임신성 당뇨 진단 기준의 고찰

양성천 ( Seong Cheon Yang ),김행수 ( Haeng Soo Kim ),양정인 ( Jeong In Yang ),이희종 ( Hee Jong Lee ),안상태 ( Sang Tae Ahn ),서성석 ( Seong Sug Seo ),유희석 ( Hee Sug Ryu ) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.11

목적: 임신성 당뇨의 진단기준을 낮추는 것이 미치는 효과를 밝히고자 하였다. 연구 방법: 임신 24-28주에 시행한 50 gm 경구 당부하검사상 혈장 혈당치가 130 mg/dl 이상인 산모에게 임신 28-32주에 100 gm 경구 당부하검사를 시행하였다. Carpenter-Coustan과 NDDG의 임신성 당뇨에 대한 진단기준을 적용하여, 대조군: 50 gm 경구 당부하검사상 정상군 (n=268), Borderline 군: Carpenter-Cousta Objective: To determine the effect of lowering the cutoff values of 3-hour oral glucose tolerance test (OGTT) for gestational diabetes mellitus (GDM). Methods: Patients with an abnormal 50 gm glucose challenge test (GCT) of more than 130 mg/dL at 24-28 we

100 gm 경구 당부하검사 결과 하나만 비정상을 보인 임신의 양상

한기수(Ki Su Han),양성천(Seong Cheon Yang),김행수(Haeng Soo Kim),양정인(Jeong In Yang),이희종(Hee Jong Lee),임재현(Jae Hyun Lim),임윤경(Yun Kyoung Lim),오기석(Kie Suk Oh) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.10

N/A Objective : To evaluate the clinical outcomes of pregnancies showing one abnormal glucose tolerance test value. Method : We performed 50 gm glucose challenge test in 5,019 pregnant women at 24-28 weeks of gestation. In 1,170 women with plasma glucose levels over 130 mg/dL, 100 gm oral glucose tolerance tests (OGTTs) were performed at 28-32 weeks of gestation. In the 888 cases who were followed up, according to the National Diabetes Data Group (NDDG) criteria, 122 cases with one abnormal 100 gm OGTT value were divided into three groups (groups 1, 2, 3 : abnormal value after 1, 2, 3 hours, respectively). These were compared with 577 cases (control group) with normal 100 gm OGTT value, retrospectively. Result : The incidence of one abnormal glucose tolerance test value was 2.6%, and there were no cases where the fasting plasma glucose level only was elevated. The incidence (control, group 1, group 2, group 3 : 19.4%, 43.8%, 25.7%, 29.6%) of poor maternal outcomes which contain any one of preeclampsia, hydramnios, cesarean delivery for cephalopelvic disproportion or failure to progress or fetal distress was highest in group 1 (p=0.025). The incidence (15.8%, 43.1%, 14.3%, 21.1%) of poor perinatal outcomes which contain any one of fetal distress, Apgar score of 5 minute < 7, hypoglycemia, respiratory distress syndrome, small for gestational age, perinatal death was also highest in group 1 (p=0.009). Logistic regression analysis for poor maternal outcomes showed odds ratio of 2.83 (95% confidence interval 1.02-7.87) in group 1 and 2.08 (95% confidence interval 1.22-3.55) in group 3, and for poor perinatal outcomes odds ratio of 4.24 (95% confidence interval 1.02-17.52) in group 1 and 3.30 (95% confidence interval 1.45- 7.48) in group 3. Conclusion : Pregnancies complicated with one abnormal glucose tolerance test value, particularly the group showing abnormal glucose tolerance test value after 1 or 3 hour exhibited adverse maternal and perinatal outcomes.

