마더세이프 프로그램 사업은 무엇인가? 배경과 과제

한정열 ( Jung Yeol Han ) 대한주산의학회 2010 Perinatology Vol.21 No.1

The anxiety of pregnant women who are receiving drug therapy is mainly caused by their misperception of the safety and risks of medications. In developed countries, teratology information services successfully provide pregnant women and their health-care providers with evidence-based teratogen information. In our country, the Korean Motherisk Program started to provide prenatal teratogen-risk counseling approximately 10 years ago first to women referred to the clinic, later by e-mail, and more recently over the telephone. The Program has also established international collaborations which propelled its capability to gain experience and obtain information on the safe use of medications in pregnancy. Since 2010, we have a unique opportunity to reduce the gap on teratogen information across our country and among medical providers including physicians, pharmacists and nurses through the Mother Safe Program supported by the Ministry for Health and Welfare. Similar to what is occurring in other developed countries, this program intends to provide pregnant women and their health-care providers with evidence-based information on their medications in order to reduce unnecessary pregnancy terminations and decrease their anxiety on the potential risks of medications prescribed during pregnancy.

임신 중 선천성 거대세포바이러스 감염: 순차적 뇌변화를 보이는 증례 보고와 최신 진단, 치료 및 예방

최은정 ( Eun Jeong Choi ),한정열 ( Jung Yeol Han ) 한국모자보건학회 2021 한국모자보건학회지 Vol.25 No.2

Congenital cytomegalovirus (CMV) infection is the most common nongenetic cause of sensorineural hearing loss and a major cause of visual, intellectual, and neurodevelopmental impairment worldwide. The seroprevalence of CMV among women of childbearing age in developing countries reaches almost 100%, and the incidence of CMV infection in neonates is 1%-2%. Approximately 87% of the infected neonates are asymptomatic at birth and 13% of them have permanent sequelae. The burden of congenital malformations due to congenital CMV infection is higher than that due to Down syndrome, fetal alcohol syndrome, and spina bifida. Nevertheless, there is little knowledge regarding congenital CMV pathogenesis, diagnosis, treatment, and prevention. In this study, we report a case that showed sequential changes of fetal brain following CMV infection in pregnancy. Additionally, we reviewed the latest information on the diagnosis, treatment, and prevention of congenital CMV infection.

임신초기 약물노출 후 임신결과; 10년간의 경험 -생식 발생 독성 정보 활용화 방안 연구-

최준식 ( June Seek Choi ),한정열 ( Jung Yeol Han ),안현경 ( Hyun Kyong Ahn ),이시원 ( Si Won Lee ),김민형 ( Min Hyoung Kim ),정진훈 ( Jin Hoon Chung ),류현미 ( Hyun Mee Ryu ),김문영 ( Moon Young Kim ),양재혁 ( Jae Hyug Yang ),최 대한주산의학회 2010 Perinatology Vol.21 No.1

Purpose: In Korea, pregnancy termination is frequently reported among women who took medications for an acute or chronic disease during pregnancy, for fear of teratogenic risk. We have previously shown that a service providing evidence-based information is helpful for women who week counseling to make a rational decision regarding their pregnancies. This study aimed to evaluate whether termination of pregnancy based on such perceptions, is justified using the `DRug Exposure and risk Assessment in Moms` (DREAM) registry. Methods: The study included 5,032 consenting pregnant women from the clinic and call center at the Korean Motherisk Program, from November 1999 to October 2008. The DREAM registry recorded the pregnancy outcomes (preterm birth, low birth weight, intrauterine fetal death, and congenital anomaly) of 3,328 women. Results: Among women exposed to medications, time of exposure ranged from 3.5-4.6 weeks of gestation. There were 1,308 different drugs prescribed to these women. The drug most frequently prescribed was acetaminophen followed by chlorpheniramine maleate, and pseudoephedrine. There were 4.7% (n=156/3,328) women who underwent a voluntary abortion for fear of birth defects. We compared frequency of birth defects between exposed women and unexposed pregnant women in our institution during gestation. The frequency of major congenital malformations was 2.5% (n=74/2,977) in exposed group and 2.9% (n=75/2,573) in unexposed group (P=0.32). There was no statistically significant difference between exposed and control group in the rate of preterm births, intrauterine fetal death and low-birth weight babies. Conclusion: We did not observe increased risk of congenital malformations and adverse pregnancy outcomes in a population of pregnant women exposed to a variety of medications. Therefore these medications are not considered teratogen.

