융모막성에 따른 쌍태아 체중 불일치의 주산기 예후

길기철 ( Ki Chul Kil ),이귀세라 ( Gui Se Ra Lee ),강영화 ( Young Hwa Kang ),김연희 ( Yeon Hee Kim ),김사진 ( Sa Jin Kim ),신종철 ( Jong Chul Shin ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.11

Objective: The purpose of this study was to examine the association between intrapair birth weight discordance and perinatal outcomes according to the chorionicity. Methods: Twin births in St. Vincent`s Hospital of Catholic University of Korea for the period 2000~2007 were retrospectively studied. Discordance was defined as an intertwin birth weight difference ≥20% and concordance was defined as weight difference <20% calculated from the larger newborn. Perinatal outcomes were compared between discordant and concordant pairs in monochorio-diamnionic and dichorionic twins. Results: Among 38 monochorionic twin births, 34.2% was discordant and 66.8% was concordant. Among 144 dichorionic twin birth, 9.9% was discordant and 91.9% was concordant. The incidences of intrauterine fetal death (FDIU), twin-to-twin transfusion syndrome (TTTS), intrauterine growth restriction (IUGR) and neonatal hypoglycemia of discordant group of monochorionic twins were statistically increased compared with concordant group of monochorionic twins. The incidences of IUGR and neonatal hypoglycemia were statistically increased in the discordant group of dichorionic twins compared with concordant group of dichorionic twins. The others were not shown statistically significant between two groups in the both chorionic twins. Conclusions: Birth weight discordance in monochorionicity seems to predict fetal death, TTTS, IUGR and newborn hypoglycemia. Birth weight discordance in dichorionicity does not seem to be good predictor of adverse perinatal outcomes except IUGR and neonatal hypoglycemia.

전치 태반에서 응급 제왕 자궁절제술의 위험 요인

길기철 ( Ki Cheol Kil ),임시연 ( Si Yeon Lim ),고현선 ( Hyun Sun Ko ),김사진 ( Sa Jin Kim ),권동진 ( Dong Jin Kwon ),신종철 ( Jong Chul Shin ),김수평 ( Soo Pyung Kim ),이귀세라 ( Gui Se Ra Lee ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.3

Objectives: The purpose of this study is to investigate the clinical risk factors of emergency cesarean hysterectomy in patients with pregnancies complicated by placenta previa and whether the third trimester transvaginal ultrasonographic findings of placenta previa would predict emergency cesarean hysterectomy. Materials and Methods: Between January 1995 and March 2005, we retrospectively reviewed the records and compared between patients with pregnancies complicated by placenta previa who underwent cesarean hysterectomy and patients with pregnancies complicated by placenta previa who did not undergo cesarean hysterectomy. Results: There were 314 had placenta previa and 34 patients were performed cesarean hysterectomy (10.83%). There were significant differences on the basis of maternal age (31.53±4.41 vs 34.06±4.12, p<0.05), parity (0.81±0.70 vs 1.29±0.63, p<0.05), the number of cesarean section (0.36±0.56 vs 0.91±0.75, p<0.05), previous history of placenta previa and presence of placenta accreta, but not on the basis of gestational age, the number of antenatal vaginal bleeding, the number of abortions and emergency operation between two groups. On the basis of third trimester transvaginal ultrasonographic findings, significant differences were found on the distances from the internal os of cervix (1.18±3.66 vs 2.67±2.94, p<0.05) and thickness of lower placental edge. However, the presence of lacuna in the lower placenta was not associated with emergency hysterectomy. Conclusions: Patients with placenta previa are at a higher risk of undergoing cesarean hysterectomy when they are associated with placenta accreta, thick lower placenta edge, and positively longer distance to the internal os of cervix. The other clinical factors such as maternal age, parity, the number of cesarean section and previous history of placenta previa might be associated the risk of cesarean hysterectomy.

