분만진통 기간에 따른 신생아 제대혈의 산,염기의 평형 및 가스분압의 정상역의 설정

신희철 ( Hee Chul Syn ),윤보현 ( Bo Hyun Yoon ),김승욱 ( Syng Wook Kim ) 대한주산의학회 1993 大韓周産醫學會雜誌 Vol.4 No.4

주산기 예후 예측에 있어서 Doppler 제대동맥 혈류속도 파형의 분석과 Nonstress test의 비교 연구

신희철 ( Hee Chul Syn ),윤보현 ( Bo Hyun Yoon ),최진 ( Jin Choe ),이필량 ( Pyl Ryang Lee ),김승욱 ( Syng Wook Kim ) 대한주산의학회 1991 大韓周産醫學會雜誌 Vol.2 No.2

지연 임신에서의 자궁경부 숙화와 유도분만

신희철 ( Hee Chul Syn ) 대한주산의학회 1992 Perinatology Vol.3 No.2

양수지수 (Amniotic fluid index)에 따른 주산기 예후 및 분만 결과에 대한 예측

신희철 ( Hee Chul Syn ),최진 ( Jin Choe ),은길상 ( Gil Sang Eun ),진호준 ( Ho Joon Jin ),( Faruk Ozcelik ),이필량 ( Pyl Ryang Lee ),윤보현 ( Bo Hyun Yoon ),김승욱 ( Syng Wook Kim ) 대한주산의학회 1992 Perinatology Vol.3 No.2

조기양막파수 환자에서 양수과소증과 양수내 , 모체의 염증성 반응 및 태아 저산소증과의 관계

신희철(Hee Chul Syn),김영아(Young Ah Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.1

N/A OBJECTIVE: To examine the relationship of the amniotic, and maternal infiammatory responses and decreased amniotic fluid in patients with preterm PROM. METHODS: Fifty three patients with preterm PROM in singleton pregnancy who delivered preterm neonates (gestational age<35 weeks) within 3 days of amniocentesis were included. Amniotic fluid index(AFI) was measured by transabdominal ultrasonography at amniocentesis. Amniotic fluid was cultured far aerobic and anaerobic bacteria and mycoplasma. The intensity of the inflammatory response was evaluated by clinical and histologic chorioamnionitis. The intensity of fetal hypoxia was evaluated by 1 min Apgar score, 5 min Apgar score, and pH of cord blood at birth. RESULTS: The prevalence of oligohydramnios, which was defined when measured AFI was equal or less than 5.0, was 34% (18/53). The prevalence of positive amniotic fluid culture was 45% (24/53) and that of patients with was significantly higher than that of patients without oligohydramnios (78% [14/l8] vs 29% [10/35], p<0.01). Intrauterine inflammatory response was significantly stronger in patients with oligohydratnnios than in patients with adequate amniotic fluid (pathologic chorioamnionitis 100% [l6/16] vs 63% [19/30], clinical chorioamnionitis 39% [7/18] vs 6% [2/35]; p<0.01 for each). However, no significant difference was found in the intensity of fetal hypoxia (I min Apgar score <7 67% [12/18] vs 66% [23/35], 5 min Apgar score <7 39% [7/l8] vs 26% [9/35], pH of cord artery blood at birth 7.27+0.13 vs 7.22+0.13; p>O.I, for each). CONCLUSION: Oligohydramnios in patients with preterm PROM is strongly pedictive for positive amniotic fluid culture, and is associated with a robust host response in amniotic, and maternal cornpartments, but not with fetal hypoxia.

산전초음파로 진단된 태아 일측성 폐무발생

이희준 ( Hee Jun Lee ),김선영 ( Sun Young Kim ),박정우 ( Jeong Woo Park ),김우오 ( Woo Oh Kim ),박찬욱 ( Chan Wook Park ),박중신 ( Joong Shin Park ),전종관 ( Jong Kwan Jun ),신희철 ( Hee Chul Syn ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.12

Unilateral pulmonary agenesis is a very rare developmental malformation that is often associated with other anomalies. The prognosis of pulmonary agenesis varies from stillbirth, to neonatal death, to survival without any symptoms depending on the presence of associated congenital malformations. Therefore, it is very important to perform a prenatal diagnosis of unilateral pulmonary agenesis. We describe a case of unilateral pulmonary agenesis diagnosed in the second trimester by transabdominal ultrasound.

