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Our findings suggested that the MTHFR gene 677 C/T and 1298 A/C polymorphisms might have protective effects for preterm birth in the Korean women.

Background and Objectives: The ACE gene encodes the angiotensin-converting enzyme (ACE), a component of the renin-angiotensin system. Increased ACE activity may cause abnormal regulation of placental circulation and angiogenesis, resulting in adverse pregnancy outcomes. Previous studies have reported that the insertion/deletion (I/D) polymorphism of the ACE gene is associated with the development of preterm birth (PTB). However, results of the association between ACE gene I/D and PTB are inconsistent in various populations. Therefore, we performed a case-control study and a meta-analysis to evaluate the association between ACE I/D polymorphism and PTB. Materials and Methods: We analyzed a total of 254 subjects (111 patients with PTB and 143 women at ≥38 weeks gestation) for the case-control study. For the meta-analysis, we searched Google Scholar, PubMed, and NCBI databases with the terms “ACE,” “angiotensin-converting enzyme,” “preterm birth,” “preterm delivery,” and their combinations. Results: Our results of the case-control study indicated that ACE I/D polymorphism is significantly associated with PTBs in the overdominant genetic model (odds ratio (OR) 0.57, 95% confidence interval (CI) 0.347–0.949, p = 0.029) and that the ID genotype of ACE I/D polymorphism has a protective effect for PTB (OR 0.57, 95% CI 0.333–0.986, p = 0.043). Similarly, the meta-analysis showed that the OR for the ACE gene ID genotype was 0.66 (95% CI 0.490–0.900, p < 0.01). Conclusion: The ACE gene ID genotype has a significant association with PTB and is a protective factor for PTB. A larger sample set and functional studies are required to further elucidate of our findings.

A 42-year-old woman with irregular uterine contractions and a history of two prior cesarean sections was admitted. At 35 weeks of gestation, preterm labor with vaginal bleeding led to a cesarean section. During placenta removal it was revealed to be a percreta and uncontrollable massive bleeding ensued. Intraoperative resuscitative endovascular balloon occlusion of the aorta (REBOA) was performed, which has been used as a resuscitative adjunct for trauma patients with noncompressible torso hemorrhage and a hysterectomy was successfully completed. Gauze packing for temporary abdominal closure and angio-embolization were performed to further control bleeding. The packed gauze was removed 2 days later and the patient recovered uneventfully. To the best of our knowledge, this is the first reported case in South Korean literature of the successful application of a REBOA as a salvage treatment for hemorrhage control, and REBOA could be a life-saving procedure for patients with peripartum hemorrhaging.