적병청와 : 서른살 지각생

권하얀 경남대학교 극동문제연구소 2009 NEWS Vol.86 No.-

산과적 출혈

권하얀 대한산부인과학회 2022 연수강좌 Vol.66 No.-

Randomized, Double-Blind, Placebo-Controlled Trial on the Efficacy of Hyaluronidase in Preventing Perineal Trauma in Nulliparous Women

권하얀,박현수,심재윤,이교원,최석주,최규연 연세대학교의과대학 2020 Yonsei medical journal Vol.61 No.1

Purpose: Hyaluronidase (HAase) has many uses in medicine, and reports suggest that it affects perineal tissue during fetal passagethrough the vaginal canal. However, its potential use for preventing perineal trauma has yet to be determined. This study sought toevaluate the efficacy and safety of perineal HAase injections in reducing perineal trauma during vaginal delivery. Materials and Methods: A multi-center, double-blind, placebo-controlled, randomized study was conducted from January 2016 toMarch 2017. Nulliparous women who planned to undergo vaginal delivery were recruited, and the enrolled women were randomlyassigned to the HAase injection group (HAase injection, 5000 IU, n=75) or the control group (normal saline injection, n=73). Thedegree of perineal laceration, rate of episiotomy, and grade of perineal edema at 1 hour and 24 hours after spontaneous vaginal deliverywere compared between the two groups. Results: A total of 148 women who underwent vaginal delivery were recruited. No significant differences were observed betweenthe HAase injection and control groups in the rates of perineal laceration (p=0.422). Perineal edema significantly decreased 24hours after delivery in the women treated with perineal HAase injections, compared to women in the control group (p=0.008). Theoverall incidences of adverse events, such as redness of the injection site, infection, and wound dehiscence, were similar betweenthe two groups. Conclusion: HAase injections in nulliparous women afforded no reductions in the rates of perineal lacerations and episiotomy. However, the use of perineal HAase injections did reduce perineal edema without severe adverse events.

보조생식술에 의한 임신의 관리

권하얀 대한산부인과학회 2017 대한산부인과학회 학술대회 Vol.103 No.-

The risk of emergency cesarean section after failure of vaginal delivery according to prepregnancy body mass index or gestational weight gain by the 2009 Institute of Medicine guidelines

권하얀 ( Ha Yan Kwon ),( Ja-young Kwon ),( Yong Won Park ),( Young-han Kim ) 대한산부인과학회 2017 대한산부인과학회 학술대회 Vol.103 No.-

Objective: To evaluate the risk of emergency cesarean section according to the prepregnancy body mass index (BMI) and gestational weight gain per the 2009 Institute of Medicine guidelines. Methods: A retrospective analysis of data from 2,765 women with singleton full-term births (2009 to 2012) who attempted a vaginal delivery was conducted. Pregnancies with preeclampsia, chronic hypertension, diabetes, planned cesarean section, placenta previa, or cesarean section due to fetal anomalies or intrauterine growth restriction were excluded. Odds ratios (ORs) and confidence intervals (CIs) for emergency cesarean section were calculated after adjusting for prepregnancy BMI or gestational weight gain. Results: Three-hundred and fifty nine (13.0%) women underwent emergency cesarean section. The adjusted OR for overweight, obese, and extremely obese women indicated a significantly increased risk of cesarean delivery. Gestational weight gain by Institute of Medicine guidelines was not associated with an increased risk of cesarean delivery. However, inadequate and excessive weight gain in obese women was highly associated with an increased risk of emergency cesarean section, compared to these in normal BMI (OR, 5.56; 95% CI, 1.36 to 22.72; OR, 3.63; 95% CI, 1.05 to 12.54; respectively), while there was no significant difference between normal BMI and obese women with adequate weight gain. Conclusion: Obese women should be provided special advice before and during pregnancy for controlling weight and careful consideration should be needed at the time of vaginal delivery to avoid emergency cesarean section.

유방암이 진단된 젊은 한국 여성에서 발견한 크루켄버그종양

권하얀 ( Ha Yan Kwon ),남은지 ( Eun Ji Nam ),김상운 ( Sang Wun Kim ),김영태 ( Young Tae Kim ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.10

Metastasis of breast cancer to lung, bone and liver is common, but metastasis to ovaries is rare in Korea. A 31-year-old woman diagnosed with breast cancer was referred to our department due to a newly detected adnexal mass via abdomen sonography during regular check-up. Imaging studies revealed solid mass on left ovary and enlarged lymph nodes. She underwent a laparotomy including hysterectomy, bilateral salpingo-oophorectomy, lymphadenectomy, with a suspected impression of primary ovarian neoplasms or Krukenberg tumors. Pathologic findings revealed metastatic adenocarcinoma from breast cancer involving left ovary and paraaortic lymph nodes. To our knowledge, this is the youngest Korean patient with Krukenberg tumors from the breast. In Korea, since the average age affected by breast cancer is younger than in the West, and the incidence and the mortality of breast cancer has increased, possible ovarian metastasis should be kept in mind when Korean patient with breast cancer visits for follow-up.

