저용량 헤파린 투여로 성공한 발작성 야간혈색소뇨증 환자의 분만

김호빈 ( Kim Ho Bin ),장혜진 ( Jang Hye Jin ),양정인 ( Yang Jeong In ),김행수 ( Kim Haeng Su ),유희석 ( Yu Hui Seog ),김효철 ( Kim Hyo Cheol ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.4

Paroxysmal nocturnal hemoglobinura is a very rare acquired clonal hematopoietic cell disorder leading to chronic intravascular hemolysis caused by abnormal complement activation. Pregnancy in a patient with paroxysmal nocturnal hemoglobinuria is often com

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.

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

골형성 부전증을 가진 여성에서의 임신

장혜진 ( Jang Hye Jin ),김행수 ( Kim Haeng Su ),양정인 ( Yang Jeong In ),유희석 ( Yu Hui Seog ),오기석 ( O Gi Seog ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.11

Osteogenesis imperfecta (OI) is an inherited disease of connective tissue disorder which represents a phenotypically heterogeneous group of conditions that results from a number of genetic defects in the synthesis of type I collagen. A pregnancy associate

임신성 내당능장애 및 임신성 당뇨를 동반한 임신의 양상 및 주산기 예후

이원종(Won Jong Lee),안성희(Seong Hee Ahn),김행수(Haeng Soo Kim),양정인(Jeong In Yang),김윤석(Yoon Seok Kim),오준환(Joon Hwan Oh),한기수(Ki Su Han),오기석(Kie Suk Oh) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.6

N/A Objective : To evaluate the clinical manifestations and perinatal outcomes of pregnancies complicated with gestational impaired glucose tolerance (GIGT) and gestational diabetes mellitus (GDM). Methods : We performed 50gm oral glucose tolerance test (OGTT) for GIGT and GDM screening in 4,367 pregnant women at 24-28 weeks of gestation. In 1,010 women with plasma glucose level over 130mg/dl, 753 women underwent 100gm OGTTs at 28-32 weeks of gestation. According to the NDDG criteria, 113 cases with GIGT (single positive level of OGTT ; group 2), 125 cases with GDM (group 3), and 515 cases with control (group 1) were identified among the 753 cases. Retrospective review of outcome of these patients was performed. ANOVA and chi-square test were used to determine the statistical significance. Results : The incidence of GIGT and GDM was 2.7%, 3.0%. The prepregnant body mass index (21.4±3.0kg/m2, 21.3±2.8kg/m2, 23.2±4.1kg/m2), overweight of BMI over 26 (7.4%, 4.4%, 14.4%) and obesity of BMI over 30 (1.2%, 0.0%, 8.0%) was significantly higher in group 3 than group 1 (p<0.05). We defined poor maternal outcome as those suffering from any one of birth canal injury, hydramnios or oligohydramnios, preeclampsia, cesarean delivery due to cephalopelvic disproportion, dystocia, fetal distress. Group 3 showed most highest poor maternal outcome (22.3%, 28.3%, 39.2%, p<0.05). And we defined poor neonatal outcome as those suffering from any one of hyperbilirubinemia, hypoglycemia, congenital anomaly, admission to neonatal intensive care unit due to respiratory distress syndrome. Group 2 and group 3 showed poor neonatal outcome than group 1 (6.2%, 13.3%, 21.6%, p<0.05). Conclusion : Pregnancies complicated with GDM showed poor maternal and neonatal outcome, and GIGT experienced no adverse maternal outcomes but showed poor neonatal outcomes compared to normal pregnancy, and showed less correlation with obesity than GDM. Further study of pathophysiology and proper management of GIGT will be mandatory.

중증 자간전증이 동반된 임산부에서 혈중 homocysteine 치 측정의 의의

임종찬 ( Im Jong Chan ),이희종 ( Lee Hui Jong ),양정인 ( Yang Jeong In ),김행수 ( Kim Haeng Su ),유희석 ( Yu Hui Seog ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.3