임신중기 유전적 양수천자 1,068예의 임상적 고찰

박현희(Hyun Hee Park),양성천(Seong Cheon Yang),김행수(Haeng Soo Kim),양정인(Jeong In Yang),오준환(Joon Hwan Oh),강현웅(Hyun Woong Kang),김현주(Hyun Joo Kim),주연종(Yeon Jong Joo),오기석(Kie Suk Oh) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10

목적: 본 연구에서는 임신중기 유전적 양수검사 1,068예의 임상적 결과를 살펴보고 타 연구와 비교 분석하고자 한다. 방법: 1994년 9월부터 1999년 2월까지 아주대학교병원 산부인과에서 시행한 임신중기 양수천자 총 1,068예를 분석하여 그 적응증 및 핵형검사 결과, 예방적 항생제 사용여부에 따른 합병증 발생 및 산과적 결과 등을 조사하였다. 결과: 총 1,068예 중 모체혈청을 이용한 선별검사 이상이 가장 흔한 적응증(57.7%)이었고, 가장 많은 연령군은 25-29세 군이었다(39.2%). 염색체이상은 56예(5.2%)로 수적 이상이 28예(50.0%), 구조적이상이 28예(50.0%) 였으며, 상염색체 이상이 50예(4.7%), 성염색체 이상이 6예(0.6%) 였다. 임신 결과는 정상 만삭분만이 86.5%이었고, 조산이 7.6%, 인공적인 임신중절이 시행된 예가 4.0%를 차지하였다. 합병증으로 태아손실은 없었으며, 1예는 경미한 양수누출 후 회복되어 임신을 지속하였다. 예방적 항생제 투여군과 투여하지 않은 두 군 간에 합병증 및 산과적 결과는 유의한 차이를 보이지 않았다. 적응증별 염색체 이상 발생 빈도에서 초음파 검사상 태아 기형이 의심되는 경우가 13.6%로 가장 높게 나타났다. 결론: 유전적 양수 검사의 가장 흔한 적응증이 고령 산모에서 현재는 산전 모체혈청을 이용한 선별검사 이상으로 변화하고 있음을 알 수 있었고, 염색체 이상의 상당수를 차지하는 젊은 연령층의 산모를 대상으로 하는 산전 모체혈청에 의한 선별검사, 산전 초음파검사, 기형아 분만 및 염색체 이상의 가족력 및 과거력 등을 바탕으로 하는 유전적 양수검사의 중요성을 알 수 있었다. 양수천자시 예방적 항생제 투여 여부에 따른 합병증 발생 및 산과적 결과는 양 군간의 비교분석상 통계학적 유의성을 나타내지 못하였으며, 더 많은 연구가 필요할 것으로 보인다. Objectives: The objective of this study is to analyze 1,068 cases of prenatal genetic amniocentesis and to compare the results with reported studies. Method: We analyzed 1,068 cases of midtrimester prenatal genetic amniocenteses from September 1994 to February 1999, and investigated the fetal chromosomal abnormality, obstetric outcomes and complications by the indications of genetic amniocentesis and prophylactic antibiotic use at the Department of Obstetrics and Gynecology, Ajou University School of Medicine. Results: Abnormal maternal serum markers were the most common indication of amniocentesis (57.7%) and the most common age distribution was 25-29 years (39.2%). One case of early amniocentesis (14 gestational weeks) was performed. The overall incidence of chromosomal aberration was 5.2% (56/1,068), of which there were 28 cases (50.0%; 28/56) of numerical aberrations and 28 cases (50.0%; 28/56) of structural aberrations. There were 50 cases (4.7%) of autosomal chromosomal aberrations and 6 cases (0.6%) of sex chromosomal aberrations. The pregnancy outcome was full-term delivery in 86.5%, preterm delivery in 7.6%, termination of pregnancy in 4.0%. There were no cases of serious complications including fetal death except for a case of self-limited amniotic fluid leakage(high leakage) in which the pregnancy was maintained. There were no significant differences between prophylactic antibiotics user group and non-user group in obstetric complications and outcomes. Conclusion: We could confirm that the trend in the indication of genetic amniocentesis had changed from advanced maternal age(35 year-old) toward abnormal maternal serum marker(triple test), and we recognized the importance of genetic amniocentesis according to the various antenatal screening tests of maternal serum marker, antenatal ultrasound, past history of fetal anomaly or family history of fetal chromosomal anomaly in the younger age groups(< 35 year-old) that are involved in more than half of the chromosomal anomaly. Further study will be needed to elucidate the efficacy of using prophylactic antibiotics in amniocentesis.

