조기분만진통 임산부에서 양수 tumor necrosis factor-α 와 조직학적 융모양막염 및 선천성 패혈증과의 관련성에 관한 연구

박교훈(Kyo Hoon Park),윤보현(Bo Hyun Yoon),전중관(Jong Kwan Jun),박중신(Joong Shin Park),김길자(Gil Ja Kim),이홍균(Hong Kyoon Lee),신희철(Hee Chul Syn) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.5

N/A Objective : Our purposes were (1) to determine whether amniotic fluid concentrations of tumor necrosis factor-α are of value in the diagnosis of histologic chorioamnionitis of preterm placenta and in the prediction of congenital sepsis in patients with preterm labor and intact membranes and (2) to compare the diagnostic performance of placental histologic finding and amniotic fluid culture with that of amniotic fluid tumor necrosis factor-α for this outcome variable. Methods : The relations among placental histologic finding, perinatal outcome, amniotic fluid culture, and amniotic fluid tumor necrosis factor-α concentrations were examined in 61 consecutive patients with preterm labor and intact membranes who delivered preterm neonates within 72 hours after transabdominal amniocentesis. Tumor necrosis factor-α was determined by enzyme-linked immunosorbent assays. Mann-Whitney U test, Fisher's exact test, receiver-operator characteristic curve, and multiple logistic regression were used for analysis. Results : 1) Women with acute histologic chorioamnionitis had significantly higher median amniotic fluid tumor necrosis factor-α concentrations than those without histologic chorioamnionitis (median 83.2 pg/ml, range 1.4 to 7241 pg/ml vs median 1.6 pg/ml, range 0 to 59.9 pg/ml, p <0.0001). Amniotic fluid tumor necrosis factor-α concentrations ≥4.6 pg/ml had a sensitivity of 88% (28/32) and specificity of 80% (23/29) in the diagnosis of acute histologic chorioamnionitis. 2) Amniotic fluid concentrations of tumor necrosis factor-α were significantly higher in neonates with congenital sepsis than in those without congenital sepsis (median 227.5 pg/ml, range 1.2 to 7241 pg/ml vs median 3.8 pg/ml, range 0 to 735 pg/ml, p <0.0005). Amniotic fluid tumor necrosis factor-α concentrations ≥41 pg/ml had a sensitivity of 82% (23/29) and specificity of 79% (38/48) in the prediction of congenital sepsis. 3) Multiple logistic regression indicated that elevated amniotic fluid tumor necrosis factor-α (≥41 pg/ml) was the only independent predictor of congenital sepsis (odd ratio 12.9, 95% confidence interval 1.3 to 125.3, p <0.05) after correction for known confounding variables [i.e., low gestational age at birth (≤32 weeks), positive amniotic fluid culture, histologic or clinical chorioamnionitis, low Apgar score (<7)]. Conclusion : Test of amniotic fluid tumor necrosis factor-α is of value in the antenatal diagnosis of histologic chorioamnionitis and congenital sepsis in patients with preterm labor and intact membranes. Amniotic fluid tumor necrosis factor-α is a better independent predictor of congenital sepsis than placental histologic finding or amniotic fluid culture.

분만 과정에 대한 경막외 마취의 영향

박교훈(Kyo Hoon Park),이홍균(Hong Kyoon Lee),이혁(Hyeok Lee),한정훈(Jeong Hoon Han),조용균(Yong Kyoon Cho),최훈(Hoon Choi),김복린(Bok Rin Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.11