제1태아가 두위인 쌍태 임신에서 분만방법에 따른 신생아 예후

김희승 ( Hee Seoung Kim ),김건우 ( Kun Woo Kim ),박현수 ( Hyun Soo Park ),박찬욱 ( Chan Wook Park ),박중신 ( Joong Shin Park ),전종관 ( Jong Kwan Jun ),윤보현 ( Bo Hyun Yoon ),신희철 ( Hee Chul Syn ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.2

목적: 본 연구에서는 제1태아가 두위인 쌍태 임신에서 질식 분만의 성공률 및 분만방법에 따른 제2태아의 이환율 및 사망률을 비교하고자 하였다. 연구방법: 1996년 12월부터 2006년 2월까지 분만한 제1태아가 두위인 349예의 쌍태 임신부 및 신생아의 임상 기록을 후향적으로 고찰하였다. 질식 분만을 시도한 군과 선택적 제왕절개 분만을 한 군으로 분류하여 두 군에서의 산모의 임상적 변수와 제2태아의 이환율과 사망률을 비교하였다. 유의한 신생아 이환율로는 뇌실 내 출혈·신생아 호흡 곤란 증후군·범발성 혈액 응고 증후군·신생아 패혈증·괴사성 장염·분만 외상을 포함하였다. 통계 방법으로는 독립 표본 t 검정, Mann-Whtiney U 검정, 카이 제곱 검정, Fisher`s exact 검정을 사용하였다. 결과: 제1태아가 두위인 349예의 쌍태 임신 중 170예 (49%)에서 질식 분만을 시도하였고, 나머지 179예 (51%)에서는 선택적 제왕절개술을 시행하였다. 170예의 질식 분만을 시도한 군에서 두위-두위인 경우는 93예 (75%), 두위-비두위인 경우는 32예 (70%)에서 질식 분만에 성공하였다. 질식 분만을 시도한 군과 선택적 제왕절개술을 시행한 군에서의 신생아 이환율과 사망률은 유의한 차이가 없었다. 질식 분만을 시도하였으나 제왕절개 분만을 시행한 군 (45예)과 선택적 제왕절개술을 시행한 군에서의 신생아 이환율과 사망률에서도 유의한 차이가 없었다. 또, 제왕절개로 분만한 초저체중 출생아 (28예)의 경우 질식 분만의 시도에 따른 신생아 이환율과 사망률의 증가는 없었다. 결론: 제1태아가 두위인 쌍태 임신의 경우 제왕절개 분만의 다른 산과적 적응증이 없다면 질식 분만을 시도하는 것이 제2태아의 신생아 이환율 및 사망률을 높이지 않고 제왕절개 분만을 줄이는 좋은 방법이 될 수 있을 것으로 사료된다. Objective: The purposes of this study were to estimate the success rate of vaginal delivery after trial of labor (TOL) and to analyze the neonatal outcome of vertex-vertex (V-V) and vertex-nonvertex (V-NV) second twin according to the mode of delivery. Methods: We reviewed retrospectively the medical records of V-V and V-NV twin delivered between December 1996 and February 2006. The patients were classified as TOL group and elective cesarean delivery (ECD) group to compare of the neonatal morbidity and mortality in second twin. Neonatal morbidity included intraventricular hemorrhage, respiratory distress syndrome, disseminated intravascular coagulopathy, sepsis, necrotizing enterocolitis, and birth trauma. Student t-test, Mann-Whtiney U test, Pearson`s chi-square, and Fisher`s exact were performed for the comparison of the neonatal outcome in second twin according to the groups. Results: There are 349 eligible cases within given period. The proportions of TOL and ECD were 49% (n=170) and 51% (n=179), respectively. The success rates of vaginal delivery after TOL were 75% (n=93) in V-V twin and 70% (n=32) in V-NV twin. There were no significant differences in the neonatal outcome between TOL and ECD group. Additionally there were no significant differences in the neonatal outcome between cesarean delivery after the failure of TOL (n=45) and ECD group. Conclusion: Our results suggest that TOL in V-V and V-NV twin may be a safe method and can reduce the rate of ECD without adverse effect on neonatal outcome of second twin unless there are other obstetrical indications for cesarean delivery.

Takayasu 동맥염이 동반된 임신의 양상과 예후

임준희(June Hee Lim),김성민(Sung Min Kim),김미하(Mi Ha Kim),오수영(Soo Young Oh),문정빈(Jeong Bin Moon),박중신(Joong Shin Park),전종관(Jong Kwan Jun),윤보현(Bo Hyun Yoon),신희철(Hee Chul Syn) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.9