산모의 다중예측 인자를 이용한 임신 합병증 예후에 관한 다변량분석

한인수(In Soo Han),한정열(Jung Yeol Han),고명인(Myong In Ko),최용관(Yong Kwan Choi),이홍복(Hong Bok Lee),양재혁(Jea Hyuk Yang),류현미(Hyun Mi Ryu),김문영(Moon Young Kim),김은성(Eun Sung Kim),한호원(Ho Won Han) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.8

산모의 다중예측 인자를 이용한 임신 합병증 예후에 관한 다변량분석 목적: Maternal serum markers(AFP, uE3, hCG ), Unexplained down syndrome screen positive에 의한 태아예후를 비교하기위함. 연구방법: 1994년 3월부터 1996년 2월까지 임신 2기에 삼성제일병원을 방문하여 Triple marker test를 시행하고 본원에서 분만 기록이 있는 단태아 5,284례를 대 상으로 하였다. 각 산모 혈청 표지물질들은 radioimmunoassay kit를 이용하여 측정하였고 다운 증후군 스크린 양성은 α-software(Ver. 4.0)를 이용하여 산출하였다. 임신과 관련된 임신 합병증 예후의 기준은 조기태반 박리는 분만시 태반 소견을 기준으로 하였으며, 저체중아는 2500gm 미만, 만삭전 파수는 임신 37주 이전에 조기 양막 파수되는 경우로 하였다. 결과: 검사를 받은 산모의 평균 연령은 30±4.8세이며, 임신횟수는 평균 2.27, 출산횟수는 0.46이며, 검사를 시행한 평균 임신주수는 17.1주이었다. 저체중아는 357례(6.8%), 미숙아는 253례(4.8%), 전치태반은 108례(2.0%), 만삭전 파수는 68례(1.3%), 임신중독증은 66례(1.3%), 조기태반박리 24례(0.5%),자궁내 태아사망은 20례(0.4%)이었다. 이러한 임신 합병증 예후와 산모의 연령 AFP,hCG,uE3,그리고 Unexplained Down syndrome screen positive의 통계적 연관성에 관한 분석에서 35세 이상군은 조기태반 박리, 미숙아, 전치태반에서, AFP 2.0 이상군은 자궁내 태아사망, 저체중아, 임신중독증, 미성숙 조기 양수 파막, 미숙아에서, hCG 3.0 이상군은 자궁내 태아사망, 저체중아, 임신중독증, 미숙아, 전치태반에서, uE3 0.75 미만군에서는 자궁내 태아사망, 저체중아, 미숙아에서만, 그리고 unexplained Down syndrome screen positive에서는 조기태반 박리 , 자궁내 태아사망, 저체중아, 미숙아에서 통계적인 의미가 있었다. 또한 임신 합병증 예후와 관련된 혼란 변수를 조절하고 가장 영향력 있는 인자를 알기위해 multivariate logistic regression을 시행하였다. 자궁내 태아사망은 AFP 2.0 MoM이상, 저체중아는 AFP 2.0 MoM이상, hCG 3.0MoM이상, uE3 0.75 MoM 미만, 임신 중독증은 AFP 2.0 MoM이상, 미성숙 조기 양수 파막은 AFP 2.0 MoM이상, 미숙아는 AFP 2.0 MoM이상, 전치 태반은 35세 이상의 산모군과 hCG 3.0 MoM 이상군에서 P value 0.05 미만으로 통계적으로 의미있는 결과가 나왔으며, 조기태반 박리의 경우 35세 이상의 산모군에서만 P value 0.07이었다. 결론: 임신 합병증 예후를 예측하기위한 예측인자로서 산모의 고령 나이를 비롯해 산모혈청의 AFP, hCG, uE3과 Unexplained Down syndrome screen positive는 모두 다변량 분석에서 통계학적으로 의미가 있으며, 또한 다변량 분석에서는 증가된 AFP이 임신 합병증을 예측하는데 가장 신뢰성 있는 인자임을 알 수 있었다. Purpose : To evaluate a role as over 35 years, maternal serum markers, and a false positive screen for Down syndrome were the predictor of adverse pregnancy outcome. Materials and Methods : From Mar.1994, through Feb.1996, 5284 women were screened triple test to detect Down syndrome in the second trimester and were delivered Samsung Cheil hospital. The values of each maternal serum markers were measured with radioimmunoassay. And then, the screen positive of Down syndrome was calculated using α-software Version 4.0. The adverse outcome of the fetus and the mother included low birth weight(LBW) ( <2500gm), prematurity( <37 gestational weeks), placenta previa, preterm premature rupture of membranes(PPROM), pregnancy induced hypertension(PIH),abruptio placenta, and intrauterine fetal death(IUFD). The predictor markers included over 35years, elevated α-fetoprotein (AFP), elevated human chorionic gonadotropin(hCG), lowered unconjugated estriol (uE3), and a false positive screen for Down syndrome. Results : Mean age and mean gestational weeks in the study were 30±4.8 years and 17.1 weeks respectively. The adverse pregnancy outcomes were 357 LBW(6.8%), 253 prematurity(4.8%), 108 placenta previa(2.0%), 68 PPROM(1.3%), 66 PIH(1.3%), 24 abruptio placenta(0.5%), and 20 IUFD(0.4%). In univariate analysis, over 35 years was significantly associated with abruptio placenta, prematurity, and placenta previa, elevated MS-AFP( >2.0 MoM) associated with IUFD, LBW, PIH, prematurity, and PPROM , elevated MS-hCG (>3.0 MoM) associated with IUFD, LBW, PIH, prematurity, and placenta previa, lowered uE3 (<0.75) associated with IUFD, abruptio placenta, LBW, and prematurity.(P <0.05). In multivariate logistic regression analysis, IUFD was significantly associated with only elevated MS-AFP, LBW associated with elevated MS-AFP, elevated MS-hCG, and lowered uE3, PIH associated with only elevated MS-AFP, PPROM only elevated MS-AFP, prematurity only elevated MS-AFP, and placenta previa over 35 years, elevated MS-hCG.(P <0.05). However, abruptio placenta was not significantly associated with predictor markers.(P >0.05) Conclusions : Some predictors such as over 35 year, elevated hCG, lowered uE3, a false positive screen for Down syndrome were significantly associated with adverse pregnancy outcome. Also in multivariate analysis, we identified especially elevated AFP to be the most reliable predictor for adverse pregnancy outcome.