임상 ; 40세 이상 고령 임신이 주산기 결과에 미치는 영향

길기철 ( Ki Cheol Kil ),이귀세라 ( Gui Se Ra Lee ),권지영 ( Ji Young Kwon ),박인양 ( In Yang Park ),김사진 ( Sa Jin Kim ),신종철 ( Jong Chul Shin ),김수평 ( Soo Pyung Kim ) 대한주산의학회 2007 Perinatology Vol.18 No.2

Impact of obesity in pregnant women performed cesarean delivery on perinatal outcome

길기철 ( Ki Cheol Kil ),( Mi Na Choi ),( Gui Se Ra Lee ),( Sa Jin Kim ),( Jong Chul Shin ) 대한산부인과학회 2007 대한산부인과학회 학술대회 Vol.93 No.-

증례 : 임신 제 2삼분기에 합병된 급성 간질성 폐렴 2예

길기철 ( Ki Cheol Kil ),이귀세라 ( Lee Gui Se Ra ),이세연 ( Se Yeon Lee ),최정수 ( Jung Soo Choi ),유희정 ( Hee Jung Yu ),권동진 ( Dong Jin Kwon ),신종철 ( Jong Chul Shin ) 대한주산의학회 2006 大韓周産醫學會雜誌 Vol.17 No.4

임신 제 2삼분기에 발생한 급성 간질성 폐렴을 기계호흡과 고용량 corticosteroid로 치료한 경험을 보고하고자 한다. 임상 양상, 검사 및 영상 진단 기술. 증례 1) 29세 G1P1 임신 24+3주의 산모가 3주간 지속된 기침, 객담, 호흡 곤란과 흉통을 주소로 내원하였다. 양쪽 폐에서 수포음을 동반한 거친 호흡음이 들렸으며 흉부 방사선 검사에서 폐렴을 의심하여 시행한 HRCT에서 ARDS를 동반한 급성 간질성 폐렴을 의심하는 소견을 보여 기계 호흡 치료 및 기관 절개를 시행하였고 항생제와 고용량 corticosteroid 치료를 시행하였으며 제왕 절개로 사산아를 출산 후 증상이 좋아져 corticosteroid 용량을 줄인 후 퇴원하였다. 증례 2) 33세 G1P1 임신 24+4주의 산모가 3개월간의 지속적인 기침과 객담, 호흡 곤란 주소로 내원하였다. 양쪽 폐에서 거친 호흡음이 청취되었고 흉부 방사선 검사에서 간질설 폐렴을 의심하는 소견을 보여 시행한 HRCT에서 ARDS를 동반한 급성 간질성 폐렴 혹은 좁쌀 결핵의 소견을 보여 즉각적으로 항생제 및 고용량 corticosteroid를 정주하였지만 호전이 없고 호흡 곤란 심해져 기관 삽관 후 기계호흡 치료를 시행하였으며 임신 26+1주에 분만을 하였고 분만 후 DIC가 발생하여 사망하였다. 급성 간질성 폐렴은 매우 드물며 치명적인 질환으로 59~100%의 사망률을 보인다. 임상 양상, 검사실 소견, 치료 방법이 아직 확립이 되지 않은 상태이다. 흉부 방사선 검사와 HRCT가 진단에 도움이 되며 고용량 steroid와 면역억제 요법이 사용되지만 그 효과는 장담할 수 없다. We present two cases of acute interstitial pneumonia (AIP) during the second trimester of pregnancy managed by mechanical ventilation, high dose corticosteroids. We described clinical course, laboratory data and imaging studies. Case 1) A 29-year-old woman, G1P1, was referred for aggravated continuous coughing, sputum and dyspnea, pleuritic chest pain and mild fever for 3 weeks at 24+3 weeks of gestation. There were coarse breathing sounds with crackles on the both lung field. Her chest X-ray showed diffuse haziness in both lungs with suspicious nodular opacities and suggested pneumonia. HRCT showed diffuse ground glass opacities with interstitial thickening and suspicious fine nodular infiltration in both lungs suggesting acute interstitial pneumonia combined with ARDS. Because her symptoms were more aggravated, she was performed mechanical ventilation treatment. After that, she was performed cesarean hysterotomy and delivered a dead male 850grams. After her symptoms were much more improved. All antibiotics were stopped and reduced the doses of steroids, she was discharged with t-tube capped state. Case 2) A 33-year-old woman, G1P1, was referred for continuous coughing, sputum and dyspnea for 3 months and low abdominal discomfort at 24+4 weeks of gestation. There were coarse breathing sounds with rales on the both lung field. Her chest X-ray showed diffuse haziness in both lungs with suspicious nodular opacities and suggested interstitial pneumonia. HRCT showed diffuse ground glass opacities with some intralobular and interlobular interstitial thickening and suspicious fine nodular infiltration in both lungs suggesting acute interstitial pneumonia or miliary TBc combined with ARDS. She was treated with antibiotics, oxygen, high dose corticosteroids, and tocolytics. There was no evidence of TBc in the bronchoscopy. She showed decreased mentality and decreased O2 saturation below 90% in spite of mechanical ventilation, high dose steroids and IVGV therapy. She delivered a boy of 870 g (Apgar score 1/5). After delivery, she was expired due to combined aggravating DIC. Her baby was expired at the next day, too. The outcome of AIP is fatal, reporting 59~100% mortality rate. The clinical course, laboratory data and treatment are not well established due to rarity of this disease entity. Chest X-ray and HRCT may be helpful in diagnosis and high dose steroid and immunosuppressive agents usually used but the efficacy is not guaranteed.

