUVECs derived from the umbilical cord of a normal pregnancy were used. The expression of alpha7 nAChR was assessed by immunostaining, RT-PCR, and western blotting. The expression of sFlt-1 and sEng protein in the cell media after 6 and 24 hours of treatment with nicotine was evaluated using a commercially available ELISA. To determine the involvement of alpha7 nAChR in the nicotinic effect, cells were treated with the alpha7 nAChR antagonist alpha-bungarotoxin (alpha-BGT) prior to the nicotine exposure. Levels of significance were determined using the Student's t-test and one-way ANOVA, and a p-value < 0.05 was considered significant.Main Outcome Measures: The levels of sFlt-1 and sEng protein were evaluated before and after the nicotine treatment with or without alpha-BGT pre-treatment.Results: In trophoblast cells, a significant reduction of sFlt-1 and sEng protein was observed after 24 hours of nicotine treatment as compared to the untreated group (p = 0.002, 0.000). In HUVECs, nicotine only had a suppressive effect on the expression of sEng at 6 hours (p = 0.03); there was no effect on sFlt-1 expression. However, pre-treatment with alpha-BGT did not reverse the nicotine-induced suppressive effect on the expression of sFlt-1 and sEng in trophoblasts and HUVECs.Conclusions: Nicotine reduced the production of sFlt-1 and sEng in trophoblasts and sEng in HUVECs. This effect was not mediated by alpha7 nAChR. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the relationship between abnormal Doppler velocimetry and adverse perinatal outcomes in pregnancies with borderline amniotic fluid index (AFI). Methods: Medical records of 3740 pregnancies with known AFI and Doppler velocimetry measurements within 2 weeks of delivery, and delivered between January 1996 and December 2003, were retrospectively analyzed. Borderline AFI was defined as 5 cm < AFI ≤ 8 cm. For the umbilical artery, Doppler velocimetry was considered abnormal when the S/D ratio was greater than 3.0 or when end-diastolic flow was absent; whereas, for the uterine artery, the S/D ratio was greater than 2.6 or presence of end-systolic notch was defined as abnormal. Adverse perinatal outcomes (small for gestational age, cesarean section for fetal distress, 5 min Apgar score of less than 7, respiratory distress syndrome, NICU admission, and perinatal death) according to Doppler velocimetry in borderline AFI were evaluated. Results: Compared to the normal AFI group ( n = 3523), the borderline AFI group ( n = 217) had significantly higher incidence of adverse perinatal outcome (28.8% vs 54.8%). There was 3-fold increase in the incidence of adverse perinatal outcome among women with the borderline AFI in comparison to normal AFI (OR, 3.00; CI, 2.27–4.00). When abnormal Doppler velocimetry was associated with borderline AFI, a 5-fold increase in the incidence of adverse perinatal outcome was noted (OR, 5.26; CI, 3.00–9.21). Conclusion: In the borderline AFI group, the presence of abnormal Doppler velocimetry measurement was related to increased risk of adverse perinatal outcome. Thus, borderline AFI of 5–8 cm, especially when associated with abnormal Doppler velocimetry, mandates closer antenatal surveillance. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the differences in urodynamic study (UDS) and the perineal ultrasonography parameters between stress urinary incontinence (SUI) patients with or without urethrovesical junction (UVJ) hypermobility. Treatment outcomes following a retropubic urethropexy were also compared. Methods: The records of 164 SUI patients (≤stage II), treated with retropubic urethropexy at our department between January 2001 and February 2004 were reviewed. The patients were categorized into a hypermobility group when the measured Q-tip angle was ≥30, and a non-hypermobility group when <30. All patients underwent UDS and perineal ultrasonography (US) preoperatively. A Burch urethropexy was performed regardless of the Q-tip result. All patients were reevaluated at 1 month and 3 months, postoperatively, and every 3 months thereafter. Results: Ninety-eight patients (60%) had an accompanying UVJ hypermobility and 66 (40%) did not. No significant differences regarding age, parity, body mass index (BMI), menopausal status, hormone replacement status, history of previous gynecologic surgery, or other medico-surgical illness were noted. UDS parameters demonstrated a significant difference between the groups, but were in the normal range. The significant difference noted in the perineal US was the bladder neck descent (BND). Following retropubic urethropexy, the success rates after 1 year were 94% and 91% for the hypermobility group and the non-hypermobility group, respectively, showing no statistical significance. Conclusion: The success rates of Burch urethropexy in the two groups were similar. This result suggests that either the Q-tip is an inaccurate method of evaluating UVJ hypermobility or the presence of UVJ hypermobility does not negatively affect the treatment outcome of a Burch urethropexy. [ABSTRACT FROM AUTHOR]

Background. To determine whether the measurement of β-human chorionic gonadotropin (β-HCG) level in the vaginal washing fluid could be useful for the diagnosis of premature rupture of membranes. Methods. Totally, 120 pregnant women were enrolled in this study. Subjects were divided into four groups [group I, no preterm labor and term delivery (n = 38); group II, preterm labor and term delivery (n = 12); group III, preterm labor and consequent premature delivery (n = 24); group IV, preterm labor with premature rupture of membranes (PROM) and consequent premature delivery (n = 46)]. After irrigating the posterior vaginal fornix with 3 ml of sterile saline and the obtained vaginal washing fluid, we measured β-HCG levels. Results. The median and range of vaginal fluid β-HCG levels were 3.60 (0.09-30.52), 4.42 (0.33-10.02), 15.50 (0.25-378.62), and 512.53 (26.95-3507.20) mIU/ml in group I, group II, group III, and group IV, respectively. Vaginal β-HCG level was significantly higher in patients with PROM followed by premature delivery (group IV) than patients in other groups (P < 0.01). From the receiver operating characteristic curve, 39.8mIU/ml was set as a cutoff value. Sensitivity, specificity, positive predictive value, and negative predictive value were 95.5, 94.7, 91.3, and 97.3%, respectively. Conclusion. Our study demonstrated that the measurement of vaginal fluid β-HCG may be reliable, simple, and rapid test in diagnosing PROM and used as a adjunctive test in equivocal cases. [ABSTRACT FROM AUTHOR]