Search

Purpose: The aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation., Methods: We reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL., Results: Sixty-four patients (46.7%) required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1%) had placenta previa totalis. The overall success rate was 75% (48/64) for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05). The drainage amount over 1 hour was 500 mL (20-1200 mL) in the balloon failure group and 60 mL (5-500 mL) in the balloon success group (p<0.01)., Conclusion: Intrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance.

Aims: To investigate risk factors for cesarean section (CS) following labor induction in nulliparas with an unfavorable cervix at or beyond 41 weeks of gestation., Methods: In this retrospective cohort study, a total of 276 nulliparas with an unfavorable cervix (Bishop score ≤6) who underwent labor induction for prolonged pregnancies were included out of a total of 646 patients who delivered ≥41 weeks (2002-2011)., Results: 82 (29.7%) patients of the 276 delivered by CS. The patients who underwent CS had less cervical dilatation and a lower Bishop score on admission than those patients who delivered vaginally (0.76 ± 0.47 vs. 0.92 ± 0.58 cm, p = 0.03 and 1.16 ± 1.25 vs. 1.51 ± 1.34, p = 0.04, respectively). Neonatal birth weight and biparietal diameter (BPD) were significantly smaller in the vaginal delivery group (3,414.93 ± 361.37 vs. 3,534.81 ± 383.05 g, p = 0.01 and 9.43 ± 0.35 vs. 9.65 ± 0.42 cm, p < 0.01). After multiple logistic regression analysis, maternal height, BPD, and early rupture of membranes (ROM) were independently related with CS. Early ROM was defined as spontaneous ROM that occurred before the onset of the active phase of labor., Conclusion: Maternal height, BPD, and early ROM were risk factors for CS following labor induction in nulliparas at or beyond 41 weeks of gestation., (© 2013 S. Karger AG, Basel.)

Background: The implications of low values on the 50 g glucose challenge test (GCT) in pregnancy are not clearly defined. Few studies have evaluated the influence of maternal low GCT values on obstetrical outcomes. This study aimed to compare pregnancy outcomes between women with low 50 g GCT values and those with normal values. Materials and Methods: Women undergoing gestational diabetes mellitus screening at 24–28 weeks of gestational age between January 2010 and December 2016 were retrospectively evaluated. Women with multifetal pregnancies, prepregnancy type I or II diabetes, GCT performed before 24 or after 28 weeks of gestational age, and women undergoing multiple GCTs in the same pregnancy were excluded. Low GCT values and normal GCT values were defined as ≤85 mg/dL and 86–130 mg/dL, respectively. Results: Of 3875 screened subjects, 519 (13.4%) women were included in the low GCT group and 3356 (86.6%) in the normal GCT group. Low GCT women had a significantly higher rate of small for gestational age (SGA) infants than normal GCT women (10.8% vs. 7.9%, p = 0.02). Cesarean section and postpartum hemorrhage (PPH) were less frequent in low GCT women than in normal women (32.6% vs. 42.8%, p < 0.01 and 0.2% vs. 1.2%, p = 0.03, respectively). Low GCT women had a 1.38-fold increased risk of bearing SGA infants (95% confidence intervals: 1.01–1.88, p = 0.04). Conclusions: Rate of SGA infants was significantly higher and cesarean delivery and PPH rates were significantly lower in women with low GCT values. Low GCT values were independently associated with an increased risk of SGA. [ABSTRACT FROM AUTHOR]

Aims: The purpose was to investigate the influence of delivery mode on the postpartum regression of abnormal cervical cytology. Methods: A retrospective review was conducted of 64 pregnant women with abnormal cervical cytology at Yonsei University Health System in Korea between 2001 and 2008. A Papanicolaou smear and pathological data were categorized into three groups by cervical intraepithelial neoplasia classification. Postpartum evaluation was taken 3-6 months after delivery. The regression rates of cervical cytologic findings were compared between the vaginal delivery group and Cesarean section group. p < 0.05 was considered significant. Results: Of the 64 women, 45 (70.3%) were delivered vaginally and 19 (29.7%) by cesarean section. No significant difference was found between the two groups with respect to age, gestational age, parity, smoking, and HPV (human papilloma virus) screening. Postpartum regression was shown in 39 (92.9%) women who delivered vaginally and in 12 (63.2%) women who underwent cesarean section (p = 0.016). In the cesarean section group, 1 patient had progressed from CIN2 to microinvasive cancer and 2 patients from carcinoma in situ to invasive cancer. Conclusion: The rate of spontaneous regression of antepartum abnormal cervical cytology was higher after vaginal delivery. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to investigate the significance of Doppler ultrasound as a predictor for adverse pregnancy outcomes in Korean women with anemia during the third trimester of pregnancy. Methods: A retrospective study comparing women with (n=377) and without (n=3183) anemia was performed. Maternal anemia was defined as hemoglobin concentration <10 g/dL. Umbilical artery Doppler (UmA) and uterine artery Doppler (UtA) velocimetry was performed before delivery. Results: There were higher rates of small for gestational age, cesareans for fetal distress, and preterm birth among the anemic compared to non-anemic women. When maternal anemia was combined with abnormal Doppler, the odds ratio (OR) of adverse pregnancy outcome was further increased. Both abnormal UtA and UmA to predict adverse pregnancy outcome showed sensitivity, specificity, positive and negative predictive values of 41.2%, 97.4%, 85.9%, and 51.2%, respectively (OR 2.0; 95% confidence interval 1.2–2.3). Conclusions: Doppler ultrasound examination could be used as a predictor for adverse pregnancy outcomes in women with anemia during the third trimester. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess whether nestin is expressed during differentiation of endothelial progenitor cells (EPCs) obtained from human umbilical cord blood (HUCB), and nestin expression is changed in hypoxia-conditioned culture of human umbilical vein endothelial cells (HUVECs). Methods: Among deliveries at our institute, 20 normal pregnant women who delivered by cesarean section at 37-40 weeks' gestation were selected. HUCB mononuclear cells (MNCs) from HUCB were isolated and cultivated. After characterization of CXCR4/KDR/CD34 positive cells (EPCs) by flow cytometry and fluorescent chemical staining, EPC culture was continued through day 10 for differentiation to outgrowth endothelial cell (OEC). For identification of EPC and OEC, RT-PCR was performed for each specific cell markers, such as AC133, CD45, CXCR4, CDH5, vWF, eNOs, CD34, and Flt 1. HUVECs were isolated from human umbilical cord veins by collagenase treatment. Culture of HUVEC in hypoxic and normoxic conditions was performed for 24 h. Nestin expression in EPCs, OECs and HUVECs was detected by RT-PCR and Western blotting. Results: Western blot analysis and RT-PCR revealed that nestin was not expressed in EPC, but well expressed in OECs and HUVECs. During 24 h of HUVEC culture, time course gene expression of VEGF was significantly increased, but nestin was not changed. Conclusions: Our results showed that nestin could be used as a new differentiation marker of EPCs, and hypoxic stimuli did not directly affect nestin gene expression. [ABSTRACT FROM AUTHOR]