HELLP 증후군과 중증 전자간증의 산모-신생아 합병증

진기홍 ( Ki Hong Jin ),김민정 ( Min Jung Kim ),안현영 ( Hyun Young Ahn ),길기철 ( Ki Cheol Kil ),박인양 ( In Yang Park ),이영 ( Young Lee ),이귀세라 ( Gui Se Ra Lee ),신종철 ( Joung Chul Shin ),김사진 ( Sa Jin Kim ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.10

자궁각 임신의 임상 양상 분석

이세연 ( Sae Yeon Lee ),길기철 ( Ki Chul Kil ),최미나 ( Mi Na Chai ),정문영 ( Moon Young Chung ),김연희 ( Yeon Hee Kim ),권동진 ( Dong Jin Kown ),이귀세라 ( Gui Se Ra Lee ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.7

Objective: To determine the efficacy of ultrasonogram in the detection of cornual pregnancy and the factors that might be affected on early diagnosis. Method: We studied 26 cases which were diagnosed as a cornual pregnancy from Jan, 1, 2000 to Dec, 31, 2004 at department of Obstetrics and Gynecology, St. Vincent`s Hospital, the Catholic University of Korea. We compared two groups about clinical characteristics and outcomes. One group (A group) was diagnosed as cornual pregnancy before beginning of treatment, another group (B group) was not diagnosed as cornual pregnancy until operation. Results: A group was 8 cases (30.8%) and B group was 18 cases (69.2%). There were no significant differences in age (33.0±6.21 years : 31.0±5.82 years), duration of amenorrhea (7.32±1.07 weeks : 8.90±5.44 weeks), previous cesarian section history (25.0% : 27.8%), present myoma (12.5% : 11.1%) and abdominal pain (50% : 77.78%), vaginal bleeding (50% : 55.6%), shock (0% : 27.8%) between two groups. There were significant differences in parity (1.63±0.74 : 1.0±0.77, p=0.032), number of abortions (2.25±1.16 : 1.11±1.18, p=0.016), previous history of ectopic pregnancy (37.5% : 0%, p=0.022). Of the method of treatments, only cornual resection (50% : 94.4%) showed significant differences between two groups. Conclusion: 30.8% of cornual pregnancy was early diagnosed by ultrasonogram. The important early detective factors for cornual pregnancy might be parity, previous ectopic pregnancy history and abortion history. Therefore if the patient has the previous ectopic pregnancy and abortion history, she can visit early to the hospital and the doctors do pay attention to the possibility of cornual pregnancy.

자궁내 태아 발육부전과/또는 전자간증에 있어서 모체 및 제대 혈청 렙틴 농도의 의의

이귀세라 ( Gui Se Ag Lee ),길기철 ( Ki Chul Kil ),이영 ( Young Lee ),안현영 ( Hyun Young Ahn ),허수영 ( Soo Young Hur ),신은영 ( Eun Young Shin ),신종철 ( Jong Chul Shin ),유영옥 ( Young Ok Lew ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.10

원저 : 신장이식 받은 여성의 임신예후: 후향적 연구

김연희 ( Yeun Hee Kim ),오세정 ( Sae Jeong Oh ),안현영 ( Hyun Young Ahn ),길기철 ( Ki Cheol Kil ),박인양 ( In Yang Park ),이귀세라 ( Gui Se Ra Lee ),김수평 ( Soo Pyung Kim ),신종철 ( Jong Chul Shin ) 대한주산의학회 2006 Perinatology Vol.17 No.4