목적: 경막외 마취가 분만 과정에 미치는 영향에 대해서 알아보고자 하였다. 연구방법: 1998년 1월부터 1998년 12월까지 본원에 내원한 산모중 자연적인 진통으로 입원한 만삭 산모로 두정위, 단태아인 경우에 국한하여 경막외 마취를 시행한 초산모 100명과 경산모 20명을 동수의 경막외 마취를 시행하지 않은 대조군과 비교 분석하였다. 분만 과정과 신생아의 안녕상태 및 출산 합병증에 대한 자료로는 입원기록과 신생아 기록을 이용하였다. 통계처리는 Student't-test와 Chi square test를 사용하였다. 결과: 경막외 마취 실험군과 대조군에 대한 비교 분석 결과는 다음과 같다. 1. 두 군간의 평균 나이, 체중, 신장, 임신 주수는 통계학적으로 유의한 차이가 없었다. 2. 분만시 oxytocin 정맥 점적 투여빈도는 초산모의 경우, 경막외 마취군에서 유의하게 높았다(p<0.05). 3. 분만 제2기의 시간은 초산모인 경우 경막외 마취군에서 유의하게 길어지는 소견을 보였다(p<0.05). 4. 기계 분만의 빈도는 초산모인 경우 유의한 차이를 보였으나(p<0.05), 태아곤란증이나 난산으로 인한 제왕절개술은 두 군 사이에 유의한 차이가 없었다. 5. 양수내 태변의 착색과 신생아 Apgar 점수, 체중은 유의한 차이가 없었다. 6. 분만시 총 실혈량에서는 유의한 차이가 없었다. 결론: 경막외 마취시 분만 제2기의 시간이 유의하게 길어지고 기계분만이 유의하게 증가하나, 제왕절개술의 빈도는 증가하지 않았으며, 출산에 따른 합병증의 증가도 없었다. Objective: Our purpose was to evaluate the effect of epidural anesthesia on labor course. Methods: Between January 1998 and December 1998, we evaluated pregnant women at term with singleton fetus in vertex presentation and with spontaneous onset of labor at our hospital. Comparison of 120 women (100 cases of primiparous women, 20 cases of multiparous women) who received epidural anesthesia in labor with 120 women (100 cases of primiparous women, 20 cases of multiparous women) who did not receive epidural anesthesia was performed. Adverse pregnancy outcomes were obtained from hospital delivery records and neonatal records. Statistical analysis were performed by Student's t-test and Chi square test. Results: The results of this study were as followings; 1. There was no significant difference in mean age, body weight, height, and gestational age between epidural anesthesia group and control group (P>0.05). 2. The frequency of oxytocin augmentation was significantly greater in the primiparous epidural anesthetic group than in primiparous control group (p<0.05). 3. The effect of epidural anesthesia on the first stage of labor revealed no significant difference in both group. 4. Prolongation of second stage of labor was noticed in nullipara of epidural anesthesia group compared to control group (P<0.05). 5. The incidence of instrumental delivery was significantly increased in the primiparous epidural group than in the primiparous control group(p<0.05). 6. The meconium-stained amnionic fluid, Apgar score and birth weight were similar in both groups. 7. The maternal blood loss was similar in both groups. Conclusion: Epidural anesthesia, significantly prolongs second stage of labor in induced patients. While instrumental delivery was more prevalent in these parturients, C-section rate and intra-partum complications were not increased in these patients.

자간전증이 prostaglandin E2 및 oxytocin을 사용한 분만유도에 미치는 영향

박교훈(Kyo Hoon Park),조용균(Yong Kyoon Cho),최훈(Hoon Choi),김복린(Bok Rin Kim),한성식(Sung Shik Han),이철민(Chul Min Lee),이홍균(Hong Kyoon Lee) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.3

