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To evaluate the role of vascular endothelial growth factor (VEGF) in the pathogenesis of preeclampsia, we measured total VEGF, free VEGF and soluble Flt-1 (sFlt-1) concentrations and determined their relationships. Maternal serum samples were collected from 20 patients with preeclampsia and 20 normotensive women with uncomplicated pregnancies matched with the patients with preeclampsia for gestational age and parity. The serum concentrations of total VEGF (2.39±0.75 vs. 0.28±0.14) and sFlt-1 (934.5±235.5 vs. 298.0±161.2) were significantly increased in the patients with preeclampsia compared to the women with uncomplicated pregnancies. However the serum concentration of free VEGF (21.5±6.3 vs. 134.0±16.3) was lower in patients with preeclampsia. There was a positive correlation between the serum concentrations of total VEGF and sFlt-1 with systolic and diastolic blood pressure, respectively. There was a negative correlation between the serum concentration of free VEGF and systolic and diastolic blood pressure. There was a strong negative correlation between free VEGF and sFlt-1 concentrations. In conclusion, we found VEGF and sFlt-1 were related to the pathogenesis of preeclampsia. Although reduced concentrations of free VEGF might interfere with endothelial cell function and survival, further studies are required to clarify its specific role in the pathogenesis of preeclampsia.

Objective To provide a standardized protocol for the measurement of cervical strain elastography, present its reproducibility, and analyze baseline clinical factors affecting the measurement of elastographic parameters. Methods This study was performed by the Korean Research Group of Cervical Elastography. We enrolled pregnant women according to our study protocol. After measuring the cervical length, elastography was performed using the E-Cervix ™ quantification tool to measure the strain of the cervix using intrinsic compression. We evaluated 5 elastographic parameters, namely, the strain of the internal os of the cervix (IOS), strain of the external os of the cervix (EOS), ratio of the strain of IOS and EOS, elasticity contrast index, and hardness ratio. For baseline clinical factors, we examined the maternal body mass index, blood pressure, heart rate, uterine artery Doppler indices, and fetal presentation. Results We established a specific protocol for the measurement of cervical elastography using the E cervix program. For all elastographic parameters, the intra-observer intraclass correlation coefficient (ICC) ranged from 0.633 to 0.723 for single measures and from 0.838 to 0.887 for average measures, and the inter-observer ICC ranged from 0.814 to 0.977 for single measures and from 0.901 to 0.988 for average measures. Regression analysis showed that the measurement of the elastographic parameter was not affected by baseline clinical factors. Conclusion We present a standardized protocol for the measurement of cervical elastography using intrinsic compression. According to this protocol, reproducibility was acceptable and the measurement of elastographic parameters was not affected by the baseline clinical factors studied.

Although Cesarean section (CS) itself has contributed to the reduction in maternal and perinatal mortality, an undue rise in the CS rate (CSR) has been issued in Korea as well as globally. The CSR in Korea increased over the past two decades, but has remained at approximately 36% since 2006. Contributing factors associated with the CSR in Korea were an improvement in socio-economic status, a higher maternal age, a rise in multiple pregnancies, and maternal obesity. We found that countries with a no-fault compensation system maintained a lower CSR compared to that in countries with civil action, indicating the close relationship between the CSR and the medico-legal system within a country. The Korean government has implemented strategies including an incentive system relating to the CSR or encouraging vaginal birth after Cesarean to decrease CSR, but such strategies have proved ineffective. To optimize the CSR in Korea, efforts on lowering the maternal childbearing age or reducing maternal obesity are needed at individual level. And from a national view point, reforming health care system, which could encourage the experienced obstetricians to be trained properly and be relieved from legal pressure with deliveries is necessary.Graphical Abstract

