병합임신의 산과적 결과에 관한 고찰

이희숙 ( Hee Suk Lee ),김주명 ( Joo Myung Kim ),유지희 ( Ji Hee Yoo ),육지형 ( Ji Hyung Yook ),김미라 ( Mi La Kim ),윤재범 ( Jae Bum Yoon ),주관영 ( Kwan Young Joo ),전종영 ( Jong Young Jun ),한호원 ( Ho Won Han ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.5

목적: 배란유도제 사용 또는 보조생식술 후 병합임신이 된 환자에서 보존적 치료 후의 임신의 결과에 대해 알아보고자 하였다. 연구 방법: 2000년 1월 1일부터 2008년 4월 30일까지 병합임신으로 진단된 24명의 환자를 대상으로 후향적 연구를 시행하였다. 환자의 보조생식술 방법, 자궁외임신 부위 및 진단당시의 자궁내임신 상태, 보존적 치료 후의 임신의 결과에 대해 알아보았다. 결과: 총 24명의 환자가 있었고, 모두 불임치료 후 발생한 경우로 자연임신 후 발생한 경우는 없었다. 환자의 평균 나이는 31.5세 였으며, 진단당시 주수는 약 8주였다. 불임의 원인인자로 가장 흔한 것은 난관의 문제로 54.2%의 환자가 이에 해당하였다. 과배란유도 방법을 사용한 환자는 4명, 시험관아기를 한 경우가 18명이었으며, 2명의 환자는 타원에서 보조생식술을 시행 받아 정확한 시술방법은 모르는 상태였다. 자궁외임신 부위는 난관이 75%, 난소가 4.2%, 자궁각이 20.8%였으며, 50%가 자궁외임신 부위가 파열된 상태에서 진단되었다. 진단 이전 계류유산으로 소파술 시행 후 자궁외임신이 진단된 환자가 3명, 계류유산과 자궁외임신이 동시에 진단된 환자가 4명이었으며, 정상 자궁내임신과 자궁외임신이 동시에 진단된 환자는 17명이었다. 24명 중 3명에서만 출혈이나 유착 등으로 인해 개복수술을 시행하였으며, 21명은 복강경수술을 시행받았고, 정상 자궁내임신이었던 17명에서 모두 자궁내임신이 유지되었으며, 단태아 12명, 쌍태아 2쌍을 분만하였고, 3명은 각각 임신 12주, 23주 5일, 27주 6일에 타원으로 전원되어 정확한 임신의 결과를 알 수 없었다. 결론: 임신 초기에 시행한 초음파상 정상 자궁내임신이 확인된 경우라도 산모가 하복통이나 질출혈의 증상이 있는 경우, 불임치료 등의 위험요인을 가진 환자에서는 반드시 병합임신의 가능성을 염두에 두고 조기에 진단 및 적절한 치료를 시행해야 할 것이다. Objective: The purpose of this study was to evaluate the pregnancy outcomes of heterotopic pregnancy. Methods: Retrospective analysis was done in 24 patients who were diagnosed as heterotopic pregnancy between January 2000 and April 2008. Patients` characteristics, risk factors, treatment methods and pregnancy outcomes were evaluated. Results: A total of 24 patients were diagnosed as heterotopic pregnancy, all of these had undergone assisted reproductive technique. The mean age was 31.5 years and the mean gestational age at diagnosis was about 8 weeks. The most common etiology of infertility was tubal factor (54.2%). Four (16.7%) of the women had undergone ovulation induction, eighteen (75%) had undergone in vitro fertilization, but 2 patients (8.3%) had undergone assisted reproductive technique at other hospital and we didn`t know the exact method. The most common of ectopic site was tube (75%), and 50% of ectopic sites were ruptured status at diagnosis. Three (12.5%) of 24 patients were diagnosed ectopic pregnancy after dilatation and evacuation due to missed abortion, 4 (16.7%) were diagnosed ectopic pregnancy and missed abortion, and 17 (70.8%) were diagnosed ectopic pregnancy and living intrauterine pregnancy at the time of diagnosis. Laparotomy was done in 3 patients (12.5%) and laparoscopy was done in 21 patients (87.5%). Among 17 patients who had normal intrauterine pregnancy, 12 (70.6%) delivered singletones, 2 (11.8%) delivered twins, but 3 (17.6%) patients were lost follow up. Conclusion: Heterotopic pregnancy should be considered in pregnant woman with abdominal pain or vaginal bleeding, although confirmed normal intrauterine pregnancy using ultrasonography at early gestational age, especially if the woman have treatment history for infertility. And early diagnosis and proper management are important.