목적 : Takayasu 동맥염을 동반한 임신의 임상적 양상과 본 질환이 산모 및 태아에 미치는 영향에 대해서 알아보고자 하였다. 연구방법 : 본 연구는 후향적 연구로서 1989년 6월부터 1999년 12월까지 서울대학교병원 산부인과에서 분만한 환자들중에 Takayasu 동맥염을 동반한 산모의 14례 임신에 대한 의무기록을 검토하여, 환자의 임신 전 상태와 주산기 예후에 대해 기술하였다. 결과 : 연구 기간 동안 본원에서 분만건수는 총 19,885례가 있었는데 이 중 Takayasu 동맥염이 동반된 여성에서의 분만은 12명의 환자에서 14례였다. 산모와 신생아 사망의 예는 없었으며, 진단 당시 평균 연령은 24.6세 (범위 18세-31세)였고, 임상양상 중에 맥관계 잡음(58.3%), 말초 혈관의 박동감소(50%), 고혈압(50%)순으로 빈도가 높았다. 고혈압 환자 6명중에 5명이(83.3%)이 신혈관성 고혈압이었고, 이중에 2명이 임신중 전자간증을 보였다. 진통중 현저한 혈압상승이 동반된 경우가 3례(25%)있었고, 이중 2례는 임신전 고혈압의 증거가 없었으며, 임신중에 전자간증도 동반되지 않았다. 제왕절개를 통한 분만은 5례(35.7%)에서 이루어졌고, 조기분만은 2례(14.3%)에서, 발육지연 상태의 신생아가 4례(28.6%)에서 있었다. 단지 1명의 신생아가 신생아중환자실에 입원하여 집중치료를 받았는데, 1분 아프가 점수가 5점으로 경도의 쳐짐을 나타내었다. 14례의 임신 중 3례에서 분만 후 산모의 합병증이 초래되었는데 이는 호흡곤란, 흉막삼출, 일시적 혈압감소 등의 심혈관계 합병증에서 기인한 것이었다.결론 : Takayasu 동맥염은 가임기 여성에서 빈발하여 임신 중 처음으로 발견되기도 한다. 주산기에 일어날 수 있는 다양한 심혈관계의 합병증의 가능성에도 불구하고 대부분 본 질환은 임신에 의해 영향을 받지 않고 산과적으로 커다란 문제없이 건강한 아이를 분만할 수 있다. Objective : To evaluate the clinical characteristics, course, and the outcomes of pregnancies with Takayasu's arteritis. Methods : The retrospective study was done by the review of medical records of 14 pregnancies with Takayasu's arteritis found between June, 1989 and December, 1999. Pre-pregnant status and pregnancy outcome were described.Results : Takayasu's arteritis was found in 14 cases among 19,885 women who had delivered at our unit during the study period. There were no maternal or neonatal death. The median age at diagnosis was 24.6 years. Common clinical findings were vascular bruit(58.3%), pulse deficit(50%), and hypertension(50%) at diagnosis. Among the 6 patients who had hypertension, 5(83.3%) showed renovascular hypertension and superimposed preeclampsia developed in 2(33.3%) cases. Marked elevation of systolic blood pressure during labor was associated with 3 pregnancies(25%), including 2 patients who were prepregnant normotensive and without preeclampsia. Cesarean section was performed in 35.7%(5/14) of cases. There were 2 preterm birth(14.3%), 4 growth-restricted newborns(28.6%). Only one was admitted into NICU with 5 Apgar score at 1 minute. Three fourteenths had various postpartum problems, most of which were related to cardiovascular events ; dyspnea, pleural effusion, and transient depressed blood pressure. Conclusion : Because the disorder affects women in childbearing age mainly, it may be recognized the first time during pregnancy. Despite various cardiovascular events which may occur in the perinatal period, the basic disease is usually unaffected by pregnancy and both maternal and fetal clinical outcome may be fair.

양수막을 통한 수분유출 기간 중 Li 이동에 미치는 항이뇨호르몬 및 Prolaction의 영향

임용철 ( Yong Chul Lim ),최석태 ( Seok Tae Choi ),박노현 ( Noh Hyun Park ),신희철 ( Hee Chul Syn ),성호경 ( Ho Kyung Sung ) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.12

