각종 과배란유도방법에 따른 난포액내의 Prolactin농도의 동태 및 체외수정의 성공과의 관련성에 관한 연구

윤보현(BH Yoon),장윤석(YS Chang) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.12

1985년 4월부터 12월까지 서울대학교 부속병원 산부인과 시험관애기 프로그램에 등록이 되어 시술을 받은 환자 26명으로부터 성숙된 배란직전의 난자가 채취된 48개의 난포액을 대상으로 본 연구를 시행하였다. A군 5명은 clomiphene citrate로, B군 5명은 clomiphene citrate와 hMG를 병용하여, C군 7명은 hMG로, D군 9명은 FSH와 hMG를 병용하여 과배란유도를 시행하였다. 채취된 난포액의 PRL의 농도를 측정하여 각각의 과배란유도 방법에 따른 농도의 차이를 확인하고, 체외수정을 시도하여 난포액내의 PRL의 농도와 체외수정 및 임신의 성공과의 관련성을 비교하여 다음과 같은 결과를 얻었다. 1. Clomiphene citrate를 사용한 A군 및 B군의 난포액내의 PRL농도는 각각 20.4±7.7ng/ml, 24.7±3.6ng/ml로 clomiphene citrate를 사용하지 않은 C군 및 D군의 44.2±6.3ng/ml, 41.9±3.4ng/ml에 비하여 통계적으로 유의하게 낮은 농도를 보였다. 그러나 A군과 B군사이, C군과 D군사이에는 유의한 농도차리를 확인할 수 없었다. 2. Clomphene군(A군 및 B군), Non-clomiphene군(C군 및 D군) 모두에게 체외수정이 확인된 난자가 채취된 난포액의 PRL농도가 체외수정에 실패한 경우와 비교하여 유의한 차이가 없었다. 3. 임신된 환자는 Non-clomiphene군에만 4명이 있었다. Non-clomiphene군에서 수정이 되어 배아이식 후에 임신이 성립된 환자의 난포액의 PRL 농도가 임신이 되지 않은 경우와 비교하여 유의한 차이가 없었다. Prolactin(PRL) has pronounced effects on ovarian physiology in vivo. Women with hyperprolactinemia have amenorrhea and infertility with poor follicular growth. Our recent study has shown that clomiphene citrate appears to have an inhibitory effect on the rise of PRL in response to increasing serum estradiol levels during hyperstimulated menstrual cycle. Ovarian hyperstimulation was carried out in 33 women with clomphene citrate(n=5), clomiphene citrate/hMG(n=5), hMG(n=7) and FSH/hMG(n=9), and follicular aspiration was performed 36h after hCG administration. PRL concentrations in follicular fluid(FF) of 48 follicles from which preovulatory oocytes were obtained were correlated with the various hyperstimulation methods, the success of fertilization in vitro and pregnancy after embryo transfer. PRL concentrations in FF from patients hyperstimulated by clomiphene citrate(20.4±7.7ng/ml), clomiphene citrate/hMG(24.7± 3.6ng/ml) were significantly lower than those by hMG(44.2±6.3ng/ml), FSH/hMG(41.9± 3.4ng/ml)(P<0.05). There was no correlation between FF concentrations of PRL and successful fertilization of human ova in vitro, and the success of pregnancy after embryo transfer. In conclusion, FF PRL concentration was decreased when clomiphene was used as hyperstimulation agent. And it seemed that FF PRL concentration did not play a pivotal role in the success of in vitro fertilization and pregnancy after embryo transfer.

HMG로 과배란 유도된 인간 난자의 체외 수정 및 난할에 관한 연구

문신용(SY Moon),윤보현(BH Yoon),오선경(SK Oh),김정구(JK Kim),이진용(JY Lee),장윤석(YS Chang) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.3

Between April of 1985 and June of 1985, 11 cycles have been studied in which oocyte aspiration for in vitro fertilization was attempted. Every follicle which could be identiied was aspirated without consideration of follicle size. Follicle aspiration was failed in two patients: one was postovulated condition and the other had severe pelvic adhesion. And 43 follicles were aspirated from which 28 oocytes were recovered. 65.1% of all follicles had at least one oocyte aspirated. 75% of the eggs were preovulatory, 17.9% were immature. and 7.1% were atretic. 71.4% of pre-ovulatory oocytes were cleaved normally and were transferred to 8 patients Only one clinical pregnancy was established and progressed normally.