Pregnancy Outcomes Following Laparoscopic and Open Surgery in Pelvis during Pregnancy: a Nationwide Population-based Study in Korea

Cho Hyun-Woong,Cho Geum Joon,Noh Eunjin,Hong Jin Hwa,Kim Minjeong,Lee Jae Kwan 대한의학회 2021 Journal of Korean medical science Vol.36 No.29

Background: Non-obstetric surgery during pregnancy is associated with adverse obstetric and fetal outcomes. The aim of this study was to investigate the risk of adverse pregnancy outcomes for women who underwent non-obstetric pelvic surgery during pregnancy compared with that of women that did not undergo surgery. Methods: Study data from women who gave birth in Korea were collected from the Korea National Health Insurance claims database between 2006 and 2016. We identified pregnant women who underwent abdominal non-obstetric pelvic surgery by laparoscopy or laparotomy from the database. Pregnancy outcomes including preterm birth, low birth weight (LBW), cesarean section (C/S), gestational hypertension, gestational diabetes, and postpartum hemorrhage were identified. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the pregnancy outcomes were estimated by multivariate regression models. Results: Data from 4,439,778 women were collected for this study. From 2006–2016, 9,417 women from the initial cohort underwent non-obstetric pelvic surgery (adnexal mass resection, appendectomy) during pregnancy. Multivariate logistic regression analysis indicated that preterm birth (HR, 2.01; 95% CI, 1.81–2.23), LBW (HR, 1.62; 95% CI, 1.46– 1.79), C/S (HR, 1.13; 95% CI, 1.08–1.18), and gestational hypertension (HR, 1.35; 95% CI, 1.18–1.55) were significantly more frequent in women who underwent non-obstetric surgery during pregnancy compared to pregnant women who did not undergo surgery. When the laparoscopic and laparotomy groups were compared for risk of fetal outcomes, the risk of LBW was significantly decreased in laparoscopic adnexal resection during pregnancy compared to laparotomy (odds ratio, 0.62; 95% CI, 0.40–0.95). Conclusion: Non-obstetric pelvic surgery during pregnancy was associated with a higher risk of preterm birth, LBW, gestational hypertension, placenta previa, placental abruption, and C/S. Although the benefits and safety of laparoscopy during pregnancy appear similar to those of laparotomy in regard to pregnancy outcomes, laparoscopic adnexal mass resection was associated with a lower risk of LBW.

