Objective: Nephrin is a protein in the glomerular podocyte slit diaphragm; therefore, its presence in urine implies damage to podocytes. This study aimed to determine the efficacy of nephrin as a biomarker in maternal urine to predict preeclampsia (PE). Design and setting: This prospective study included pregnant women admitted for delivery at Seoul National University Bundang Hospital: March 2019 – May 2020. Population: Patients who had been diagnosed with PE were included and patients without a history of underlying diseases were recruited for the control group. Important clinical data has been collected. Methods: Urine samples were obtained, and nephrin signaling was detected through test strips using a lateral flow assay. Main Outcome Measures: The results of the point-of-care test were compared between the 2 groups: patients with PE, and without (control group) using the exact concentration of nephrin by enzyme-linked immunosorbent assay (ELISA). Results: Clinical characteristics – maternal age, rate of nulliparity, proportion of twin pregnancies, height, weight, cesarean section rate – were comparable between the PE and control groups. Nephrin signals were classified into four groups. In the PE group, signals 0, 1, 2, and 3 were found in 18.4% (9/49), 44.9% (22/49), 24.5% (12/49), and 12.2% (6/49) of participants, respectively. This was significantly different from the control group, in which 84.3% (43/51) were found to have signal 0 (P<0.001). Conclusions: Nephrin signaling in maternal urine could be a noninvasive and useful test for predetecting severity of PE.

Objective: To compare maternal, perinatal and long-term outcome of triplet pregnancies managed expectantly with those reduced to twins Design: A retrospective cohort study Setting: Tertiary medical institutions in South Korea Population: We examined short-term and long-term outcomes in 524 triplet pregnancies with three live fetuses before 14 weeks of gestation that were comprised of expectant management(EM) group (n=213) and embryo reduction(ER) group (n=311) from 2006 to 2017. Methods: The two groups were compared for the following outcomes. Main Outcome Measures: 1) the rates of non-viable pregnancy loss before 23 weeks, 2) the rates of preterm birth before 32 weeks of gestation; 3) the number of survival fetuses; and 4) long term neurodevelopmental outcomes. Results: In the EM group, the risk of preterm delivery (<36, <34, <32, and <28 weeks) was higher compared to the ER group. However, the risk of non-viable pregnancy loss was lower [2(0.9%) vs. 20(6.4%), p=0.008] in EM group, and the rate of cases with at least one alive neonate were higher in EM group than ER group [208(97.7%) vs. 287(92.3), p=0.013]. The survival rate until discharge of neonates were also significantly higher in the EM group than the ER group [607(95.0%) vs. 545(87.6), p=0.001]. The risk of developmental delay or cerebral palsy in survived neonates was not different between the two groups of cases. Conclusions: In triplet pregnancies, EM may improve the chance of fetal survival, without any significant differences in developmental delay and cerebral palsy.