산전 일과성 태아 복수를 보인 자궁내 장중첩증

양정인 ( Jeong In Yang ),김행수 ( Haeng Soo Kim ),양성천 ( Seong Cheon Yang ),유희석 ( Hee Suk Ryu ),오기석 ( Kie Suk Oh ) 대한주산의학회 2001 Perinatology Vol.12 No.3

임신 제 3 분기까지 진행된 비교통성 흔적자궁각 임신 1 예

황경주(Kyung Joo Hwang),양정인(Jeong In Yang),오기석(Kie Suk Oh),김행수(Haeng Soo Kim),안은주(Eun Joo Ahn),양성천(Seong Cheon Yang),이은주(Eun Ju Lee),주희재(Hee Jae Joo) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.1

The uterus with rudimentary horn occurs as a result of a lack of development during fetal life of the middle and lower parts of one of the Miillerian ducts, in which there is a failure of fusion of the two ducts, The incidence of this uterine anomaly is rare. Many cases of rudimentary uterine horn are not discovered since they do not become involved in a pregnancy, and thus remain symptomless and uncomplicated, and the diagnosis usually being made only with pregnancy with rupture. In this presentation, we describe a case of diagnosis and management of unruptured non-communicating rudimentary uterine horn pregnancy at the third trimester. The patient diagnosed by ultrasonography and MRI, was hospitalized for further evaluation and delivery under the impression of unruptured non-communicating rudimentary horn pregnancy. A living male infant weighing 1,930 gm was delivered by cesarean section at 33+l weeks due to impending preterm labor. Some articles concerned this subject were reviewed briefly to discuss relevant method of diagnosis, treatment, and clinical characteristics.

HELLP 증후군의 임상적 고찰

안상태 ( Sang Tae Ahn ),김행수 ( Haeng Soo Kim ),양정인 ( Jeong In Yang ),오준환 ( Joon Hwan Oh ),한기수 ( Ki Su Han ),양성천 ( Seong Cheon Yang ),오기석 ( Kie Suk Oh ) 대한주산의학회 2001 大韓周産醫學會雜誌 Vol.12 No.2

자궁외임신의 최근 8년간의 임상적 고찰

박성호 ( Sung Ho Park ),나연식 ( Yon Sik Na ),정지윤 ( Ji Yoon Jung ),양성천 ( Seong Cheon Yang ),최수란 ( Su Ran Choi ),김성주 ( Sung Joo Kim ),장봉림 ( Pong Rheem Jang ),권용일 ( Yong Il Kwon ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.2

목적: 자궁외임신에 대한 임상 및 역학적 특성을 분석하고 그 조기진단과 적정한 치료법을 확인하기 위해 본 연구를 시행하였다. 연구 방법: 2000년 1월부터 2007년 12월까지 한림대학교 의료원의 자궁외임신 환자의 의무기록지를 조사하였다. 결과: 자궁외임신의 빈도는 13.6개의 분만당 1건이었고 호발 연령은 26~30세였다(29.5%). 위험인자는 과거 복부나 골반수술 병력(37.0%), 인공유산 병력(30.8%) 골반염 병력(12%), 난관불임술 병력(9.6%) 순이었다. 증상은 무월경(88.7%), 하복통(81.2%), 질출혈(60%) 순으로 나타났으며, 증상 발현은 마지막 생리시작일 후 6~8주가 47%로 가장 높은 빈도를 보였다. 혈색소는 10 gm/dL 이상이 79%였고 8 gm/dL 이하가 3.9%였다. 발생부위는 난관에 89%, 자궁각에 7.2%, 난소에 1.1%, 자궁경부에 2.7%였다. 수술은 복강경이 755예(71.6%), 개복술이 273예(25.9%), 소파수술이 26예(2.5%)에서 행해졌다. 수술 시 난관 절제가 82.4%로 가장 많았고, Methotrexate(MTX) 치료는 13예 (1.21%)에서 성공적으로 행해졌다. 결론: 자궁외임신의 조기진단은 혈청 β-hCG와 질초음파를 함께 이용하는 것이 가장 유용하다고 생각되며 치료는 복강경수술이 개복술에 비해 입원기간 및 합병증을 낮출 수 있어 향후 치료에 더욱 중요한 역할을 하리라 생각된다. Objective: The study was designed to ascertain a proper method of early diagnosis and treatment of ectopic pregnancy by analyzing its clinical and epidemiological characteristics. Methods: The medical records of patients who were diagnosed to ectopic pregnancy at Hallym medical center during the period from January 1, 2000 to December 31, 2007 have been reviewed. Results: The incidence of ectopic pregnancy was 7.3% (1,067) out of 14,519 deliveries. The most frequent age group was 26~30 (29.5%). Risk factors they had were previous histories of abdominal or pelvic surgery (37.0%), artificial abortion (30.8%), pelvic inflammatory disease (12%), and tubal sterilization (9.6%). Most frequent clinical symptoms were amenorrhea (88.7%), lower abdominal pain (81.2%), and vaginal spotting (60.0%). Percentage of patients with hemoglobin level over 10.0 gm/dL was 79% and below 8.0 gm/dL 3.9%. The clinical symptoms of ectopic pregnancy most commonly occurred after 6~8 weeks from last menstrual period (47%). Ectopic gestation was implanted on the fallopian tube in 89%, cornus in 7.2%, ovary in 1.1% and the cervix in 2.7%. Laparosopic surgeries were performed in 755 cases (71.6%) and laparotomies in 273 cases (25.9%) and dilatation and curettages in 26 cases (2.5%). Salpingectomy was performed most frequently (82.4%). Methotrexate (MTX) treatment was successful in 13 cases (1.21%). Conclusion: The early diagnosis of ectopic pregnancy is most useful when serum β-hCG and vaginal sonography are used together. Laparoscopy would be a preferred method because of its short hospitalization period and low complication rate compared with laparotomy in ectopic pregnancy treatment.