장상 임신주수에 따른 태아 흉부 하강대동맥 혈류속도파형의 변화양상

신희철(HC Shin),윤보현(BH Yoon),김승욱(SW Kim) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.9

서울대학교병원 산부인과를 내원하여 태아의 흉부하강대동맥 doppler 초음파 검사를 시행받 고 임신의 결과가 정상으로 확인된 특별한 질환이 없는 79명의 정상임산부에서 시행된 135 회의 검사결과를 임신주수에 따라 분석하였다. 임신이 진행됨에 따라 태아 흉부하강 대동맥의 수축기의 최고혈류속도와 이완기말의 혈류속 도는 임신 32주 이후에는 거의 비슷하였다. 임신 전기간을 통하여 임신주수에 따른 혈류속 도파형의 A/B ratio, PI, RI치의 큰 차이는 볼 수 없었다. 본 연구결과 한국인 정상 태아의 임신주수에 따른 흉부하강대동맥의 혈류속도파형 양상이 설정되었으므로 앞으로 태아의 흉부하강대동맥 혈류가 변화될 것으로 여겨지는 여러상황에 서 유용한 지표로 사용될것으로 생각된다. Blood flow velocity waveforms from the fetal descending thoracic aorta were obtained by a combination of realtime and pulsed doppler unltrasonic equipment, a spectral analyzer. In 79 normal pregnancy, 135 determinations were carried out from the 14th to the 41th week of gestation. Both peak velocity(A) and end diastolic velocity(B) increased with advancing gestation. but end diastolic velocity remained unchanged from the 32 th week of gestation. The A/B ratio , pulsatility index (PI) and resistance indes(RI) had a relatively constant level throughout the second and third trimester of pregnancy. The reference values obtained from this study may be useful as a basis for new basic reseach and clinical application in prenatal care.

Doppler 초음파를 이용한 정상임신주수에 따른 태아제대동맥 혈류속도파형의 변화양상

신희철(HC Shin),윤보현(BH Yoon),김승욱(SW Kim) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.3

서울대학교병원 산부인과를 내원한 정상임산부의 제대동맥에서 doppler초음파검사를 시행하 고 임신의 결과가 정상으로 확인된 104명의 임산부에서 시행된 188회의 검사결과를 임신주 수에 따라 분석하였다. 제대동맥의 혈류속도파형은 최고수축기속도(A)와 이완기속도(B)의 비 (A/B ratio), pulsatility index(PI), resistance index(RI)의 3가지 지표를 사용하여 분석하였다. 임신 14주이하에 검사가 불가능하였던 경우는 없었으며 임신이 진행됨에 따라서 A/B ratio, PI, RI모두 감소하여, 임신이 진행됨에 따라서 태반의 저항이 감소하여 제대정맥의 이완기말 의 혈류속도파형의 변화양상이 확립되었으며 앞으로 태아의 산전건강평가에 유용한 지표로 사용될것으로 여겨진다. Time-velocity waveforms or sonograms obtained by pulsed doppler ultrasound from the umbilical artery were analysed in the fetuses from 104 normal pregnancy women. One hundred eighty-eight determinations were carried out from the 13th to the 41th weeks of pregnancy. The ratio of peak systolic to end-diastolic flow velocity pulsatility index of a ratio overcomes the obstcle of not knowing the angle between the incindence beam and the direction progressively, indicating a gradual fall in resistance in the umbilical-placental circulation in normal pregnancy. The analysis of umbilical artery blood flow velocity waveforms provieds a new and non-invasive measure of fetoplacental blood flow resistance and has the potential of being an important aid in prenatal care.

정상임부, 자간전증의 임부 및 신생아에서의 혈청면역복합체에 관한 연구

김정구(JK Kim),박준우(JW Park),윤보현(BH Yoon),김승욱(SW Kim) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.12

Circulating immune complexes were measured using the polyethylene glycol (PEG) precipitation assay in 29 normal nonpregnant women 108 normal pregnant women 18 preeclamptic pregnant women and 20 normal newborn infants The results were as follows: 1. In normal pregnant women there was no significant change in levels of circulating immune complexes complexes during pregnancy Also there was no significant difference in the mean levels of circulating immune complexes between normal pregnant and nonpregnant women 2. Taking into account a upper level (mean + 2. S.D.) in the nonpregnant state more preeclamptic pregnant women(8/18) than normal pregnant women in third trimester (7/47) showed levels beyond this point 3. The mean level of circulating immune complexes in normal newborn infants was about 1/4 of that in paried normal pregnant women

사후제왕절개술에 의한 생존쌍생아의 1례

이정수(JS Lee),이신애(SA Lee),윤보현(BH Yoon),김암(A Kim),강순범(SB Kang),이효표(HP Lee) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.11

A case of postmortem cesarean section by which live twin babies were delivered 6 minutes and 8 minutes respectively after maternal death is presented with a brief review of literature