A comparison of abdominal sacral colpopexy with total abdominal hysterectomy and McCall culdoplasty with vaginal hysterectomy in the treatment of uterine prolapse(초)

권하얀 ( Ha Yan Kwon ),( Yeo Jung Moon ),( Sei Kwang Kim ),( Sang Wook Bai ) 대한산부인과학회 2009 대한산부인과학회 학술대회 Vol.95 No.-

Krukenberg tumor arising from breast cancer: a case of the youngest patient in Korea(초)

권하얀 ( Ha Yan Kwon ),( Yong Wook Jung ),( San Hui Lee ),( Jiheum Paek ),( Eun Ji Nam ),( Sang Wun Kim ),( Jae Wook Kim ),( Young Tae Kim ) 대한산부인과학회 2009 대한산부인과학회 학술대회 Vol.95 No.-

Addition of Cervical Elastography May Increase Preterm Delivery Prediction Performance in Pregnant Women with Short Cervix: a Prospective Study

박현수,권하얀,곽동욱,김문영,설현주,홍준석,심재윤,최세경,황한성,오민정,조금준,김건우,오수영 대한의학회 2019 Journal of Korean medical science Vol.34 No.9

Background: We investigated whether there is a difference in elastographic parameters between pregnancies with and without spontaneous preterm delivery (sPTD) in women with a short cervix (≤ 25 mm), and examined the ability of elastographic parameters to predict sPTD in those women. Methods: E-CervixTM (WS80A; Samsung Medison, Seoul, Korea) elastography was used to examine the cervical strain. Elastographic parameters were compared between pregnancies with and without sPTD. Diagnostic performance of elastographic parameters to predict sPTD ≤ 37 weeks, both alone and in combination with other parameters, was compared with that of cervical length (CL) using area under receiver operating characteristic curve (AUC) analysis. Results: A total of 130 women were included. Median gestational age (GA) at examination was 24.4 weeks (interquartile range, 21.4–28.9), and the prevalence of sPTD was 20.0% (26/130). Both the elastographic parameters and CL did not show statistical difference between those with and without sPTD. However, when only patients with CL ≥ 1.5 cm (n = 110) were included in the analysis, there was a significant difference between two groups in elasticity contrast index (ECI) within 0.5/1.0/1.5 cm from the cervical canal (P < 0.05) which is one of elastographic parameters generated by E-Cervix. When AUC analysis was performed in women with CL ≥ 1.5cm, the combination of parameters (CL + pre-pregnancy body mass index + GA at exam + ECI within 0.5/1.0/1.5 cm) showed a significantly higher AUC than CL alone (P < 0.05). Conclusion: An addition of cervical elastography may improve the ability to predict sPTD in women with a short CL between 1.5 and 2.5 cm.

한국의 모성사망 원인과 경향 분석(2009-2014)

박현수 ( Hyun Soo Park ),권하얀 ( Ha Yan Kwon ) 대한주산의학회 2016 Perinatology Vol.27 No.2

목적: 본 연구는 2009년부터 2014년 사이 우리 나라의 모성사망 경향과 원인을 분석하고자 시행되었다. 방법: 모성사망의 경향과 원인을 분석하기 위하여 2009년부터 2014년까지 통계청에서 조사한 사망원인보완조사 결과를 사용하였다. 산모의 나이, 주거지, 사망원인, 사망 시 임신 주수 등의 정보를 추출하였다. 모성사망비(maternal mortality ratio)와 모성사망율(maternal mortality rate)을 계산하였으며 산모의 나이, 주거지역에 따른 모성사망비를 분석하였다. 모성사망의 원인을 세계보건기구(WHO)에서 제안한 기준으로 국제질병코드(ICD-10)를 이용하여 분류하였다. 결과: 연구기간 동안 평균 모성사망비는 13.16, 평균 모성사망율은 0.45였다. 모성사망비는 2011년에 17.2로 가장 높았고, 2012년 9.9로 가장 낮았다. 각 지역별 모성사망비는 광주 7.51, 제주 26.84로 큰 편차를 보였다. 연령별로는 20-24세 그룹이 6.9로 가장 낮았고 45-49세 그룹이 143.7로 가장 높은 수치를 보였다. 직접모성사망과 간접모성사망은 각각 평균 66.2%와 29.9%를 차지했다. 모성 사망의 3대 원인은 산과적 색전증(24.4%), 산후출혈(18.3%), 임신 중 고혈압성 질환(5.5%)으로 나타났다. 결론: 연구기간 동안 점차 모성사망비가 줄어들기는 했지만, 산모의 연령, 주거지 등에 따라 매우 큰 차이를 보였다. 모성사망을 줄이기 위한 방법으로, 모성 사망 중 예방가능한 원인에 대한 대처법을 찾고, 지역별로 이용가능한 의료자원의 편차를 줄이는 방법 등을 고려해 볼 수 있을 것이다. Purpose: This study was conducted to analyze recent trends and causes of maternal mortality in Korea between 2009 and 2014. Methods: We investigated trends and causes of maternal death using the data from Complementary Investigations on the Infant, Maternal, and Perinatal Mortality carried out by Statistics Korea between 2009 and 2014. Maternal age, administrative district, causes of death and gestational age at the time of death were collected from data. Statistics including maternal mortality ratio (MMR) and maternal mortality rate were calculated. We also analyzed MMR according to the age, and administrative districts. The causes of maternal death were sorted and classified using International Classification of Diseases and World Health Organization recommendations. Results: The average MMR during 6 years was 13.16 and maternal mortality rate was 0.45. MMR was highest in 2011 (17.2) and lowest in 2012 (9.9). The average MMR of the administrative districts varied greatly from 7.51 (Gwangju) to 26.84 (Jeju). The average MMR during the study period was lowest in maternal age of 20- 24 (6.9), and highest in 45-49 (143.7). On average, direct and indirect maternal deaths accounted for 66.2% and 29.9% of total maternal death, respectively. The three most common causes of maternal deaths were obstetrical embolism (24.4%), postpartum hemorrhage (18.3%), and hypertensive disease of pregnancy (5.5%) in decreasing order of frequency. Conclusion: Although MMR is decreasing during the study period, it fluctuates widely according to maternal age, districts, and constant effort for improvements is necessary. To reduce maternal deaths, solution to control preventable causes of maternal deaths, careful management of pregnancies with advanced maternal age, and policy to solve the discrepancy in the medical services among diverse regions in the country are needed.