In order to investigate the effects of vasopressin and prolactin on the regulation of amniotic fluid volume and sodium concentration in pregnant rabbits, lithium transport as an index of sodium transport and amniotic fluid volume regulation through amniotic membrane was studied. Pregant rabbits were anaesthetised with pentobarbital (30mg/kg) and exposed uterus. To exclude possible contamination of residual hormone in amniotic fluid, 70 % of amniotic volume were replaced by isotonic saline. Isotonic saline (0.5ml) containing 0.5mg of congo red and 15mM of LiCl was injected into each amniotic sac. Amniotic fluid samples were taken in 30 and 60 minutes after saline injection and measured Na+, Li+ and congo red concen1rations. Only the amniotic samples which showed the decrease in congo red concentration after 30 or 60 minutes were chosen to analyse in this study. Vasopressin (25ng) or prolactin (1mg) was injected into experimental amniotic sacs and measuerd Na+, Li+, congo red and amniotic fluid volume as in control group. Then the rate of water efflux, Li-and Na-influx and efflux were ana1ysed and compared. The results were obtained as follows; 1) The efflux ratio of Na+ to water in amniotic fluid was relatively constant (about 95 %) in control, which was independent from the magnitude of water efflux rate. The efflux ratio of lithium to water, however, increased from 20 % with the increase of the magnitude of water efflux. 2) In vasopressin injected group, the water efflux rate was decreased than in control group and the efflux ratio of Na+ to water was not consistent (sometimes decreased or increased). On the other hand the efflux ratio of Li+ to water was in the same range as in control when the water efflux rate was in the range of control value, however, it profoundly increased when the water efflux rate was below 10%. 3) In prolactin treated group, the water efflux rate was very high when the initial Na+ concentration was low. The influx or efflux of Li+ was very large independently from the magnitude of water efflux rate or from initial Na+ concentration probably due to vigorous diffusion. From the above results, it is suggested that vasopressin inhibit the increase of the amniotic fluid volume during fetal urination and maintain Na+ concentration of the amniotic fluid not through the direct effect on the amniotic membrane, but thorugh the effect on fetal kidney. On the other hand, prolactin regulates Na+ concentration of the amniotic fluid very rapidly by the increase of diffusion of monovalent cations through the amniotic membrane.

임신 20주 이상 지속된 선천성 자궁기형 환자에서의 산과적 예후

구연희 ( Yeon Hee Ku ),김건우 ( Kun Woo Kim ),한지혜 ( Jee Hye Han ),박현수 ( Hyun Soo Park ),박찬욱 ( Chan Wook Park ),박중신 ( Joong Shin Park ),전종관 ( Jong Kwan Jun ),윤보현 ( Bo Hyun Yoon ),신희철 ( Hee Chul Syn ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.5

목적: 선천성 자궁 기형이 있는 여성에서 임신 20주 이상 지속된 경우 산과적 예후를 알아보고자 한다. 연구 방법: 1990년 1월부터 2005년 12월까지 16년간 서울대학교병원 산부인과에서 선천성 자궁 기형으로 진단받은 환자 106명을 대상으로 의무기록을 이용한 후향적 연구방법을 사용하였다. 선천성 자궁 기형은 쌍각자궁, 이중자궁, 중격자궁, 궁상자궁, 단각자궁으로 분류하였으며 각 형태에 따른 산과적 예후를 알아보았다. 결과: 전체 자궁 기형 중 쌍각자궁이 59.5% (63/106), 이중자궁이 17.9% (19/106), 중격자궁이 15.1% (16/106), 궁상자궁이 4.7% (5/106), 단각자궁이 2.8% (3/106)이었다. 전체 자궁 기형에서 조기 분만율은 22.6% (24/106)이었고 제왕절개술은 74.5% (79/106)에서 시행하였다. 제왕절개술 빈도가 높은 것은 자궁성형술, 비정상 태위 및 자궁 기형 자체 때문이었다. 조기분만율과 제왕절개술 빈도는 각 기형 형태에 따라 통계적으로 유의한 차이를 보이지는 않았다. 사산이 5예 있었으며 태반조기박리로 인한 신생아기 사망이 1예 있었다. 전체 take-home baby 비율은 94.3% (100/106)이었다. 모성 사망은 없었으며 산후 출혈이 1예 있었다. 결론: 선천성 자궁 기형이 있는 여성에서 임신 20주 이상 지속된 경우에는 비교적 양호한 산과적 예후를 기대할 수 있다. Objective: To evaluate the pregnancy outcomes of women with congenital uterine anomaly exceeding 20 weeks of gestation. Methods: We reviewed retrospectively the birth records of the Seoul National University Hospital between January 1, 1990, and December 31, 2005. We grouped congenital uterine anomalies into five classes, namely bicornuate, didelphys, septate, arcuate, and unicornuate uterus. We compared the pregnancy outcomes with each anomaly. Results: We found 106 cases of congenital uterine anomaly within a given period of time. There were 63 cases of bicornuate uterus, 19 cases of didelphys, 16 cases of septate uterus, 5 cases of arcuate uterus, and 3 cases of unicornuate uterus. The overall preterm delivery rate was 22.6% (24/106) and cesarean section rate was 74.5% (79/106). A high cesarean section rate was due to metroplasty, abnormal fetal presentation, and uterine anomaly itself. The preterm delivery rate and cesarean section rate of each uterine anomaly did not differ statistically from one another. Five fetuses were stillborn, and one fetus died after birth because of a placenta abruption. The overall take-home baby rate was 94.3% (100/106). There was no maternal mortality and only one case was suffered from postpartum bleeding. Conclusion: Our results suggest that the most of women with uterine anomaly exceeding 20 weeks of gestation may take their baby home.