응급과 긴급 자궁경부 원형결찰술을 시행한 임신부에서 조기분만 예측 인자로서 수술 후 측정한 자궁경부 길이의 유용성

박수예 ( Soo Ye Park ),최수란 ( Soo Ran Choi ),이혜란 ( Hea Ran Lee ),양성천 ( Sung Cheon Yang ),이용우 ( Yong Woo Lee ),송지은 ( Ji Eun Song ),문종수 ( Jong Soo Moon ),김성주 ( Seong Joo Kim ),이근영 ( Keun Young Lee ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.9

목적: 응급과 긴급 자궁경부 원형결찰술을 시행 받는 임신부에서 임신 30주 이전 조기분만을 예측할 수 있는 예측인자로서 수술 후 질식초음파를 이용하여 측정한 자궁경부 길이의 유용성을 알아보고자 하였다. 연구방법: 자궁경부가 개대 되고 양막이 질쪽으로 탈출되어 응급 자궁경부 원형결찰술을 시행한 51명과 초음파상 자궁경부 내구의 깔대기모양 변화와 더불어 자궁경부 길이가 25 mm 미만으로 짧아져 긴급 자궁경부 원형결찰술을 시행한 40명을 대상으로 후향적으로 연구하였다. Receiver-operating characteristic (ROC) curve 분석, Pearson`s partial correlation coefficient와 다중로지스틱회귀분석을 사용하여 통계학 적으로 분석하였다. 결과: 입원당시 평균 임신 주수는 응급 자궁경부 원형결찰술을 시행한 군은 21.2 ± 2.3주 긴급 자궁경부 원형결찰술을 시행한 군은 21.8 ± 3.2 주이었다. 수술 후 측정한 자궁경부 길이는 응급 자궁경부 원형결찰술군은 17.6 ± 8.6 mm, 긴급 원형결찰술 군은 21.8 ± 8.7 mm로 증가하였다. ROC curve 분석에서 응급 자궁경부 원형결찰술군은 자궁경부 길이를 16.5 mm로 기준할 때, 민감도 85%, 특이도 50%, 양성예측도 17%, 음성예측도 16%, 긴급 자궁경부 원형결찰술군은 수술 후 자궁경부의 길이를 23.2 mm로 기준할 때, 민감도 65%, 특이도 45%, 양성예측도 17%, 음성예측도 8%이었다. 다중로지스틱회귀분석 결과, 수술 후 측정한 자궁경부 길이는 교란인자 보정 후 임신 30주 이전 조기분만과 독립적인 상관관계가 없었다(응급 원형결찰술군 P = 0.65, 긴급 원형결찰술군 P = 0.77). 결론: 응급과 긴급 자궁경부 원형결찰술 후 질식초음파를 이용하여 측정한 자궁경부의 길이는 증가하였으나, 임신 30주 이전 조기분만을 예측할 수 있는 유용한 인자는 아니다. Objective: The aim of this study is to evaluate the value of the ultrasonographic cervical length after emergent and urgent cervical cerclage to prediction of preterm delivery in patients with incompetence of cervix. Methods: Fifty-one women who underwent emergent cervical cerclage and forty women who underwent urgent cervical cerclage were studied respectively. Receiver-operating characteristic (ROC) curve analysis, Pearson`s partial correlation coefficient, and multiple logistic regression analysis were used for statistical analysis. Results: The mean gestational age at admission was 21.2 ± 2.3 weeks in emergent cerclage group and 21.8 ± 3.2 weeks in urgent cerclage group. Postoperative mean cervical length was 17.6 ± 8.6 mm in emergent group and 21.8 ± 8.7 mm in urgent group. The diagnostic indices of postoperative cervical length (cut-off value 16.5 mm in emergent cerclage, 23.2 mm in urgency cerclage) by ROC curve were sensitivity of 65%, specifi city of 45%, positive predictive value of 17%, and negative predictive value of 8% in emergent cerclage group and in urgent cerclage group, sensitivity of 85%, specifi city of 50%, positive predictive value of 17%, and negative predictive value of 16%. Multiple logistic regression analysis indicated that postoperative cervical length was not an independent predictor of preterm delivery after adjustment of confounding factors in emergent group (P=0.65) in urgent groups (P=0.77). Conclusion: In the both groups, the postoperative cervical length was longer than preoperative. However the postoperative cervical length is not a useful predictor of preterm delivery in patients with emergent and urgent cervical cerclage.