흰쥐의 번식과정에 있어서 Progesterone-tube 이식이 난소와 태반중량 및 임신기간에 미치는 영향

민관식,오석두,윤창현 한국동물번식학회 1990 Reproductive & developmental biology Vol.14 No.4

This study was conducted to find out the changes of ovarian, placental and fetal weights and periods of pregnancy in rats implanted with progesterone-tube during the reproductive stages. One hundred and thirty-four mature rats, 10~13 weeks old, were offered for this experiment. The animals, which were implanted with silicon tubes filled with progesterone on day 15 of pregnancy, were sacrified at 18, 20, 21 and 22 days of pregnancy. The changes of ovarian, placental and fetal weights and the number of fetuses during late pregnancy were recorded. The results obtained were summarized as follows : 1. After progesterone-tube implantation, ovarian weight reached to a peak value of 92.0$\pm$0.9mg at 20 days of pregnancy, there after decreased significantly to 79.5$\pm$7.6 and 68.26$\pm$4.2mg at 20 and 22 days of pregnancy(P<0.01). 2. The placental weight increased rapidly during 15~18 days of pregnancy in control and progesterone treated rats. A peak value of 447.78$\pm$20.9mg was shown at 20 days of pregnancy after progesterone-tube implantation, and in control rats the value decreased significantly to 419.42$\pm$11.6 and 404.1$\pm$29.3mg at 20 and 21 days of pregnancy(P<0.01). 3. The fetal weights was not shown any significant differences between control and progesterone-tube implanted rats. 4. The number of fetuses in control rats were 14.75$\pm$0.4 at 8~10 days of pregnancy and 13.5$\pm$0.3 and 13.25$\pm$0.4 at 12 and 20 days of pregnancy. 5. The significant difference in periods of pregnancy was appeared between progesterone-tube implanted(27.3$\pm$0.3 days) and control(22.1$\pm$0.3 days)rats(P<0.01).

건강한 임신을 위한 임신 전 부부의 생활습관

고현선,박인양,신종철 대한의사협회 2011 대한의사협회지 Vol.54 No.8

The purpose of this article is to outline lifestyle habits of couples during pre-pregnancy that promote a healthy pregnancy. A healthy pregnancy is the hope of every couple who intend to have children. However, many of them are surprisingly unaware of practices worth pursuing in everyday life in order to promote a healthy pregnancy. Not only having knowledge about pregnancy but building the lifestyle to prepare one’s body adequately for pregnancy will raise the chances of conception, in turn increasing the chance of a healthy pregnancy. Six months prior, a couple should have plans for pregnancy and have proper vaccination. A consultation on living and eating habits helpful for pregnancy is needed and controlling one’s weight and checking the overall environment of the work place and home should take place. Three months prior, smoking and drinking should be stopped. A couple should pursue proper eating habits with balanced nutrition and multivitamins including folic acid. A husband should check his lifestyle, always taking into consideration the fact that the fertilized sperm are generated 100 days prior. One month prior to pregnancy, a final check on whether the couple still pursues bad habits for a healthy reproductive life should be done. A wife should avoid passive smoking and any kind of medication. For a healthy pregnancy, a couple should practice the right lifestyle that increases the opportunity for a safe pregnancy.

임신성 세포변화의 판독오류 - 임신 중 비정상 자궁목 세포검사의 분만 후 퇴행률에 미치는 영향 -

김혜선,Kim, Hye-Sun 대한세포병리학회 2007 대한세포병리학회지 Vol.18 No.1

An aim of this study was to evaluate an effect of misinterpretation of pregnancy related cellular changes on the postpartum regression rate of abnormal cervical smears in pregnancy. A series of 265 cases with abnormal cervical smears in pregnancy were selected from a database of cervical smear results. The selected cases were classified as regression, persistence, and progression based on the results of postpartum cervical smears and histology. Of the selected cases, 162 cases were classified as regression and the postpartum regression rate was 61.1% (162/265). We reviewed abnormal cervical smears in pregnancy these cases. The primary cytologic diagnoses of these cases were ASCUS (118 cases), AGUS (2 cases), ASCUS/AGUS (1 case), LSIL (25 cases), LSIL R/O HSIL (2 cases), and HSIL (14 cases). With information of the pregnacy, we identified decidual cells in 24 cases, but cells identified by the Arias-Stella reaction and trophoblasts were not found. Sixteen cases out of 162 cases were reclassified as a pregnancy related change rather than an abnormal. Desidual cells were considered as ASCUS in 15 cases and as LSIL in one case. The revised postpartum regression rate was 55.5%(147/265) and was lower than the original. Consequently, misinterpretation of the pregnancy related cellular changes has an effect on a rise of the postpartum regression rate of the abnormal cervical smear in pregnancy. Pathologists may diagnose pregnancy related cellular changes as abnormal findings if they do not have information regarding the pregnancy. Therefore, clinical information of pregnancy and knowledge about the pregnancy related cellular changes are essential to prevent misinterpretation.

