Prostaglandin F₂α의 양막외주입에 의한 중기임신중절

신수재(SJ Shin),정승균(SK Chung),한치동(CD Han),김성도(SD Kim),안재영(JY Ahn) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.6

Although much research is being carried out all over the world, midtrimester abortion still presents many difficult medical problem. It is well known that prostaglandin E and F are effective in uterine contraction in both pregnant and nonpregnant uterus. The use of prostaglandin F₂α administered by extraamniotic infusion through Foley catheter for the induction of abortion was studied in 35 patients between 17 and 33 weeks gestation, and this method had been proved to be safe and effective mean of the termination of the pregnancies at midtrimester. The results were as followings: 1. The range of age was between 24 and 42. 2. Nulliparas were 17 cases and multiparas were 18 cases. 3. Intrauterine fetal death were indicated in over the half. 4. The mean duration from infusion to the delivery of the fetus was 15.70 hours. The mean duration for the multiparas was 14.17 hours, and the mean duration for the primipara was 15.25 hours. 5. The mean total dosage of prostaglandin F₂α was 5.692mg in primiparas and 4.479mg in multiparas. 6. The abortion was successfully induced in 88.2% of primiparas and 88.9% of multiparas within 24 hours. 7. The successful abortion rate by the balloon size of the Foley catheter were 86.4% in the group of 30~40cc balloon size and 100% in the group of 80~100cc balloon size within 24 hours. 8. The duration of the oxytocin infusion after the expulsion of Foley catheter were 4.59 hours in the group of 30~40cc balloon size and 1.32 hours in the group of 80~ 100cc balloon size. 9. The most common side effect was consisted of gastrointestinal symptom such as nausea, vomiting and diarrhea. Other side effects were included transient pyrexia, chilling and facial flush. 10. The main complication in this series was incomplete abortion, which occurred in 6 patients. Others were excessive bleeding over 500ml, endometritis and cervical laceration.

난소임신 2예

한치동(CD Han),신수재(SJ Shin),정승균(SK Chung),김성도(SD Kim),안재영(JY Ahn) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.3

Primary ovarian pregnancy is comparatively rare in ectopic pregnancy and the Spiegelberg`s criteria should be fulfiled for the diagnosis of ovarian pregnancy. Thw cases of ovarian pregnancy were seen in recent years at Korea General Hospital and presented with a brief literature.

자궁경관 임신의 보존요법후 성공적인 임신 1 예

이기호(KH Lee),임대성(DS Lim),신수재(SJ Shin),김성도(SD Kim),안재영(JY Ahn) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.1

본 증례는 33세경산부가 불완전 유산이라는 진단하에 소파수술을 받던중 대출혈을 일으켜 본원으로 이송되어 초음파를 이용 자궁경관임신으로 진단한후 보존요법의 하나인 자궁경부 결찰과 함께 질폐색을 시도하여 치료에 성공한 후 임신되어 남아를 분만한 경우로 다음에 임신을 원하는 경우에는 우선 일차적으로 보존요법을 시행해 보는 것이 바람직하다고 생각 되어 진다. Cervical pregnancy is a rare form of ectopic gestation in which the ovum implants within the cervix below the internal os. The exact cause of the cervical pregnancy is not known, however permanent injury to the uterine mucosa is suspected . Because of uncontrolled profuse painless vaginal bleeding total hysterectomy is mostly perfomred in the management of cervical pregnancy . We present a case of cervical pregnancy in 33years old mulipara who delivery a healthy male infant after conservative treatment , and literatures on the cervical pregnancy were briefly reviewed.

Intrapartum Electronic Fetal Heart Rate Monitoring의 임상경험

이춘화(CH Lee),정기성(KS Chung),신수재(SJ Shin),조성욱(SH Cho),안덕호(DH Ahn),황태식(TS Hwang) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.10

