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쌍태임신에서 쌍태아간 출생체중 차이에 따른 주산기 예후의 비교
정재현,노정래,양순하,박선혜,서용수,최세미 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.9
저자들은 임신 25주에서 37주 미만의 쌍태임신 119예를 대상으로 쌍생아간 출생체중 차이에 따라 대상군을 네 군으로 나눈 후 각 군간의 주산기 예후를 비교함으로써 다음과 같은 결과를 얻었다. 1. 연구 대상이었던 238명의 쌍생아 중 10% 이하인 Ⅰ군은 128명(54%), 10∼20%인 Ⅱ군은 58명(24%), 20∼ 30%인 Ⅲ군은 32명(13%) 그리고 30% 초과인 Ⅳ군은 20 명(8%)이었다. 2. 각 군간 제태주령과 출생체중 간에는 유의한 차이를 보이지 않고 있으나 저출생체중아 및 신생아 호흡부전 증후군이 Ⅳ군에서 유의하게 많이 발생한 것으로 나타났다(p<0.001 and p<0.05, respectively). 신생아 사망률과 주산기 사망률은 각 군간에 유의한 차이가 없었다. 3. 신생아 중환자실에서의 집중치료가 필요했던 경우가 Ⅳ군에서 많았으나 통계적으로는 의미가 없었으며, 신생아 중환자실 재원 기간도 각 군간에 통계적인 차이가 없었다. 4. 출생체중이 큰 쌍태아와 작은 쌍태아의 주산기 예후를 비교해 보았을 때 저출생체중의 빈도를 제외하면 두 군간에 통계적으로 유의한 빈도 차이를 보이는 예후 인자는 발견되지 않았다. 5. 다른 주산기 예후의 예측인자들과 같이 multiple logi stic regression analysis를 시행한 결과 출생체중의 차이는 불량한 주산기 예후의 독립적 예측인자로 생각되지 않았다. 결론적으로 쌍태임신에서 쌍태아간의 출생체중 차이 그 자체는 주산기 예후의 독립적 예후인자가 되지 않는 것으로 생각되며 이 결과는 쌍생아간 체중불일치의 정의를 보다 엄격히 정함으로써 쌍태임신의 산전관리 및 신생아 처치에 오류를 범하지 않아야함을 시사한다. 이의 증명을 위하여는 향후 보다 많은 수의 쌍태임신을 대상으로 하여 전향적 연구를 시행하여야 한다고 사료된다. Objective: The purpose of this study was to determine the effect of discordant fetal growth on subsequent perinatal and neonatal outcome for different degrees of birth weight discordance in twin gestations. Study design: One hundred nineteen sets of twins delivered between 25 and 37 weeks` gestation were studied. They were stratified into four categories according to the percent difference in infant birth weight: ≤10%, 10% to 20%, 20% to 30%, and >30%, which was defined as ([Birth weight of larger twin - Birth weight of smaller twin]/Birth weight of larger twin)×100. The relationship between different birth weight categories and the perinatal and neonatal outcome and the difference in outcome between the large and small infants were evaluated. Multiple logistic regression analysis was used to determine the relationship between the poor perinatal outcome and independent variables. Results: Twin gestations with >30% birth weight discordance were associated with a higher incidence of small-for-gestational-age (SGA) infants and respiratory distress syndrome of neonates (p<0.001 and p<0.05, respectively). Outcome of the large and small twins showed no significant difference except incidence of SGA infants. Multiple logistic regression analysis revealed that birth weight discordance >30% was not an independent predictor for perinatal outcome. Conclusion: In twin gestations the use of a 30% birth weight difference to define twin discordance seems to be most clinically relevant in identifying those infants at risk for adverse perinatal outcome. However, birth weight discordane is not an independent risk factor for perinatal mortality and morbidity. It suggests that the estimated fetal weight discordance by prenatal ultrasonography is not an indication of preterm delivery.
