Background: In contrast to consistent epidemiologic evidence of the role of sexual transmission of human papillomavirus (HPV) in adults, various routes may be related to HPV infection in infants. We have assessed the extent of HPV infection during the perinatal period, and the relationship between mode of delivery and vertical transmission. Results: A total of 291 pregnant women over 36 weeks of gestation were enrolled with informed consent. Exfoliative cells were collected from maternal cervix and neonatal buccal mucosa. HPV infection and genotypes were determined with an HPV DNA chip, which can recognise 24 types. The HPV-positive neonates were re-evaluated 6 months after birth to identify the presence of persistent infection. HPV DNA was detected in 18.9 % (55/291) of pregnant women and 3.4 % (10/291) of neonates. Maternal infection was associated with abnormal cytology (p = 0.007) and primiparity (p = 0.015). The infected neonates were all born to HPV-positive mothers. The rate of vertical transmission was estimated at 18.2 % (10/55) which was positively correlated with maternal multiple HPV infection (p = 0.003) and vaginal delivery (p = 0.050), but not with labour duration and premature rupture of membranes. The rate of concordance of genotype was 100 % in mother-neonate pairs with vertical transmission. The neonatal HPV DNAs found at birth were all cleared at 6 months after delivery. Conclusions: Vertical transmission of HPV DNA from HPV infected mother to the neonate increased when the infant was delivered through an infected cervix. However, the absence of persistent infection in infants at 6 months after delivery may suggest temporary inoculation rather than true vertical infection.

We aimed to evaluate diagnosis and management of an ectopic pregnancy developing in a previous cesarean scar. Between March 2003 and October 2015, total 64 cases of cesarean scar pregnancy (CSP) were retrospectively reviewed. The cliniscal characteristics, diagnosis, various methods of treatment and clinical outcomes were analyzed. The mean gestational age at diagnosis was 6.5 ± 1.1 weeks and the number of previous cesarean section was 1.6 ± 0.6. The main ultrasonographic findings included anterior implantation of gestational sac within the previous CS scar and thinning of anterior myometrium (average: 3.0 ± 2.0 mm). Excluding 6 cases that were lost to follow up after diagnosis, 58 patients underwent first line treatment. The treatment was successful with first line therapy alone in 32 patients (55.2%). Emergency hysterectomy was necessary in 4 cases during following up of first line treatment. In 22 patients who underwent second line treatment, all of them were successfully treated with no additional treatment. MTX treatment alone as first line treatment showed low success rate (41.3%). Wedge resection (100%) and hysteroscopy (66.7%) were relatively safe and they were the most successful treatment modalities in this study. Dilatation and curettage as first and second line treatment had about 20% and 16.7% risk of emergency hysterectomy due to severe hemorrhage respectively. Therefore, surgical modalities with direct visualization excluding dilatation and curettage seem to be more safe and successful than medical treatment using MTX alone. Early precise diagnosis and management of CSP will be very important to minimize the extent of treatment and thus improve clinical outcomes of the patients.

Choi SH, et al. Yonsei Med J. 2023 Mar;64(3):204-212. https://doi.org/10.3349/ymj.2022.0278

Background: The purpose of this study was to evaluate the prevalence of velamentous cord insertion (VCI) and the actual association between pathologically confirmed VCI and perinatal outcomes in twins based on the chorionicity. Methods: All twin pregnancies that received prenatal care at a specialty clinic for multiple pregnancies, from less than 12 weeks of gestation until delivery in a single institution between 2015 and 2018 were included in this retrospective cohort study. Results: A total of 941 twins were included in the study. The prevalence of VCI in dichorionic (DC) twins and monochorionic diamniotic (MCDA) twins was 5.8% and 7.8%, respectively (p = 0.251). In all study population, the prevalence of vasa previa and placenta accreta spectrum was higher in VCI group than that of non-VCI group (p = 0.008 and 0.022). In MCDA twins with VCI, birth weight, 1 and 5-min Apgar score were lower than DC twins with VCI (p = 0.010, 0.002 and 0.000). There was no significant association between VCI and selective fetal growth restriction (p = 0.486), twin-to-twin transfusion syndrome (p = 0.400), and birth-weight discordance (>20% and >25%) (p = 0.378 and 0.161) in MCDA twins. Conclusion: There was no difference in the incidence of VCI in twins based on the chorionicity. Moreover, VCI was not a risk factor for adverse perinatal outcomes excepting vasa previa and placenta accreta spectrum, which had a high incidence in twins with VCI.