목적 : 증가된 혈중 homocysteine은 동맥경화증 발생의 중요한 독립적 위험인자이다. 동맥경화증과 비슷한 병태생리를 가지는 중증 자간전증 임산부의 혈장 homocysteine치를 측정하여 homocysteine값의 변화가 있는지를 알아보고자 하였다. 연구 방법 : 28명의 중증 자간전증 임산부 (연구군)와 연구군의 임산부 나이, 임신 주수, 산과력 및 임신 전 체질량지수가 일치하는 정상 혈압을 가진 임산부 26명 (대조군)을 대상으로 분만전 24시간 이내, 분만후 24시간째에 혈중 homocysteine치를 비교하였다. 혈중 homocysteine은 fluorescent polarization immunoassay방법을 이용하였다. 통계처리는 Student t-test를 이용하였다. 결과 : 중증 자간전증이 있는 산모군에서 분만전 및 분만 24시간 후 평균 homocysteine은 대조군에 비해 분만 전 [7.17±2.71 vs 5.37±1.49 g/mL (mean SD); p<0.05]과 분만 후 [6.38±2.03 vs 4.48±0.40 g/mL (mean± SD); p<0.05] 모두 유의하게 높았다. 결론 : 혈중 증가된 homocysteine은 동맥경화증에서와 유사하게 자간전증의 발생과 관계가 있으며 향후 더 많은 연구대상을 통해 임신중독증의 예측 지표로서 사용될 수 있으리라 사료된다. Objective : The elevated plasma homocysteine concentrations is a independent risk factor of atherosclerosis. We investigated the level of plasma homocysteine is associated with severe preeclampsia. Methods : 28 pregnant women with severe preeclampsia (study group) and 26 normotensive, healthy pregnant women (control group), matched by maternal age, gestational age, pre-pregnant body mass index and parity were enrolled into this study. Blood samples were collected within 24 hours before delivery and just 24 hours after delivery. The level of plasma homocysteine was measured by fluorescent polarization immunoassay. Statistical analysis was performed using Student t test. Results : Plasma homocysteine levels in the women with severe preeclampsia were significantly elevated than those of control group in antepartum and postpartum 24 hours [7.17 2.71 vs 5.37 1.49 g/mL (mean SD); p<0.05 in antepartum, 6.38 2.03 vs 4.48±0.40 g/mL (mean SD); p<0.05 in postpartum]. Conclusion : In the present study the increase of plasma homocysteine in pregnant women with severe preeclampsia is related the pathogenesis of preeclampsia as like in atherosclerosis and may be used as a marker of preeclampsia by further research.

출생 체중 불일치를 보이는 쌍태임신의 주산기 예후

이희종(Hee Jong Lee),이준서(June Seo Lee),김행수(Haeng Soo Kim),양정인(Jeong In Yang),오준환(Jun Hwan Oh),한기수(Ki Su Han),오기석(Kie Suk Oh) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.3

N/A Objective : To evaluate the perinatal outcomes of twin pregnancies with birth weight discordancy and to determine factors affecting on the outcomes. Methods : We studied 367 pairs of twin delivered after 28 weeks of gestation at the Ajou University Hospital between June 1994 and June 2000. Twins were stratified into three groups according to the percent difference of birth weight. Birth weight difference less than 15%(concordant) was classified into control group(268 pairs), between 15% and 25% into group 1(72 pairs), and more than 25% into group 2(27 pairs). Perinatal outcomes of each group were assessed retrospectively. Results : In smaller twins, mean birth weight(control vs group 1 vs. group 2 : 2274.3±424.9 gm vs. 2012.9±303.2 gm vs. 1635.2±440.8 gm, p<0.05), duration of neonatal intensive care unit admission(7.6±11.5 days vs. 11.6±10.8 days vs. 18.6±14.4 days, p<0.05), and the frequency of neonatal jaundice(8.6% vs. 12.5% vs. 29.6%, p<0.05), the frequency of small for gestational age infant(8.2% vs. 40.3% vs. 74.1%, p<0.05), and perinatal mortality(2.6% vs. 2.8% vs. 11.1%, p<0.05) in group 2 showed statistically significant difference from control group. No difference was found in larger twins. In multiple logistic regression analysis, independent prognostic factors of discordant twin were gestational age and birth weight. Conclusion : In twin pregnancies with birth weight discordancy, larger twins showed no difference in perinatal outcomes but smaller twins with birth weight discordancy more than 25% showed significantly higher perinatal mortality and morbidity. However independent prognostic factor was not discordancy itself but gestational age and birth weight.