임신 중절 적응증의 최근 경향 변화 ( 1993 - 2000 )

김지은(Ji Eun Kim),한정열(Jung Yeol Han),오동출(Dong Chul Oh),김연주(Yon Ju Kim),정영철(Young Chul Chung),정상희(Sang Hee Jung),최준식(June Seek Choi),박소연(So Yeon Park),안현경(Hyun Kyong Ahn),오민정(Min Jeong Oh),류현미(Hyun Mee R 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.11

N/A Objective : To evaluate the recent trend of indication for pregnancy termination. Method : From 1993 to 2000, 1,087 cases of termination out of 61,842 cases of deliveries in Samsung cheil hospital were analyzed. We reviewed retrospectively the data-base and charts of delivery, and analyzed the indication for pregnancy termination. Results : Among 61,842 cases of deliveries, indications of pregnancy termination were fetal structure anomalies in 399 cases (0.7%), IUFD in 261 cases (0.4%), PROM in 215 cases (0.4%), chromosomal anomalies in 138 cases (0.2%), anhydroamnios in 32 cases (0.05%), rubella infection of mother or fetus in 24 cases (0.04%), and others in 20 cases (0.03%). Autopsy was performed in 242 cases of fetal anomalies (60.7%), 116 cases of UIFD (44%), and 59 cases of fetal chromosomal abnormalities (43%). The cases of chromosomal anomaly as indication of termination increased and rubella infection of mother or fetus decreased recently, and it is statistically significant r=0.95(P=0.00) and r=-0.73(P=0.04). The fetal weight terminated due to PROM is significantly decreased (Y=517-26 x year P=0.002). Conclusion : The indications of termination for fetal chromosomal abnormalities were increased, but for rubella infections were decreased. In cases of PROM, the terminated fetal weight were significantly decreased. However, no change was observed in cases of fetal anomaly, IUFD,and PROM.