원발성 난소임신

문진성 ( Jin Sung Moon ),이연은 ( Yeun Eun Lee ),최영실 ( Young Sil Choi ),양성천 ( Seong Cheon Yang ) 대한산부인과학회 2005 Obstetrics & Gynecology Science Vol.48 No.12

100gm 경구 당부하검사 결과 정상 임신의 양상

이원종(Won Jong Lee),손병철(Byung Cheol Sohn),김행수(Haeng Soo Kim),양정인(Jeong In Yang),양성천(Seong Cheon Yang),조미영(Mi Yeong Jo),류종만(Jong Man Ryou),오기석(Kie Suk Oh),유희석(Hee Sug Ryu) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.1

Objective : To evaluate perinatal outcomes in patients with abnormal 50 gm challenge test followed by normal 100 gm oral glucose tolerance test (OGTT) value. Methods : We examined the pregnancy outcomes of 423 women classified as the study group with abnormal 50 gm oral glucose challenge test (OGCT) followed by normal 100 gm OGTT based on NDDG criteria. If the 1-hour plasma glucose value of 50 gm OGCT was over 130 mg/dL, the patient was scheduled for a full 3-hour 100 gm OGTT. 50 gm OGCT and 100 gm OGTT were administered at 24-28 and 28-32 weeks' gestation, respectively. The control group constituted of 467 age- and body mass index (BMI)-matched negative screenees. We defined poor maternal outcomes as those suffering from any one of hydramnios or oligohydramnios, preeclampsia, cesarean delivery due to cephalopelvic disproportion, dystocia, or fetal distress. We also defined poor neonatal outcomes as those suffering from any one of hyperbilirubinemia, hypoglycemia, congenital anomaly, admission to neonatal intensive care unit due to respiratory distress syndrome, or perinatal mortality. Retrospective review of outcomes of these patients was performed. Student t-test, Fisher's exact test and chi-square test were used to determine the statistical significance. Results : There were no significant differences in demographic and obstetric characteristics between the control group and the study group. There were no significant differences in gestational age (38.7±1.5 vs 38.5±1.5 weeks), birth weight (3189.2±420.9 vs 3236.7±423.1 gm), between the groups. And there were no significant differences in preterm birth (6.2% vs 7.4%), large for gestational age births (4.5% vs 5.0%), intrauterine growth restriction (5.4% vs 4.3%) between the groups. There were no significant differences in poor maternal outcomes (15.6% vs 18.7%) and poor neonatal outcomes (3.9% vs 5.7%) between the groups. Conclusion : We conclude that abnormal value on 50 gm challenge test followed by normal 100 gm OGTT is not associated with adverse perinatal outcomes