신장이식 여성의 임신 예후

김대진(Dae Jin Kim),유혜경(Hye Kyung Yoo),원혜성(Hye Sung Won),구자남(Ja Nam Gu),이필량(Pil Ryang Lee),이인식(In Sik Lee),김암(Ahm Kim),박수길(Soo Gil Park),한덕종(Deok Jong Han),목정은(Jung Eun Mok) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.8

목적: 신장이식을 받은 여성에서 임신 예후에 영향을 미치는 임신 전 및 임신 중의 요인들을 확인하고자 한다. 연구방법: 1996년 6월부터 1998년 2월까지 서울중앙병원에서 신장이식을 받고 임신이 된 모든 환자의 병록지를 후향적으로 검토하여 임신 전, 임신 중 및 출산 또는 유산 후 결과를 조사하였다. 결과: 신장이식을 받은 환자들 중 13명에서 17례의 임신이 이루어졌으며, 각 임신의 결과는 만삭분만 7례, 조산 4례, 자연유산 2례, 치료적 유산 또는 임신중절이 4례였다. 한 환자를 제외하고는 모든 환자가 임신 전후로 cyclosporin A, azathioprine 및 prednisolone으로 면역억제 치료를 받았다. 신장이식 후 임신되기까지의 평균기간은 28.8±14.3개월(범위, 6-60개월)이었다. 생존아를 출산한 11례에서 출산시 평균 임신주수는 37.7±1.2주였고 평균 출생체중은 2.85±0.37킬로그램이었으며, 5분 Apgar 수치는 모두 8 이상이었다. 이들에게서 나타난 산과적 합병증으로는 임신성 고혈압 6례(55%), 임신으로 악화된 고혈압 2례(18%), 태아발육지연 1례(9%) 및 조산 4례(36%)였다. 제왕절개술은 4례(36%)에서 시행되었는데, 3례는 기왕 제왕절개술의 병력이, 1례는 조절이 되지 않는 고혈압이 적응증이었다. 신생아 합병증으로는 일시적인 신생아 빈호흡증이 1례 있었다. 임신 전 신장이식 거부반응이 4례 있었으며, 3례는 조산이 되었고 1례는 치료적 유산을 시행하였다. 임신 전에 신장의 기능이 정상이었던 경우에는 임신기간과 출산 또는 유산 후 6-58개월간의 추적기간 중에도 신장 기능이 정상을 유지하였다. 임신 중 신장이식 거부반응이나 소실은 없었다. 결론: 신장이식을 받은 여성들 중 임신을 원하는 경우에는 비록 고혈압 등의 임신과 관련된 합병증의 빈도가 비교적 높게 나타나기는 하나 성공적인 임신 예후를 기대할 수 있을 것으로 판단되었다. 따라서 이들 신장이식 환자에 대하여 그들의 신장 기능이 정상 범위를 유지하는 경우에는 임신 및 출산을 권할 수 있을 것으로 사료된다. Objective : To assess the pre-pregnancy and pregnancy factors influencing pregnancy outcome in renal transplanted women Materials and Methods : This retrospective study included all pregnancies in renal transplanted women in Asan Medical Center between June 1996 and February 1998. We collected data from the medical records of allograft recipients. Pre-pregnant status and pregnancy outcome were described. Results : Seventeen pregnancies in 13 allograft recipients resulted in 7 term deliveries, 4 preterm births, 2 spontaneous abortions, and 4 therapeutic abortions. All but one patient received immunosuppressive therapy with cyclosporin A, azathioprine, and prednisolone during pregnancy. The mean interval from the time of transplantation to conception was 28.8±14.3 months(range 6-60 months). In live birth group, the mean gestational age at delivery was 37.7±1.2 weeks and the mean birth weight of their offspring was 2.85±0.37 kilogram. Apgar scores at 5 minutes were 8 or more in all of them. The obstetric complications were distributed as follows: pregnancy induced hypertension in 6 cases(55%), pregnancy aggravated hypertension in 2 cases(18%), fetal growth restriction in 1 case(9%), prematurity in 4 cases(36%). Cesarean sections were done in 4 cases(36%) because of previous Cesarean section(3 cases) and uncontrolled hypertension(1 case). Neonatal complication, transient tachypnea of the newborn, was found in one case. Graft rejection after transplantation occurred in 4 cases: 3 cases in preterm births and 1 case in therapeutic abortions. Maternal renal functions were normal during pregnancy and postpartum period whose pre-pregnant renal functions had been normal. No patient experienced any rejection episode or graft loss during pregnancy. Conclusion: Successful pregnancy can be expected in women with a renal transplant, although there was high incidence of pregnancy-related complications, especially hypertensive disorders. Pregnancy can be encouraged to these allograft recipients if they have good renal function.