N/A Objective : The purposes of this study were 1) to determine whether preeclampsia itself affects failure of labor induction with prostaglandin E2 and oxytocin and 2) to investigate risk factors for failed induction in women with preeclampsia. Method : Fifty preeclamptic women and 175 nonpreeclamptic women requiring labor induction were studied prospectively. Intravaginal prostaglandin (PG) E2 tablet (Dinoprostone, The Upjohn company, 3 mg) followed by a second dose if the cervix assessed 6 hours later was 5 or less of Bishop score, and oxytocin were used for labor induction. Women with rupture of membrane, spontaneous contraction resulting in cervical change or an initial cervical examination showing more than 2 cm dilatation and 50% effacement were excluded. Statistics were analyzed with 2 test, Student t test, and multiple logistic regression. Results : 1) The women with preeclampsia had a significantly higher rate of failed induction than did those without preeclampsia [24% (2/50) versus 9% (16/175); p <0.05]. However, the women with preeclampsia had a higher rate of the use of magnesium sulfate, and were more likely to decrease gestational age at induction and increase maternal weight than those without preeclampsia (p <0.0001, respectively). There were no significant differences in prevalence of nulliparity and low initial Bishop score (≤3) between the women with and without preeclampsia. 2) Multiple logistic regression showed that preeclampsia itself was not associated with failed induction after correction of known confounding variables (odds ratio 0.22, 95% confidence interval 0.03-2). 3) In women with preeclampsia, the use of magnesium sulfate only was associated with increased risk of failed induction analyzed by multiple logistic regression(odds ratio 38.5, 95% confidence interval 1.6-897). Maternal weight with 70 kg or more was associated with increased risk of failed induction, but it is not statistically significant (p=0.055). Conclusion : 1) The risk of failed induction is increased in women with preeclampsia, but not by preeclampsia itself but by the use of magnesium sulfate, prematurity, and increased maternal weight secondary to preeclampsia. 2) The use of magnesium sulfate is independent risk factor for failed induction in women with preeclampsia.

조기 양막파수된 임산부에서 자궁내 감염의 산전 진단과 주산기 예후 예측에 있어 양수내 IL-6 측정과 양수배양 검사의 비교 연구

박교훈(Kyo Hoon Park),윤보현(Bo Hyun Yoon),김미하(Mi Ha Kim),김길자(Gil Ja Kim),김데리샤(Teresa Kim),이홍균(Hong Kyoon Lee),신희철(Hee Chul Syn) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.6