1981년 3월 16일부터 1982년 7월 31일까지 악 1년 5개월간 Electronic F.H.R. monitoring을 시행한 265예에 대한 임상적 관찰을 하여 얻은 주요한 것은 다음과 같다. 1. 265예중 고위험임신군이 157예 (59.25%), 정상임신군 108예 (40.75%) 였으며 고위험임신군은 10종류로 분류 되었는데 주요한 것은 임신성 고혈압, 과숙아 조기파막이였다. 2. Electronic F.H.R. monitoring의 abnormal record는 정상임신군에 17예(17:108 15.74%) 고위험임신 군에서 44예 (44:157=28.0%)로서 총 61예(61:265=23.0%) 였다. 3. 고위험임신군에서 Electronic F.H.R. monitoring의 abnormal record 44예증 late deceleration 13예, Variable deceleration 8예, prloonged deceleration 14예, otbers 9예 였다. 4. Abnormal F.H.R. monitoring이 나타난 61예를 Apgar score를 토대로 하여 분석 하였다. 5. pitocin induction 및 Augmentation을 한 96예와 자연진통군 l69예중 Hypertonic Uterine Contraction으로 인한 prolonged deceleration이 각각 7예(7:96=7.30%)와 4예(4:169=2.37%) 가 발생하였다. 상술한 예는 F.H.R. monitoring중 조기 발견되어 치료됨으로서 fetal distress을 예방할 수 있었다. 6. Electronic fetal heart rate monitoring 시행한 265예중 제왕절개를한 환자는 62예로서 23%의 빈도를 나타냈으며 그중 fatal distress로 제왕절개를한 환자는 23예로서 8.67%였다 7. 대부분의 예에서는 external fetal heart rate monitoring이 임상적으로 이용가치가 있음을 인정하였다. 그려나 앞으로는 internal 과 fetal scalp blood의 P.K 검사를 적극적으로 시행하여 더욱더 정확성을 기하도록 할 것이다. The continuous intrapartum electronic fetal heart rate monitoring has been performed as the primary means of fetal assessment for the improvement of neonata1 outcome. This retrospective study was composed of 265 patients intrapartum fetal heart rate monitorings, who were admitted for delivery at obstetrics and gynecologic department of Korea general hospital in Masan from 16th of march, 1981. to thirty first of july, 1982. The results were as follow; 1. This study was performed on 265 patients who were composed of 157 patients (59.25%) in high risk pregnancy and 108 patients (40.75%) in control group. High risk pregnancies were subdivided into 10 varieties, and 3 major varieties were pregnancy induced hypertension, post-term and premature rupture of membrane. 2. Abnormal records of F.H.R. monitoring were 61 cases (61 : 265=23.0%) which were composed of 17 cases (17 : 108=15.74%) in control group and 44cases (44 : 157 =28.0%) in high risk pregnancy. 3. 13 cases of late deceleration, 8 cases of variable deceleration, 14 cases of prolonged deceleration and 9 cases of others were seen in high risk pregnancy group. 4. 61 cases of abnormal fetal heart rate records were analysed according to Apgar score, birth weight, coiling of cord and type of delivery 5. Proloned decelerations caused by hypertonic uterine contraction were seen 7 cases (7.3%) out of 96 cases of pitocin induction or augumentation and 4 cases (2.37%) out of l69 cases of spontaneous labor. Those cases of hypertonic uterine contraction were detected early by using electronic fetal heart rate monitoring. 6. C/S rate was 23%, i.e. 62 cases in 265 cases of intrapatum electronic fetal heart rate monitoring were performed continuously, however 8.67%, i.e. 23 cases of C/S were performed because of fetal distress. 7. The external electronic fetal heart rate monitoring is proved to be valuable, however internal monitoring and fetal scalp blood P.H. will be carried out effectively to get further precise study.

분만 2 기의 태아심음 점수제와 제대 동맥혈 pH와의 관계

안재영,신수재,김종민,양성우,윤형근 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.10

서울 고려병원 산부인과에서는 1987년 4월부터 1988년 4월까지 입원분만한 환자중 분만 2기에 직접 태아감시장치를 시행한 71명을 대상으로하여 점수제와 1분치 Apgar점수 및 제대동맥혈 pH를 비교분석하여 다음과 같은 결론을 얻었다. 1. 총 71명의 분만 2기에서의 평균점수는 7.6이었으며, 평균 pH는 7.271, 평균 1분치 Apgar점수는 7.4이었다. 2. 점수제와 pH, 1분치 Apgar점수 사이에는 직선적인 상관관계가 있었다. 3. 점수가 6점이상인 군에서 pH 7.2이하가 3명(5.7%)에 비해, 점수가 5점이하인 군에서는 8명(44.4$)으로 높게 나타났다. 4. 초산부와 경산부의 비교에서는 경산부가 점수 0∼4인 경우가 1명(11.1%)인 반면, 초산부는 10명(16.4%)로 많이 나타났으며, 평균점수도 경산부가 7.6인데 비해 초산부는 6.8로 낮게 나타났다. 5. 점수 5점과 pH 7.2를 기준으로한 sensitivity는 72.7%였으며, specificity는 83.3%이었다. We performed the study on 71 patients to evaluate the significance of various fetal heart rate patterns encountered during second stage of labor and to determine whether there is any correlation between fetal heart rate scoring system, umbilical artery PH and Apgar score at one minute. The results were as follows. 1. The mean score at second stage of labor was 7.6 and the mean umbilical artery PH was 7.271 and mean 1 minute Apgar score was 7.4. 2. There was a definite relationship showing linear appearence between fetal heart rate scoring system, umbilical artery PH and 1 minute Apgar score. 3. In the group of patients whose fetal heart rate scoring was above 6.0, only 5.7% of patients belonged to below 7.2 of umbilical artery PH, whereas in the group of scoring systems below 5, 44.4% of patients belonged to PH below 7.2. 4. The mean score was significantly higher in multipara than those of primipara. 5. The sensitivity was 72.9% and specificity was 83.3%