In Vitro Bone Cell Response to Fluid Shear Stress during Pregnancy

Heon Goo Lee,김병관,곽지현,김경환,김지현 한국조직공학과 재생의학회 2009 조직공학과 재생의학 Vol.6 No.13

Pregnancy can affect bone remodeling through changes in the physical and hormonal environment. Our objective was to understand the bone cell response to physical loading during different stages of pregnancy. Primary bone cells from non-pregnant, 10 days pregnant (10D: corresponding to the second pregnancy trimester) and 18 days pregnant (18D: corresponding to the third pregnancy trimester) ICR mice were obtained. Oscillatory fluid flowinduced shear stress of 1 Pa was applied to bone cells for 1 hour. Real-time RT-PCR was used to determine the changes in mRNA levels of bone resorption-related genes, receptor activator of NF-κB ligand (RANKL) and osteoprotegerin (OPG), and bone formation-related genes, type I collagen (Col I) and osteopontin (OPN). Alkaline phosphatase (ALP) protein activities were also compared. Oscillatory fluid flow did not lead to anabolic response in 10D groups unlike non-pregnant groups displaying no changes in RANKL/OPG mRNA ratio, Col I mRNA level, and OPN mRNA level. 18D groups displayed anabolic responses similar to non-pregnant groups with a significantly greater sensitivity. Our study suggests that bone cells may respond differently to physical loading depending on the different stages of pregnancy. Loading appears to be less effective during the second trimester of pregnancy. Bone cell response to loading is recovered to a much greater extent compared to non-pregnant conditions during the third trimester. Pregnancy can affect bone remodeling through changes in the physical and hormonal environment. Our objective was to understand the bone cell response to physical loading during different stages of pregnancy. Primary bone cells from non-pregnant, 10 days pregnant (10D: corresponding to the second pregnancy trimester) and 18 days pregnant (18D: corresponding to the third pregnancy trimester) ICR mice were obtained. Oscillatory fluid flowinduced shear stress of 1 Pa was applied to bone cells for 1 hour. Real-time RT-PCR was used to determine the changes in mRNA levels of bone resorption-related genes, receptor activator of NF-κB ligand (RANKL) and osteoprotegerin (OPG), and bone formation-related genes, type I collagen (Col I) and osteopontin (OPN). Alkaline phosphatase (ALP) protein activities were also compared. Oscillatory fluid flow did not lead to anabolic response in 10D groups unlike non-pregnant groups displaying no changes in RANKL/OPG mRNA ratio, Col I mRNA level, and OPN mRNA level. 18D groups displayed anabolic responses similar to non-pregnant groups with a significantly greater sensitivity. Our study suggests that bone cells may respond differently to physical loading depending on the different stages of pregnancy. Loading appears to be less effective during the second trimester of pregnancy. Bone cell response to loading is recovered to a much greater extent compared to non-pregnant conditions during the third trimester.