연구목적 : 본 연구의 목적은 조기양막파수된 임산부에서 첫째, 자궁내 감염의 조직학적 증거인 태반의 급성 염증성 병변(조직학적 융모양막염)과 주산기 예후를 산전에 예측하는데 양수내 interleukin-6 (IL-6) 농도 측정이 유용성이 있는지 알아보고 둘째, 양수내 감염의 진단 기준으로 생각되고 있는 양수배양 검사와 그 유용성을 비교하고자 하였다. 연구방법 : 양수천자 후 72시간 내에 분만된 조기양막파수 임산부 65명에서 경복부 양수천자에 의한 양수배양, 양수내 IL-6 농도를 측정하고, 분만후 태반의 조직학적 검사와 신생아 예후를 추적 관찰하여 그 관련성을 분석하였다. IL-6 농도 측정은 효소면역측정법 (enzyme-linked immunosorbent assay, ELISA)을 사용하였고, 통계분석은 Receiver-operator characteristic (ROC) 도표, Mann-Whitney U test, Fisher's exact test를 사용하였다. 연구결과 : 1) 조직학적 융모양막염이 존재한 임산부는 조직학적 융모양막염이 존재하지 않은 임산부보다 양수내 IL-6 농도는 유의하게 증가하였다 (median 12.6 ng/ml, range 0.03 to 142.2 ng/ml vs median 0.5 ng/ml, range 0.03 to 16 ng/ml; p < 0.0001). 2) ROC 도표에 의하여 양수내 IL-6 농도 3.2 ng/ml 이상은 조직학적 융모양막염을 산전에 예측하는데 민감도 78% (35/45) 특이도 95% (19/20)를 나타냈으며, 유의한 신생아 이환(신생아 패혈증, 호흡곤란증후군, 폐렴, 기관지 폐 이형성증, 뇌실내 출혈, 괴사성 장염 중 어느 한가지가 존재할 때로 정의)과 사망을 산전에 예측하는데 민감도 74% (25/34) 특이도 65% (20/31)를 나타내었다. 3) 조직학적 융모양막염, 유의한 신생아 이환과 사망을 산전에 예측하기 위한 양수내 IL-6 농도 측정의 민감도는 양수배양 검사의 민감도 보다 유의하게 높았으며 특이도는 두 검사 사이에 유의한 차이가 없었다 (조직학적 융모양막염: 78% vs 51%, p < 0.01; 유의한 신생아 이환과 사망: 74% vs 47%, p < 0.01). 결론 : 조기양막파수된 임산부에서 양수내 IL-6 농도 측정은 태반의 급성 염증성 병변과 주산기 예후를 산전에 예측하는데 매우 유용하며 양수내 감염의 진단 기준인 양수배양 검사보다 민감도가 더 높은 검사이다. Objectives : Our purpose was (1) to determine whether amniotic fluid concentrations of interleukin-6 are of value in the diagnosis of histologic chorioamnionitis of preterm placenta and in the prediction of significant perinatal morbidity and mortality in patients with preterm premature rupture of membranes and (2) to compare the diagnostic performance of amniotic fluid interleukin-6 with that of amniotic fluid microbial culture for these outcome variables.Method : The relation among placental histologic finding, perinatal outcome, amniotic fluid culture, and amniotic fluid interleukin-6 concentrations were examined in 65 patients with preterm premature rupture of membranes who delivered preterm neonates within 72 hours after transabdominal amniocentesis. Interleukin-6 level was determined by enzyme-linked immunosorbent assay. Receiver-operator characteristic curve, Mann-Whitney U test, and Fisher's exact test were used for analysis. Results : 1) Patients with acute histologic chorioamnionitis had significantly higher median amniotic fluid interleukin-6 concentrations than those without histologic chorioamnionitis (median 12.6 ng/ml, range 0.03 to 142.2 ng/ml vs median 0.5 ng/ml, range 0.03 to 16 ng/ml; p < 0.0001). 2) Amniotic fluid having interleukin-6 concentrations higher than 3.2 ng/ml had a sensitivity of 78% (35/45) and specificity of 95% (19/20) in the diagnosis of acute histologic chorioamnionitis and sensitivity of 74% (25/34) and specificity of 65% (20/31) in the prediction of significant neonatal morbidity and mortality. 3) These sensitivities were significantly higher than those of amniotic fluid culture, but there were no significant difference in specificities between amniotic fluid interleukin-6 and culture (histologic chorioamnionitis: 78% vs 51%, p<0.01; significant neonatal morbidity and mortality: 74% vs 47%, p<0.01, respectively).Conclusion : Test of amniotic fluid interleukin-6 is of value and more sensitive than amniotic fluid culture for the antenatal diagnosis of histologic chorioamnionitis and for the prediction of perinatal outcome in patients with preterm premature rupture of membranes.

자간전증 임신부의 지방단백질 및 지질의 혈청농도

조용균 ( Yong Kyoon Cho ),박교훈 ( Kyo Hoon Park ),민현주 ( Hyun Ju Min ),최훈 ( Hoon Choi ),김복린 ( Bok Rin Kim ),이홍균 ( Hong Kyoon Lee ) 대한주산의학회 1999 大韓周産醫學會雜誌 Vol.10 No.4

거대아: 산전 초음파에 의한 태아 체중 예측과 분만 및 주산기 예후

한정훈 ( Jeong Hoon Han ),박교훈 ( Kyo Hoon Park ),이혁 ( Hyeok Lee ),조용균 ( Yong Kyoon Cho ),최훈 ( Hoon Choi ),김복린 ( Bok Rin Kim ),이홍균 ( Hong Kyoon Lee ) 대한주산의학회 1999 大韓周産醫學會雜誌 Vol.10 No.3