Human Menopausal Gonadotropin을 이용한 배란유도 및 임신률에 관한 연구

이진용(JY Lee),고경심(KS Ko),윤보현(BH Yoon),김정구(JK Kim),문신용(SY Moon),장윤석(YS Chang) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.1

Human Menopausal Gonadotropin , 배란유도 , 임신률 Ovulation induction with Human Menopausal Gonadotropin and Human Chorionic Gonadotropin is a form of hormone replacement therapy. HMG is a purified gonadotropin preparation extracted from the urine of postmenopausal women. Each ampule contains 75 IU of follicle stimulating hormone and 75 IU of luteinizing hormone. This study is a clinical trial to induce ovulation with HMG-HCG. For induction of ovulation, HMG-HCG was used clinically to the infertile women, who visited the Infertility Clinic in the Department of Obstetrics and Gynecology, S.N.U.H. from Feb. 1982 to Feb. 1985. The results were as follows: 1.HMG-HCG was given to 32 anovulatory women who were failed in ovulation with clomiphene citrate, one women with poor cervical mucus and one women with habitual abortions, in 111 treatment cycles. 2. The combinations of both clomiphene citrate and HMG-HCG were tried in 9 cycles(8.1%). 3. The mean ampules of HMG used in treatment were 28.5 ampules, of pregnancy, 21.9 ampules, and of ovarian hyperstimulation, 20.5 ampules, respectively. 4. The ovulation rate was 77.5%. 5. The pregnancy rate was 38.2%. 6. There was a significant improvement of pregnancy rate using USG and E2 rapid assay as monitoring methods. 7. The abortion rate was 33.3%. 8. The multiple pregnancy rate was 20.0%. 9. There was one congenital anomalous baby(e.g. transposition of great arteries) out of 9 newborns. 10. The rate of ovarian hyperstimulation, including mild and severe forms, was 16.2%.

자궁경부암을 동반한 완전자궁탈출증 1례

신면우(MW Shin),김환규(HK Kim),임대종(DJ Lim),진영수(YS Jin),윤보현(BH Yoon) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.10

Cervical carcinoma complicating procidentia is so rare that most gynecologist cannot expierence the case. It has been generally accepted that the prolapsed uterus has immunity to carcinoma Recently we expierenced the cervical carcinoma complicating procidentia in elderly women and present with a brief review of literature,

발육지연 태아에서 불량한 주산기 예후의 독립적 예측인자로서 제대동맥 혈류속도 파형분석 의 유용성

윤보현,양순하 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.11

1990년 10월 1991년 9월까지 서울대학교병원 산부인과에 태아위험이 의심되어 태아감시를 위해 입원하였거나 외래를 방문한 환자들 중 분만전 7일이내 도플러 초음파를 이용한 제대 동막 혈류속도 파형분석검사를 시행하여 기형이 없는 26주이상의 단태 저체중 신생아를 분만 한 84례에 대하여 주산기 예후를 조사하여 다음과 같은 결과를 얻었다. 1. 대상환자중 36예(43%)에서 비정상적으로 증가된 pulsatility index를 보였으며 이러한 비정 상적 도플러파형군은 정상군에 비하여 분만시 임신주수 및 출생체중이 낮았으며 제왕절개술 이 필요한 태아 곤란증, 조기분만, 7이하의 1분 및 5분 아프가 수치 신생아중환자실 입원, 의미있는 신생아 이환 및 주산기 사망의 발생빈도가 유의하게 증가되어 있었다. 2. ROC curve 분석에 의해 도플러 제대동맥 파형분석은 의미있는 신생아 이환 및 불량한 주산기 예후의 예측에 유용한 방법임을 알 수 있었다. 불량한 주산기 예후를 예측함에 있어 그 민감도는 89.7%, 특이도는 81.8%, 양성 예측율은 72.2%, 음성예측율은 93.8%이었다. 의미있는 신생아 이환을 예측함에 있어서는 민감도는 92.2% 특이도는 67.1% 양성예측율은 36.1%, 음성예측율은 97.9%이었다. 3. Multiple logistic regression analysis를 이용하여 비정상적인 제대동맥 도플러 파형은 출생시 임신주수를 보정한 후에도 의미있는 불량한 주산기 예후 및 신생아 이환을 유의하게 반 영하는 지표임을 알 수 있었다. 결론적으로 도플러 초음파를 이용한 제대동맥 혈류속도 파형분석은 저체중 태아의 불량한 주산기 예후 예측에 매우 유용하면서도 출생시 임신주수와는 독립적인 예측인자로써 저체중 태아의 산전 태아감시와 분만시기 결정에 유용하게 이용될 수 있으리라 생각되며 향후 다른 태아 감시방법과의 전향적 비교연구가 필요하리라 사료된다. Background : Umbilical artery doppler velocimetry has been recognized as an useful predictor of adverse perinatal outcome. However, it has not been established whether this is related to the earlier gestational age at delivery of fetuses with abnormal Doppler result or whether doppler findings are an independent predictor of perinatal outcome. Objective : To determine if an abnormal doppler umbilical artery waveform is associated with adverse perinatal outcome even after controlling the gestational age at delivery as a confounding variable in the small-for-gestational-age fetuses. Study design : Umbilical artery velocimetry studies were performed within 7 days of delivery in 84 patients delivered of small-for-gestational-age newborns at our unit. An adverse perinatal outcome was defined as fetal distress requiring cesarean delivery, Apgar verse score $lt; 7 at 5 minutes, significant neonatal morbidity or perinatal death. significant neonatal morbidity was defined as neonatal sepsis intraventricular hemorrhage (grade =$gt;2), respiratory distress syndrome, pneumonia, bronchopulmonary dysplasia, acute renal failure, seizure, or necrotizing enterocolitis . Multiple logistic regression and receiver-operator characteristic curve analysis were used for statisical analysis. Results : patients with abnormal umbilical artery velocimetry had a significantly higher rate of complications including cesarean section for fetal distress, preterm delivery, low Apgar scores, significant neonatal morbidity, and perinatal death than did patients with a normal waveform. Receiver-operator characteristic curves and multiple logistic regression analysis indicated that an abnormal umbilical artery waveform was significant independent predictor for the development of adverse perinatal outcome after adjustment of gestational age at delivery. Conclusion : An abnormal Doppler umbilical artery waveform is a strong and independent predictor of adverse perinatal outcome in small-for-gestational-age fetuses.