임신초기 융모막 융모생검에 의한 산전태아 유전질환의 진단

안재영,김성도,신수재,계흥순,박연우 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.9

1 융모막 융모생검의 적응증은 고령산모가 65예로 44.9%를 차지했으며 선천성 이상아 분만력이 25예, 염색체이상아 분만력이 17예, 약물복용이 18예등이었다. 2. 융모생검의 성공률이 154예중 145예에서 성공하여 94%의 성공률을 보였으며 카테터 삽입횟수 는 1회가 44.1%, 2회가 40.7%,3회가 15.2%였다. 3.생검시 임신주수는 10-11주가 70예로 가장 많았으며 9-10주가 45예, 11-12주가 21예, 12-13주가 9예이었다. 4. 염색체이상은 10예로서 major group 인 Down`s syndrome, 16trisomy, 8trisomy, 3trisomy with 8p- Translocation, Heterochromatin 등과 minor group 인 15p+, 9 inversion 9qh+등이었다. 5. 생검후 자연유산은 5예로 3.4%이었으며 abnormal result 로 임신중절을 받은 경우는 7예로 4.8%이었다. CVS for the first trimester prenatal diagnosis is the potential diagnostic tool for study of fetal chromosomal anomaly compared with utilizing midtrimester genetic amniocentesis. Because of prompt results and possible erarly therapeutic application,physical and psy-chological burdens on the patients were markedly reduced. In this study, chorionic villi were obtained by transcervical application under the ultra-sound guidaned,and 24hours incubation method was employed for the chromosome preparation. The patients were consisted of 145 cases in which performed chorionic villi sampling in 9 to 13 weeks gestation with indications of sampling. The results obtained were as follows; 1. The success rate of sampling was 94%(145/154). 2. The chromosomal abnormality was found in 10 casesd(6.9%). 3. The fetal loss was found in 5 cases(3.4%).

융모양막염의 진단에 있어서 C-Reactive Protein의 의의에 관한 임상적 연구

안재영,김성도,신수재,엄수하,윤형근,정수영 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.3

1989년 1월부터 1990년 6월까지 서울 고려병원 산부인과에 조기양막파수로 입원한 산모 89 명과 정상대조군 산모 46명을 대상으로 융모양막염의 조기진단을 위한 C-reactive protein검사를 시행하여 아래와 같은 결과를 얻었다. 1. 두 군사이에 기존 검사인 백혈구수, 감별혈구수 및 적혈구 침강속도와 CRP의 평균치를 비교해본 결과 파수군에서 모두 높게 나타났으며, 특히 CRP test에서는 파수군 8.7mg/L, 대조 군 3.5mg/L로 유의한 차이를 보였다(p$lt;0.01). 2. CRP양성율은 파수군이 43.8%로 대조군의 17.4%보다 높았다. 3. 융모약막염에서 염증 정도에 따라 경증 및 중증으로 분류하여 CRP평균치를 비교해 본 결 과, 경증은 10.7mg/L, 중증은 33.2mg/L로써 염증정도가 심한 경우 CRP평균치가 의미있게 높 았다(p$lt;0.01). 4. CRP의 민감성, 특이성, 양성 및 음성 예측율을 기존의 검사법(백혈구수, 감별혈구수, 적혈 구 침강속도)과 비교한 결과 CRP test가 78.5%, 87.2%, 76.7%, 82.0%로써 기존의 검사법보다 모두 우수한 결과를 보였다. 5. 파수군에서, 양막파수후 분만까지 시간이 경과할 수록 CRP양성율은 증가하는 경향을 보 였다. 6. 파수군에서, 임신주수가 적을 수록 CRP치도 높고, CRP양성율도 증가하는 경향을 보였다. 7. 두 군사이의 분만 방법을 비교해 본 결과, 파수군에서 제왕절개술의 비율이 39.3%로써 대 조군의 21.7%보다 높았다. Chorioamnionitis occurs about 10% in patient with premature rupture of membrane. It can cause severe complications to mother and fetus. So, early detection and proper treatment is the best way to protect mother and fetus from complications. We studied the role of the C-reactive Protein in early detection of the chorioamnionitis in patients with Premature rupture of membrane. 89 cases with ruptured membrane and 46 cases with intact emembrane wer taken and analyzed. The results were as follows: 1. There was no significant difference in demographic characteristics between PROM and control group(age, gestational age, gravity, parity). 2. Positive CRP rate was significantly higher in PROM group (43.8%) than control group (17.4). 3. The sensitivity, speicificity, positive predictive value of the CRP test was higher in comparision with other laboratory tests such as WBC count, differential count, and Ery-throcyte sedimentation rate. 4. CRP level was correlated with severity of histological chorioamnionitis. 5. CRP level was correlated with the duration of ruptured time in PROM group. 6. Caesarean section rate was higher in PROM group (39.3%) than control group (21.7%).