만삭전 조기양막파열 산모에서 양수과소증이 주산기 예후 및 분만 잠복기에 미치는 영향

구천회 ( Chun Hoe Ku ),박교훈 ( Kyo Hoon Park ),우헌탁 ( Hun Tack Woo ),김문영 ( Moon Young Kim ),김유미 ( You Mi Kim ),이철민 ( Chul Min Lee ),조용균 ( Yong Kyoon Cho ),최훈 ( Hoon Choi ),김복린 ( Bok Lin Kim ),이홍균 ( Hong Kyo 대한주산의학회 2002 Perinatology Vol.13 No.2

연구목적:본 연구의 목적은 만삭전 조기양막파열 산모에서 양수과소증이 주산기 예후 및 분만 잠복기에 미치는 영향을 살펴보고자 한다. 방법:조기양막파열로 입원한 임신 26주에서 35주의 단태임신 98명을 대상으로 후향적 관찰 연구를 시행하였다. 모든 대상 환자에서 입원 직후 경복부 초음파를 시행하여 양수 지수를 측정하였으며 모든 산모와 신생아 의무 기록을 검토하여 양수과소증이 주산기 예후 및 분만 잠복기에 미치는 영향을 조사하였다. 양수과소증은 양수지수가 5 이하일때로 정의하였고 분만 잠복기의 정의는 양막파열부터 분만까지의 시간으로 하였다. 통계 처리는 비율의 비교는 Chi-spuare test 또는 Fisher`s exact test를 사용하였으며, 연속형 변수의 비교는 변수의 특성에 따라 Student-t test 또는 Mann-Whitney U test를 사용하였다. 결과:1) 총 98명의 연구 대상자 중 양수과소증이 존재하지 않은 군이 59명(60%)이었고 양수과소증 군은 39명(40%)이었다. 조기양막파열 산모에서 분만 주수, 분만시 신생아 체중은 양수과소증이 존재한 군에서 양수과소증이 존재하지 않은 군보다 유의하게 낮았으나 1분 아프가 점수 7점 미만의 빈도, 5분 아프가 점수 7점 미만의 빈도, 신생아 이환율 및 주산기 사망률은 두 군 사이에 유의한 차이가 없었다. 2) 조기양막파열 산모에서 양수과소증이 분만 잠복기에 미치는 영향을 알아보기 위하여 산모 및 태아적응증으로 유도분만이나 제왕절개술을 시행한 산모 73명을 제외한 25명을 대상으로 하였다. 분만 잠복기는 양수과소증이 존재하지 않은 군의 중앙값이 41.5시간으로 양수과소증이 존재한 군의 중앙값 44시간과 유의한 차이를 나타내지 않았다. 결론:만삭전 조기양막파열 산모에서 양수과소증은 불량한 주산기 예후 및 분만 잠복기와는 유의한 관련성을 나타내지 않았다. Objectives:To examine the effects of the oligohydramnios on perinatal outcome and latency period in patients with preterm premature rupture of membranes. Methods:We performed a retrospective analysis of 98 singleton pregnancies complicated by preterm premature rupture of membranes, with delivery between 26 and 35 weeks` gestation. Amniotic fluid index was determined using transabdominal ultrasound at admission. All medical records of mothers and neonates were reviewed. Oligohydramnios was defined as amniotic fluid index less or equal to 5.0cm and latency period was defined as time interval from membrane rupture to delivery. Chi-spuare test, Fisher`s exact test, Student-t test, Mann-Whitney U test were used for statistical analysis. Results:1) Of the 98 patients, 59 patients(60%) were oligohydramnios group(AFI≤5.0) and 39 patients(40%) were non-oligohydramnios group(AFI>5.0). Both groups were similar with respect to selected dermographics, gestational age at rupture of the membranes, chorioamnionitis, 1 min Apgar score and 5 min Apgar score. Patients with oligohydramnios demonstrated a lower gestatoinal age at birth and lower birth weight. There were no statistically significant correlations in neonatal morbidity and perinatal mortality between both groups. 2) For comparing latency period, we excluded deliveries of Cesarean section or induction. Comparing the remained group(25 patients), median of latency period in oligohydramnios group were 41.5 hours and median of latency period in non-oligohydramnios group were 44 hours. There were no statistically significant correlations in oligohydramnios and latency period. Conclusion:There were no significant effects of the oligohydramnios on poor perinatal outcome and latency period in patients with preterm premature rupture of membranes