Background We investigated whether there is a difference in elastographic parameters between pregnancies with and without spontaneous preterm delivery (sPTD) in women with a short cervix (≤ 25 mm), and examined the ability of elastographic parameters to predict sPTD in those women. Methods E-Cervix TM (WS80A; Samsung Medison, Seoul, Korea) elastography was used to examine the cervical strain. Elastographic parameters were compared between pregnancies with and without sPTD. Diagnostic performance of elastographic parameters to predict sPTD ≤ 37 weeks, both alone and in combination with other parameters, was compared with that of cervical length (CL) using area under receiver operating characteristic curve (AUC) analysis. Results A total of 130 women were included. Median gestational age (GA) at examination was 24.4 weeks (interquartile range, 21.4–28.9), and the prevalence of sPTD was 20.0% (26/130). Both the elastographic parameters and CL did not show statistical difference between those with and without sPTD. However, when only patients with CL ≥ 1.5 cm (n = 110) were included in the analysis, there was a significant difference between two groups in elasticity contrast index (ECI) within 0.5/1.0/1.5 cm from the cervical canal ( P < 0.05) which is one of elastographic parameters generated by E-Cervix. When AUC analysis was performed in women with CL ≥ 1.5 cm, the combination of parameters (CL + pre-pregnancy body mass index + GA at exam + ECI within 0.5/1.0/1.5 cm) showed a significantly higher AUC than CL alone ( P < 0.05). Conclusion An addition of cervical elastography may improve the ability to predict sPTD in women with a short CL between 1.5 and 2.5 cm.

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Cervical cancer is the third most common malignant disease of women worldwide. Despite advances in screening and treatment strategies, a significant number of patients have advanced and recurrent disease. These patients are not amenable to curative treatments, such as surgery and radiation, and have poor prognosis. Therefore, palliative treatment remains the standard of care for these patients. Several phase II/III trials have demonstrated that cisplatin is the most active single agent, and the combination of cisplatin and paclitaxel is considered a standard regimen for clinical practice and trials in these patients with improved response rates and progression-free intervals. Although other cisplatin doublet chemotherapy regimens were not superior to cisplatin plus paclitaxel, substituting topotecan or gemcitabine for paclitaxel might be helpful for some patients considering different toxicity profiles. Because the response to palliative chemotherapy is poor, several targeted agents including bevacizumab, erlotinib, pazopanib, lapatinib, sunitinib and cetuximab, each of which inhibits cell proliferation and angiogenesis, were evaluated in these patients. Of them, bevacizumab, targeting vascular endothelial growth factor, showed favorable results. Recent phase III trial showed that bevacizumab combined with chemotherapy was shown to significantly improve the response rate, progression-free interval, and overall survival compared to chemotherapy alone. These results suggest that targeted agents could significantly improve survival and affect practice guidelines in these patients showing poor prognosis. Thus, future trials using newly developed targeted agents are warranted to improve treatment strategies in these patients.

PurposeThe aim of this study was to evaluate the changes of the regulatory T cell subset in peripheral blood caused by gestational age and premature rupture of membranes (PROM) with or without labor to verify the role of regulatory T cells in pregnancy.Patients and MethodsWe investigated regulatory T cell distribution in the peripheral blood of pregnancies during the first trimester (group I, n = 2), the second trimester (group II, n = 12), and the third trimester without PROM and labor (group III, n = 15). In addition, we evaluated pregnancies in the third trimester complicated by PROM (group IV, n = 4) and labor with no complication by PROM (Group V, n = 5). Comparisons were made with non-pregnant controls (group VI, n = 4) using flow cytometry.ResultsDuring uncomplicated pregnancy, the CD4+CD25bright regulatory T cell population decreased with advancing gestational age (group I = 3.35 ± 0.47, group II = 2.91 ± 1.44, group III = 2.81 ± 1.36, group VI = 2.52 ± 0.71, p = NS). When we compared group IV with group III and V to evaluate the changes of the regulatory T cells with PROM, the CD4+CD25bright regulatory T cell population was significantly decreased in group IV compared to group III (p = 0.001) and group V (p = 0.026).ConclusionThe present results revealed that the regulatory T cell population increased in early pregnancy but decreased in pregnancies complicated by PROM, indicating that regulatory T cells might be related to the maintenance of pregnancy.