정재현,서연림,노정래,양순하,박선혜,임소덕 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.4
본 저자 등은 임신 제 28 주의 산모에서 산전 초음파를 이용하여 진단된 선천성 신경교모세포종 1 예를 경험하였기에 간단한 문헌 고찰과 함께 보고하는 바이다. We present a case of congenital cerebral glioblastoma. The prenatal ultrasound scan showed a hyperechoic mass occupying right hemisphere accompanied with contralateral ventriculomegaly and deviation of midline cerebral structures. Glioblastoma is one of the rarest congenital brain tumours and has the poorest prognosis with no recorded cases surviving beyond one year. We have experienced a case of congenital cerebral glioblastoma at 28 weeks′gestation, which is presented with a brief review of the literatures.
다중혈청지표를 이용한 다운증후군 태아선별검사의 위양성 결과에 따른 임신결과에 관한 연구
정재현,노정래 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.4
Object: To assess the relative risk of an adverse pregnancy outcome in women with a false-positive risk for Down syndrome by prenatal screeen using triple markers(maternal serum alpha- fetoprotein[AFP], unconjugated estrio[uE₃], and human chorionic gpna dotropin[hGC] levels) and age. Methode : Case-Control study including sixity four women with false-positive screens for Down sydrome and a matched control group of 128 women whose screen indicated a risk for Down syndrome of less than 1 :270. The risk for adverse pregnancy outcome was compared for the two groups, and the roles of maternal serum AFP, uE₃, and hCG as predictors of adverse pregnancy outcome were determined. Result : Women with false-positive screen for Down syndrome were not significantly different from their matched controls in the incidence of preterm delivery (5% versus 2%), preterm premature rupture of membrane(3% versus 0%), placental abruption(0% versus 1%), preeclampsia(3% versus 1%), small for gestational age newborns(5% versus 6%), and fetal demise after 20 week`s gestation(2% versus 0%). The occurrence of an adverse outcome in 7 of 64(11%) pregnancies with a flase positive screen for Down syndrome was not different from that in 12 of 128(9%) matched control pregnancies. Only maternal age (odds ratio 1.19,95% cofidence interval 1.05~1.34, p$lt;0.005) was siginificantly associated with adverse outcome after controlling for the effects of maternal serum AFP, hCG and uF₃. Conclusion : Althought the sample on this study , women with a false-positive screen for Down syndrome do not seem to be at increased risk for a adverse pregnancy outcome when compared to those with a negative screen result. Among maternal age, maternal serum AFP, hCG, and uE₃level, only maternal age seemed tobe a predictor of an adverse pregnancy outcome.
조기분만진통 산모에서 조기분만의 예측에 있어 fetal fibronectin과 자궁경부 초음파검사의 유용성 비교
정재현,노정래,양순하 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1
Objective: The purpose of this study was to compare the diagnostic performance of fetal fibronectin and ultrasonographic examination of the cervix in the prediction of preterm delivery in patients with preterm labor and intact membranes. Study Design: Fifty-one women of singleton pregnancy admitted with preterm labor (22 to 35 weeks) and cervical dilation < 3 cm were included in this study. Endovaginal ultrasonography of uterine cervix and qualitative assay of fetal fibronectin in cervicovaginal secretion were performed at the time of admission. Cervical parameters evaluated included endocervical length, presence of funneling, funnel length, and funnel width. Cervicovaginal fetal fibronectin was determined by immunoassay kit using fetal fibronectin-specific monoclonal antibody FDC-6 (ROM-CheckR, Adeza Biochemical, U.S.A). Outcome variables were preterm delivery before the 36th week of gestation, preterm delivery before the 34th week of gestation and admission-to-delivery interval. Results: The prevalence of preterm pregnancy was 35.4%(18/51). The diagnostic indices of fetal fibronectin and ultrasonographic examination of the cevix(cervical length ≤2.6cm and presence of funneling), considered separately, were approximately equivalent in predicting delivery before 34th week of gestation and delivery before 36th week of gestation. Combining fetal fibronectin and cervical length ≤2.6cm did not improve positive predictive value. Patients with positve fetal fibronectin, cervical length ≤2.6cm, or presence of funneling resulted in shorter admission-to-delivery interval. Conclusion: Both of fetal fibronectin and cervical ultrasonographic examination are useful predictors of preterm delivery in patients with preterm labor and intact membranes. For physicians equipped to perform transvaginal ultrasonography, however, the additional information about the result of fetal fibronectin provides little benefits.