산전 초음파에 의한 태아 체중 예측의 정확성에 관한 연구

강영숙 ( Young Sook Kang ),박교훈 ( Kyo Hoon Park ),이혁 ( Houk Lee ),한정훈 ( Jung Hoon Han ),조용균 ( Yong Kyoon Cho ),최훈 ( Hoon Choi ),김복린 ( Bok Rin Kim ),이홍균 ( Hong Kyoon Lee ) 대한주산의학회 1999 大韓周産醫學會雜誌 Vol.10 No.3

자간전증 임신부의 Tumor Necrosis Factor-α(TNF-α)의 혈청농도

조용균 ( Yong Kyoon Cho ),박교훈 ( Kyo Hoon Park ),최훈 ( Hoon Choi ),김복린 ( Bok Rin Kim ),이홍균 ( Hong Kyoon Lee ) 대한주산의학회 2000 大韓周産醫學會雜誌 Vol.11 No.1

임신 토끼에서 항생제 투여시 지속된 자궁내 감염이 주산기 예후에 미치는 영향

전종관(Jong Kwan Jun),윤보현(Bo Hyun Yoon),신희철(Hee Chul Syn),이홍균(Hong Kyoon Lee),박교훈(Kyo Hoon Park) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.2

N/A Objective: In a rabbit model using hysteroscopy-guided inoculation of E.coli with antibiotic administration, we determine the effects of persistent intrauterine infection on perinatal outcome including fetal death, congenital sepsis, and abnormal fetal-placental growth and amniotic fluid volume in live fetuses. Methods: Rabbits with timed pregnancies underwent hysteroscopy at 20 to 21 days of gestation(70%). Animals were inoculated with E. coli (0.2 ml containing 10 cfu/ml) and administered ampicillin-sulbactam(100 mg/kg/day; Unasyn; Pfizer) every 8 hours beginning 30 minutes after microbial inoculation until they were killed 5 days after hysteroscopy. In the first study, the following outcome parameters were evaluated between fetuses with and without pe#rsistent intrauterine infection: fetal survival, congenital sepsis, maternal morbidity, and placental pathology. In second study was performed in 16 rabbits having only both live fetuses with and without persistent intrauterine infection in a rabbit simultaneously. We evaluate the effects of persistent intrauterine infection on fetal-placental weight and amniotic fluid volume in live fetuses. Results: 1) Fetuses with persistent intrauterine infection had significantly fewer live fetuses, more positive cord blood cultures than those without (live fetuses: 44% vs 82%, p<0.000001; positive cord blood cultures: 44% vs 3%, p<0.000001, respectively; Fishers exact test). However the rates of maternal morbidity and placental inflammatory lesions were similar between the two groups. 2) The placental weight and amniotic fluid volume were significantly less in live fetuses with than in those without persistent intrauterine infection. Moreover the fetal weight was decreased in live fetuses with persistent intrauterine infection, but it was not statistically significant(placental weight: p<0.05; amniotic fluid volume: p<0.05; fetal weight: p 0.051, respectively; Wilcoxon matched-pairs signed ranks test). Conclusion: Fetal complications including fetal death, congenital sepsis, and decreased fetal-placental weight and amniotic fluid volume wae produced in utero when pasistent intrauterine infection was present with antibiotics administration after inoculstion of E. coli. Therefore, when treating with antibiotics in intrauterine infection, it is needed to observe and monitar the presence of persistent intrauterine infection, and if it is peristent, delivery may be considered for the improvement of pregnancy outcome.