Alcohol Use during Pregnancy and Related Risk Factors in Korea

So Hee Lee,Seung Ju Shin,원성두,Eun-Ju Kim,오동열 대한신경정신의학회 2010 PSYCHIATRY INVESTIGATION Vol.7 No.2

ObjectiveaaThe number of Korean women of childbearing age who drink alcohol and binge drink has increased remarkably in recent years. In the present study, we examined self-reported rates of alcohol use before and during pregnancy and identified maternal characteristics associated with drinking in pregnancy. MethodsaaOne thousand pregnant Korean women who visited the Department of Obstetrics and Gynecology (OB/GYN) completed a self-administered questionnaire that sought information on their demographic characteristics and incorporated features of the Alcohol Use Disorder Identification Test (AUDIT)-C to investigate their use of alcohol, including binge drinking, during three time periods (“in the year before this pregnancy,” “during this pregnancy,”and “in the previous 30 days”). ResultsaaOf these participants, 16.4% reported using alcohol during their pregnancy, 12.2%had used alcohol in the previous 30 days, and 1.7% reported binge drinking during their pregnancy. In the year before pregnancy, 77.1% had used alcohol, and 22.3% had binge drunk. The group using any amount of any alcohol during pregnancy showed a lower educational level,a lower rate of planned pregnancy, a lower level of knowledge relating to the risks of drinking alcohol during pregnancy, and a higher frequency of alcohol drinking in the year before pregnancy when compared with the abstinent group. Low educational level and unplanned pregnancy were revealed to be significant risk factors for alcohol consumption in pregnant women. ConclusionaaThis is the first study to examine any alcohol and binge alcohol drinking during pregnancy in Korea. Clinical attention and monitoring system on alcohol use during pregnancy are necessary in Korea.

초임부의 임신경험과 임신 중 체중변화에 대한 태도와의 관계

신기수,김미옥 한국여성건강간호학회 2019 여성건강간호학회지 Vol.25 No.2

Purpose: We aimed to examine the correlations between pregnancy experience and attitude regarding weight change during pregnancy. Methods: This correlative study was conducted from July 2017 to October 2017 by involving 156 primigravida women who were over pregnancy 20 weeks in Seoul and Gyeonggi-do province. Data were collected using a questionnaire, which included questions on demographic data, experience during pregnancy, and attitude regarding weight change during pregnancy. Descriptive statistics were calculated. Also, independent t-test, ANOVA, and Pearson's correlation coefficients were used for data analysis. Results: The mean age of the participants was 30.62 years and their score of attitude regarding weight gain during pregnancy was low. Moreover, a significant correlation was found between the pregnancy experience and attitude regarding weight gain during pregnancy in primigravida women. Conclusion: As a result of analyzing the correlation between pregnancy experience and attitude towards weight gain during pregnancy, it is apparent that attitudes toward weight change are different according to experience during pregnancy in women. Based on these results, it can be concluded that nursing intervention programs are necessitated to enhance the attitude of pregnant primigravida women towards pregnancy and weight gain.

만성 간질환자에서의 임신

정성훈 ( Sung Hoon Jung ) 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.2(S)

Advances in the treatment of chronic liver disease have resulted in higher conception rates and more successful pregnancy outcomes. So it is important for physicians caring for such patients in complex clinical situation, pregnancy, to understand how to approach complications and tailor medications. Chronic HBV infection is usually mild in pregnancy, but may flare after delivery. Antiviral treatment near or during pregnancy must be individualized. Currently, lamivudine, tenofovir and telbivudine can be used during pregnancy. The role of antiviral therapy in 3rd trimester to minimize risk of vertical transmission remains indefinite. In general, the HCV infection does not affect the clinical course of pregnancy despite of limited reports of prematurity and low birth weight. At present, there are no recommendations for the treatment and measures to prevent vertical transmission. The course of autoimmune hepatitis in pregnancy is highly variable and stable immunosuppression with steroids and /or azathioprine should be maintained during pregnancy and postpartum period. Patients with Wilson`s disease must be adequately treated before pregnancy and continue on therapy throughout pregnancy. Most patients with advanced cirrhosis are infertile, but successful pregnancy is achievable in case of mild compensated disease with careful monitoring. Successful pregnancies after liver transplantation have been reported but remains high risk. Closer monitoring, especially of immunosuppression is needed. Unfortunately, the optimal management of pregnancy with chronic liver disease is undefined to date. Further clinical studies are necessary to overcome this weakness.