토끼에서 세균에 의한 조산의 유발과 항생제가 예후에 미치는 영향

장윤석,윤보현,전종관 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.1

Bacterial infection has been implicated in premature labor in human. But it is impossible to undergo human study of bacteria-induced preterm delivery. If we carry out animal experiment which simulate human preterm delivery induced by bacteria, studies for mechanism, diagnosis, and treatment of preterm delivery will be progressed rapidly. To elucidate mechanisms and potential intervention strategies in preterm pregnancy loss, we observed bacteria-induced preterm labor and the protecting effect of administration of antibiotics with hysteroscopy-guided intracervical inoculation of Escherichia coli. Sterile saline solution(group I, n=5) or 2x107cfu (colony-forming units) of E. coli bilaterally in the cervix of pregnant New Zealand White rabbits on day 20 or 21(70% of gestation) by hysteroscopy was inoculated and rabbits were assinged to ampicillin-sulbactam therapy beginning at 0hr(group II, n=4), 2 hr(group III, n=4), 4 hr(group IV, n=2), and 16 hr(group V, n=2) after inoculation with E. coli, or to no antibiotic therapy(group VI, n=3). Unasyn(ampicillin-sulbactam) was used and its daily dosage was 100 mg/kg/day. The occurrence of vaginal bleeding or preterm birth was observed every two hours. If one rabbit fetus was found to be delivered, exploratory laparotomy was done. Amniotic fluid culture on each sac, decidual culture on each uterine cavity, and pathologic examinations on each placenta were done. The results of experiments are as follows. In control group(0.2cc sterile saline inoculation only), there was no preterm labor and no bacterial growth in culture. In all three rabbits in group VI, preterm delivery occurred and the culture results were all positive in maternal blood, decidua, and amniotic sacs. Preterm delivery also occurred in group V, but results of maternal blood culture were all negative. Increased trend in the occurrence of preterm delivery was statistically significant in the order(p$lt;0.05) : group I(0/5), group II(0/4), group III(0/4), group IV(0/2), group V(2/2), and group VI(3/3). Pregnancy outcomes on the basis of the number of living fetus, dead fetus, and macerated fetus, have significant trend in the above order. Amniotic fluid culture results also had significant relationship(p$lt;0.05) : group I(0.20), group II(20/26), group III(18/30), group IV(10/11), and group VI(7/7). In group V, amniotic fluid fail to be obtained due to severe oligohydramnios. Decidual culture results also had an increased trend; group I(0/32), group II(21/29), group III(20/30), gorup IV(16/16), gorup V(11/11), and group VI(25/25). It is statistically significant(p$lt;0.05) Incidence of histologic chorioamnionitis was also significantly increased from group I to VI. These results indicate that E. coli inoculation has induced preterm delivery and antibiotic therapy has somewhat prevented preterm birth , amniotic fluid infection , decidual infection, and histologic chorioamnionits. Antibiotic effects were attenuated in cases of delayed antibiotic administration.