Anti-SS-A/Ro 항체 양성과 연관된 태아의 선천성 완전 심블록 1례

오동출 ( Dong Chul Oh ),한정열 ( Jung Yeol Han ),김연주 ( Yon Ju Kim ),김지은 ( Ji Eun Kim ),류현미 ( Hyun Mee Ryu ),김문영 ( Moon Young Kim ),양재혁 ( Jae Hyug Yang ),민지연 ( Jee Yeon Min ) 대한주산의학회 2001 Perinatology Vol.12 No.3

IEC 61850 기반 154[㎸] 변전자동화 시스템의 실계통 구축

김용학(Yong-Hak Kim),한정열(Jeong-Yeol Han),이남호(Nam-Ho Lee),김병헌(Byeong-Heon Kim),박내호(Nae-Ho Park),홍정우(Jung-Woo Hong) 한국조명·전기설비학회 2010 조명·전기설비학회논문지 Vol.24 No.5

본 논문에서는 IEC 61850 기반의 지능형전자장치(IED)를 구비한 변전자동화 시스템(SAS)의 가용성 및 신뢰성을 실계통에서 향상시키기 위한 가이드라인을 제시한다. IEC 61850 표준의 통신 네트워크 및 시스템은 전력사가 변전소를 신/증설하는 경우에 새로운 설계 개념을 도입하도록 하고 있다. 그러나 현재는 기존의 2차계통인 보호, 감시, 제어 및 고장기록장치와 1차계통의 설비간에 배선에 의한 인터페이스에 기반을 두고 있으므로, 다기능의 IEDs가 기존과 유사한 방법으로 인터페이스를 하게 된다. 최근에는 전 세계적으로 많은 변전자동화 시스템의 구축사업이 보고되고 있으며, 또한 IEC 61850은 가장 보편적인 변전자동화 시스템을 위한 통신 표준이 되고 있다. This paper presents the guideline for enhancing the reliability and availability of SAS with IEC 61850 based IEDs in real power system. The IEC 61850 standard communication networks and systems allow utilities to consider new designs for substations applicable both new substation and refurbishments. The existing solutions are based on hardwired interface between the primary substation equipment and the secondary protection, monitoring, control and recording devices. All over the world, lots of projects at different stages of realization have been reported during the last year leading to a rapid maturation of the associated technologies. At present, IEC 61850 is becoming a popular communication standard for the substation automation system.

수유 중 약물 복용에 따른 불안과 수유율

차선화 ( Sun Hwa Cha ),한정열 ( Jung Yeol Han ),김해숙 ( Hae Suk Kim ),전선영 ( Seon Young Jeon ),허윤희 ( Yoon Hee Huh ),이경자 ( Kyong Ja Lee ),안현경 ( Hyun Kyong Ahn ),최준식 ( June Seek Choi ),김경아 ( Kyung Ah Kim ),신손문 ( 대한주산의학회 2003 Perinatology Vol.14 No.3