양수과다증이 임신성 당뇨 산모의 임신 결과에 미치는 영향

임종찬 ( Im Jong Chan ),이희종 ( Lee Hui Jong ),김행수 ( Kim Haeng Su ),양정인 ( Yang Jeong In ),김준형 ( Kim Jun Hyeong ),유희석 ( Yu Hui Seog ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.5

목적 : 임신성 당뇨 임부에서 발생하는 양수과다증이 임신 및 신생아 예후에 미치는 영향을 알아보고자 하였다. 연구 방법 : 아주대학교 병원에서 NDDG 기준에 의해 임신성 당뇨로 진단된 277명의 단태 임신부를 대상으로 하였다. 대상 임신부들은 초음파검사상 양수 지수가 10-24인 대조군 (254명)과 24 이상인 연구군 (23명)으로 분류하였다. 산모와 신생아의 임상기록을 후향적으로 분석하였다. 통계학적인 검증은 Student t-test, chi-square test, Fisher`s exact test와 logistic regression analysis를 이용하였고 p<0.05를 유의하다고 하였다. 결과 : 양 군 사이에 임신부의 나이와 산과력은 유의한 차이가 없었다. 조기 진통은 대조군보다 연구군 (4.3% vs. 34.8%, p<0.001)에서 유의하게 높았으나, 아두골반 불균형이나 진행 장애에 의한 제왕절개분만, 전자간증, 태반 조기박리 등의 모성 합병증의 빈도는 유의한 차이가 없었다. 신생아 합병증으로는 연구군에서 유의하게 재태연령 (38.2±1.4주 vs. 36.7±2.5주, p<0.05)이 짧고, 출생시 평균 체중 (3,405.0±595.2 gm vs. 3,701.3±757.9 gm, p=0.026)이 무거웠다. 거대아 (13.0% vs. 47.8%, p<0.001), 과출생체중아 (24.8% vs. 60.9%, p=0.001), 조산 (5.1% vs. 39.1%, p<0.001), 신생아의 중환자실 입원 (7.1% vs. 34.8%, p=0.05), 호흡기계 합병증 (3.9% vs. 21.7%, p<0.001), 고빌리루빈혈증 (11.0% vs. 47.8%, p<0.001) 등의 빈도는 희귀분석을 이용하여 재태연령을 보정한 후에도 연구군에서 유의하게 높았다. 결론 : 임신성 당뇨 임신부에서 발생하는 양수과다증은 조산과 신생아 호흡기계 합병증 등은 증가시키지만 조기 진통을 제외한 모성 합병증은 증가시키지 않았다. Objective : To determine whether hydramnios occurring in pregnant women complicated with gestational diabetes mellitus (GDM) affects maternal and neonatal outcomes. Methods : We evaluated 277 pregnant women with singleton pregnancies and GDM diagnosed by the National Diabetes Data Group (NDDG) criteria. The study group was consisted of 23 pregnant women diagnosed as hydramnios (Amniotic fluid index ; AFI>24㎝) by ultrasonography, and the control group was consisted of 254 pregnant women with normal AFI (10-24㎝). REtrospective review of maternal and neconatal outcomes in these women was performed. Student t-test, chi-square test, Fisher`s exact test, and logistic regression analysis were used for statistics. Results : There were no significant differences in the maternal age and parity between the two groups. The frequency of preterm labor was higher in the study group compared to the control group (4.3% vs. 34.8%, p<0.001). The frequencies of cesarean delivery due to cephalopelvic disproportion or failure to progress, preeclampsia, and placental abruption were not significantly different between the two groups. The study group showed significantly shorter gestational age (38.2±1.4 weeks vs. 36.7±2.5 weeks, p<0.05) and heavier neonatal birth weight at delivery (3,405.,±595.2 gm vs. 3,701.3±757.9 gm, p=0.026). The frequencies of preterm birth (5.1% vs. 39.1%, p<0.01), macrosomia (13.0% vs. 34.8%, p<0.001), admission to neonatal intensive care unit (7.1% vs. 34.8%, p=0.050), neonatal respiratory complications (3.9% vs. 21.7%, p<0.001), and hyperbilirubinemia (11.0% vs. 47.8%, p<0.001) were higher in the study group even after logistic regression analysis for controlling gestational age. Conclusion : Hydramnios occurring in pregnant women with GDM may be associated with increased risk of preterm birth and neonatal respiratory complications, but not associated with adverse maternal outcomes, except preterm labor.