쌍태임신시 태반유형 및 제대부착형태가 성장 불일치에 미치는 영향에 관한 연구

안현경(H . K . Ahn),양광문(K . M . Yang),홍성란(S . R . Hong),류현미(H . M . Rheu),김문영(M . Y . Kim),한정열(J . R . Han),최규홍(K . H . Choi),양재혁(J . H . Yang),김은성(E . S . Kim) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.11

N/A Object : The purpose of the study is to determine whether the type of placentation and abnormal cord insertion can affect discordant growth in twin gestation. Materials and methods : We investigated 422 sets of structually normal twin delivered at our twin clinic after 26 weeks of gestation from 1995-1997. All cases of placenta were examined for pathologic evaluation during the study periods. The type of placentation was divided into four groups: monochorionic monoamniotic placenta (n=4); monochorionic diamniotic placenta (n=62); dichorionic diamniotic fused placenta (n=163); dichorionic diamniotic separate placenta(n=193). Cord insertion was also divided into three groups: both side abnormal insertion (n=17); either side abnormal insertion (n=101); both side normal insertion (n=304). Intertwin weight discordancy was classified as mild form (15-25%) and severe form (>25%) by the degree of the discrepancy. Results : The results were as follows; 1. Of these 422 twin sets, 132 (31%) consisted of twin discordancy in weight by 15% or greater (mild form 19%, severe form 12%). 2. There are no significant difference in the frequencies of discordancy between MC twins and DC twins (31.8% vs 31.2%, p=0.97). 3. The prevalence of abnormal cord insertion was 16% and much more frequent in MC placenta than DC placenta (26.5% vs 14%, p=0.001). 4. Although mean gestational age at delivery and mean birth weight were significantly lower in either side abnormal cord insertion group than both side normal cord insertion group (35.7 vs 36.7weeks, p=0.004 : 2317 vs 2475gm, p=0.01), no difference in the frequency of discordancy was observed in these two groups (37.6% vs 29%, p=0.1). Conclusion : The type of placentation and/or abnormal cord insertion were not revealed to affect discordant growth in twin gestation.

응급 주산기 자궁적출술의 5 년간 경험

안현경(H . K . Ahn),김은성(E . S . Kim),한정열(J . Y . Han),김문영(M . Y . Kim),류현미(H . M . Ryu),최규홍(K . H . Choi),양재혁(J . H . Yang) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.12

N/A Objective : To review the cases of peripartum hysterectomy in women delivered at a Hospital. Methods : This is a retrospective study of all cases of emergency peripartum hysterectomy performed between August 1994 and July 1998. Results : During the study period a total of 35 emergency peripartum hysterectomy was performed. The overall incidence was 0.9/1,000 deliveries. The mean age of patients was 33.7±0.8 years old, the median gravidity was 5 and mean gestational age was 37.7±0.4 weeks. The main indications for hysterectomy were massive bleeding due to abnormal placental adhesions or uterine atony. There was no maternal death, However, maternal morbidity was 34.3%. Conclusions : The data show abnormal adherent placentation as the primary cause for gravid hysterectomy. The data illustrate how the incidence of emergency peripartum hysterectomy increases significantly with increasing parity, especially when influenced by a current placenta previa or a prior cesarean section. Maternal morbidyity remained high although no maternal deaths occurred.

다운증후군의 산전진단을 위한 다양한 선별검사의 기여율 비교 - 산전 및 신생아때 진단된 96 례 분석 -

한정열(J . Y . Han),김문영(Y. M . Kim),조준형(J . H . Cho),안현경(H . K . Ahn),류현미(H . M . Ryu),김진미(J . M . Kim),김영미(Y . M . Kim),박소연(S . Y . Park),한혜경(H . K . Han),이영호(Y . H . Lee),양재혁(J . H . Yang) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.10