목적: 수유부에서 약물 노출의 종류와 빈도 및 이들 약물에 노출시 수유아에 어느 정도 우려되는 영향을 미치는지 느끼는 정도와 이러한 우려가 모유 수유율에 영향을 미치는지 평가하고자 한다. 방법: 2003년 4월 15일부터 2003년 5월 15일까지 삼성제일병원 산부인과 외래에 출산 후 8주에 내원한 산모 중 설문에 답했던 91례를 대상으로 하였다. 설문은 출산력, 분만방법, 모유수유 여부, 약물 노출의 빈도와 종류를 포함하고 있으며, 10cm Visual analogue scale를 이용하여 수유부가 복용했던 약물에 의해 영아에 미치는 영향에 대한 우려정도를 측정하였다. 결과: 연구 대상자의 평균 나이는 31세였으며, 평균 출산 아기 수는 1.3 명이었다. 이들의 출산 후 8주에 수유율은 65.9%(60/91)이었다. 모유수유를 선택하지 않고 분유를 선택한 이유는 젖이 잘 나오지 않아서가 38.7%(12/31)이었으며, 직장 12.9%(4/31), 함몰유두 6.5%(2/31), 약물복용 3.2%(1/31), 유방울혈 3.2%(1/31), 순이었으며, 기타는 35.5%(11/31)이었다. 모유 수유율과 관련된 변수들 중 산모의 나이와 출산아이의 수는 통계학적으로 유의하지 않았으나, 출산 방법에 따른 모유 수유율은 정상자연분만은 76.9%(30/39), 유도분만에 따른 정상질식분만 70.0%(14/20), 그리고 제왕절개술 50%(16/32)로 통계학적으로 유의한 결과를 나타내었다(P<0.05). 수유 중 약물 사용율은 50%(30/60)이었으며, 복용한 약물의 종류는 단일 노출로는 한약이 가장 많아 36.7%(11/30)이었으며, 영양제 10%(3/30), 감기약 6.7%(2/30)순이었고, 복합적으로 처방 받은 예를 포함하면 한약은 46.7%에 이른다. 수유 중 약물 노출 후 수유부가 느끼는 영아에 미치는 나쁜 영향의 정도는 약 49%이며, 출산방법에 따른 차이를 비교하면 자연질식분만이 46.5±6.6%, 유도분만 48.9±8.6%, 그리고 제왕절개술 51.2±8.2%으로 통계학적인 차이는 없었지만, 분만과정에서 중재가 심할수록 산모가 느끼는 약물이 신생아에 미치는 우려의 정도가 크게 나타났다. 결론: 대부분의 수유부는 수유 중 모체의 약물 복용이 수유아에 악영향을 미칠 수 있다고 생각하며, 실제 이는 모유 수유율을 감소시키는 한 요인으로 작용한다. Objective: To determine the type and frequency of medication taken by breast-feeding women and to evaluate the effects of maternal anxiety related to medication during lactation on the breast-feeding rate. Methods: From April 15 to May 15 2003, we conducted a survey with a prepared questionnaire on ninety-one mothers who visited the obstetric clinics of Samsung Cheil hospital at eight weeks after delivery. The questionnaire contained information about parity, mode of delivery, whether to feed breast-milk, and the type and frequency of medicinal exposure. We also asked the degree of perceived adverse effects on her baby associated with maternal medication using 10cm visual analogue scale. Results: The mean age of respondents was thirty-one years and the mean number of children born to the respondents was 1.3. At the eighth week after delivery the breast-feeding rate was 65.9%. The breast-feeding rate was not related to maternal age or the number of children but rather, the mode of delivery, which was 76.9% in NSVD, 70.0% in vaginal delivery with labor induction and 50% in cesarean delivery(P<0.05). The frequency of maternal medication intake during lactation was 50%. The most frequent type of medicine was herb medicine (36.7%). The average score of perceived adverse effect on a respondent`s baby during breast-feeding was about 49% in total, which was 46.5% in NSVD, 48.9% in vaginal delivery with labor induction, and 51.2% in cesarean delivery. Conclusion: Most nursing mothers think that their medications during lactation affect adversely their babies, who, in turn, may be associated with the decrease of breast-feeding rate.

습관성 유산환자의 향후임신에서 분석한 산과적 결과

허걸(Kuol Hur),양광문(Kwang Moon Yang),한정열(Jung Yeol Han),한국선(Kuk Sun Han),이홍복(Hong Bok Lee),김진영(Jin Young Kim),송인옥(In Ok Song),송지홍(Ji Hong Song),전종영(Jong Young Jun),궁미경(Mi Kyoung Koong),유근재(Keun Jai Yoo) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.3

N/A Objective: To obtain etiology and obstetric outcome of women who had a history of recurrent miscarriage. Met hods: From 1 June 1998 to 30 June 2000,82 patients who attended infertility & recurrent miscarriage clinic at Samsungcheil hospital and progressed beyond 24 weeks gestation following pregnancy were included in this study. The control population was 154 pregnancies considering age and parity over the same period. Retrospectively, we analyse the etiology of recurrent miscarriage and compare obstetric outcomes of two groups. Results: The etiology of recurrent miscarriage was immunologic factor (36.6%),unexplained (30.4%), anatomic cause (13.4%), endocrinologic abnormality (13.4%)and chromosomal abnormality (5.6%).The rate of preterm delivery (11%)and incidence of pregnancy induced hypertention (8.5%)were significantly higher than those of control group (3.2%and 2.5%respectively). There was no significant difference in the rate of small for gestational age, oligohydroamnios, cesarean section, perinatal loss and the incidence of gestational diabetes mellitus. Conclusion: The pregnancy with a history of recurrent miscarriage is associated with increased risk of pregnancy induced hypertension and preterm delivery and represent a population at high risk of obstetric problems. Therefore, close surveillance during antenatal period is required.

IED 동특성 시험을 위한 MMS 시험시스템 개발

이유진(You-Jin LEE),이남호(Nam-Ho LEE),장병태(Byung-Tae JANG),한정열(Jeong-yeol HAN),김영일(Young-Il KIM),정남준(Nam-Joon Jung),안용호(Yong-Ho An) 한국조명·전기설비학회 2015 한국조명·전기설비학회 학술대회논문집 Vol.2015 No.5