연구의 목적은 다운증후군을 산전진단하기 위한 다양한 산전선별검사 (나이; 35세 이상, 임산부 혈청 marker를 이용한 triple test, 초음파; 비정상 소견, 후경부 투명대 (nuchal translucency), 후경부두께 (nuchal fold thickness))의 기여율를 비교하기 위한 것이다. 1990년 1월부터 1999년 9월까지 본원에서 산전 및 산후에 진단된 례는 총 96례 이었다. 산전 및 신생아기에 진단된 다운증후군의 빈도는 각각 68례 (71 %), 28례 (29 %)였다. 다운증후군 태아를 임신했던 임산부의 평균연령은 33±5.7세이다. 다운증후군의 1,000분만당 연도별 빈도율은 1990년부터 1999년까지 각각 0.4, 1.3, 0.7, 0.7, 1.6, 0.7, 1.2, 2.2, 2.0, 그리고 2.3 (Y=0.28±0.18 year, P=0.01)이었다. 산전진단된 다운증후군의 비율 (%)은 지난 10년간 각각 0 (0/2), 43 (3/7), 50 (2/4), 25 (1/4), 56 (5/9), 100 (5/5), 71 (5/7), 78 (14/18), 78 (14/18), 그리고 89 (17/19) (Y=12.9±8.9 year, P=0.000) 이었다. 다운증후군을 산전진단하기 위한 다양한 산전선별 검사에 따른 기여율은 35세이상의 연령에 의하면 30.2±5.6 %, triple test의 경우 18.2±3.4 %, 초음파에 의한 경우 51.7±6.3 % 이며, 초음파에 의한 산전 선별 검사가 통계적으로 유의하게 연령이나 triple test에 의한 경우 보다 다운증후군의 산전진단에 기여율이 높았다. (P=0.008) 결론적으로 본 연구에 의하면 지난 10년 동안 다운증후군을 산전 진단하기 위한 여러 선별 검사방법의 적용은 효율적이었으며, 특히 초음파에서 다양한 소견을 이용한 다운증후군의 산전선별검사는 연령이나 triple test 보다는 더욱더 의미가 있다고 추론된다. Objective : The purpose of this study was comparison of the contribution rate for prenatal diagnosis of Down syndrome using various screening methods (Age: greater than or equal to 35 years old, Serum markers: Triple test, Ultrasonography: abnormal sonographic findings, nuchal translucency, nuchal fold thickness).Methods : Total 96 cases of Down syndrome, prenatally or postnatally diagnosed between Jan. 1990 and Sept. 1999, made up the study population. We got the contribution rate of various prenatal screening methods of down syndrome, and obtained the efficiency of various screening program applied for last 10 years. Results : The frequencies of Down syndrome confirmed in prenatal and postnatal were 68 (71%) and 28 (29%) in respectively. The mean age of mother of Down syndrome fetus was 33.0±5.7 years old. The frequency rate of Down syndrome was 0.4, 1.3, 0.7, 0.7, 1.6, 0.7, 1.2, 2.2, 2.0 and 2.3 a 1,000 deliveries from 1990 to 1999 (Y= 0.28+0.18 year, P=0.01). The percentage of Down syndrome diagnosed prenatally was 0 (0/2), 43 (3/7), 50 (2/4), 25 (1/4), 56 (5/9), 100 (5/5), 71 (5/7), 78 (14/18), 78 (14/18) and 89 (17/19) from 1990 to 1999 (Y= 12.9+8.9 year, P=0.000). The contribution rate of prenatal diagnosis for Down syndrome was 30.2±5.6% by age, 18.2±3.4% by triple test and 51.7±6.3% by ultrasonography, and was significantly difference among each screen methods (P=0.008). Conclusions : This study shows that our prenatal screening program is highly effective to detect Down syndrome and especially ultrasonographic findings (abnormal sono findings, Nuchal translucency, Nuchal fold thickness) may be more important than that of age or Triple test to detect the Down syndrome prenatally.

임신 제일삼분기 약물 및 진단용 방사선 노출 임신부에서 기형 발생 위험에 관한 근거중심적 상담의 효과

한정열(J . Y . Han),박소연(S . Y . Park),김영미(Y . M . Kim),김진우(J . W . Kim),정상희(S . H . Jung),정영철(Y . C . Chung),최준식(J . S . Choi),안현경(H . K . Ahn),오민정(M . J . Oh),류현미(H . M . Ryu),김문영(M . Y . Kim),궁미경(M . K 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.1

N/A Objective : To evaluate the effectiveness of evidence-based teratogenic risk counseling by relevant medical literature concerning pregnant women exposed to medication or diagnostic radiation during the first trimester. Methods : Between January 2001 and April 2001, 67 pregnant women exposed to medication or diagnostic radiation visited our clinic for teratogenic risk counseling. We counseld the teratogenic risk of their fetus by relevant medical literature.Also, We measured the score to terminate pregnancy and the perceptive risk on their fetus with major congenital anomaly using 10cm visual analogue scale. Results : None of them were exposed to any known teratogenic drugs or radiation in any teratogenic doses. Other physicians had already recommended, to about a third of patients, pregnancy termination. Their perceptive estimation on the risk of major congenital malformation in the general population was 4.6±1.1%. The perceptive risk on their fetus with major congenital anomaly decreased from 39.5±3.1% before consultation to 10.8±1.6% thereafter (P<0.05). Also, their score on the visual analogue scale to terminate pregnancy was 6.4±2.7 before consultation and 9.1±1.6 thereafter. Their tendency to terminate pregnancy significantly decreased after consultation (P<0.05). Conclusion : Evidence-based counseling for pregnant women exposed to medication or diagnostic radiation during the first trimester may prevent unnecessary pregnancy terminations as well as reduce anxiety.