목적 : 신장이식수술을 받은 환자에서 생긴 임신의 결과와 이식신의 예후에 대하여 알아보고자 하였다. 방법 : 1990년 1월부터 2003년 12월까지 14년 간 신장이식수술을 받은 가임기(15~45세) 여자 환자를 대상으로 후향적으로 연구하였다. 이식수술 후 발생한 임신에 대하여 임신의 결과와 산과적 합병증 및 신생아 결과 그리고 이식신의 예후에 대하여 의무기록을 검토하였다. 결과 : 연구기간 중 총 224명의 가임기 여성이 신장이식수술을 받았으며 21명의 환자에서 34예의 임신을 경험하였다. 임신 시 평균 나이는 29.5세였으며 이식수술로부터 평균 61.9개월(범위:1~162)후 임신하였다. 임신의 결과로 생존출생 67.6% (23예) 중 13예가 조산하였으며 자연유산 8.8% (3예), 인공유산 20.5% (7예) 그리고 자궁외임신이 2.9%(1예)였다. 산모측 합병증으로 전자간증39.1%, 조기진통 43.4%, 요로감염 38.2% 그리고 임신성 당뇨 8.6%가 발생하였다. 이식수술 후 2년 미만에 임신한 9예에서 임신의 결과와 합병증이 2년 이후에 임신한 군과 통계적으로 유의한 차이를 보이지 않았다(자연유산: p=0.77, 인공유산: p=0.88, 생존출생: p=0.36). 임신 후 일시적 신기능 장애를 보인 군에서 유산율이 유의하게 증가하였으며(p=0.006), 임신 전 혈청크레아티닌이 1.4 mg/dL 이상인 경우에 조산이 증가하였다(p=0.30). 분만 후 3~6개월 후 혈청크레아티닌 농도가 임신 전에 비하여 유의하게 증가하였으나(p=0.04), 분만 후 2년 이식편 생존율이 95.2%, 이식수술 후 5년 생존율이 95.2%였다. 결론 : 이상의 결과로 이식신의 기능이 양호하다면 이식수술 후 2년 미만에 임신한 경우에 좋은 임신의 예후를 기대할 수 있다. 이식편의 분만 후 2년, 수술 후 5년 생존율이 양호하며 임신이 이식신의 장기간 생존율에 영향을 주지 않는 것을 보인다. Objective : The aim of our study was to identify graft, obstetric and maternal outcomes of pregnancies in renal transplant recipients at our center. Methods : A 14-year retrospective study between January 1990 and December 2003, 224 women 15 to 45 years of age had transplantation and were analyzed the outcomes of pregnancies, obstetric complications and graft function. Results : Thirty-four pregnancies occurred in 21 of 224 patients. The mean age at the time of conception was 29.5 years (21 to 36 years) with a mean interval of 61.9 months (one to 162 months). In the pregnancy outcome, there were the 23 live births (67.6%) included 13 preterm and 10 term deliveries, 3 spontaneous abortions (8.8%), 7 artificial abortions (20.5%) and one case of ectopic pregnancy (2.9%). Obstetric complications were; preeclampsia (39.1%), preterm labor (43.4%), urinary tract infections (38.2%) and gestational diabetes (8.6%). Nine pregnancies within 2 years of transplantation had the permissible obstetric outcomes comparing with the others after 2 years (spontaneous abortion: p=0.77, artificial abortion: p=0.88, live birth: p=0.36). In twelve pregnancies appearing renal dysfunction associated with pregnancy, the abortion rate was increased comparing the others with stable renal function (p=0.006). Pre-pregnancy serum creatinine .1.4 mg/dl was associated with increased preterm delivery, but not significant (50.0% vs 28.5%, p=0.30). In graft function, serum creatinine 3~6 postpartum was significantly increased comparing pre-pregnancy levels (p=0.04). Five cases of 7 patients with acute rejection episode associated with pregnancy conceived after 4 years of transplantation. Two-year graft survival after delivery was 95.2% (20/21) and chronic rejection and graft failure was diagnosed in one case at postpartum 14 months. Conclusion : These findings suggest that, if the graft function is stable, pregnancy within 2 years after renal transplantation might be safe. Pregnancy does not appear to have adverse effects on long term graft survival.

전신성 홍반성 루푸스를 동반한 임산부 94예의 임신 경과 및 산과적 고찰

안현영 ( Hyun Young Ahn ),김연희 ( Yeon Hee Kim ),길기철 ( Ki Chul Kil ),박인양 ( In Yang Park ),이귀세라 ( Guisera Lee ),김사진 ( Sa Jin Kim ),박성환 ( Sung Hwan Park ),신종철 ( Jong Chul Shin ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.2

Objective: The purpose of this study was to assess the maternal and fetal outcomes in pregnant women with systemic lupus erythematosus (SLE) and to evaluate clinical and laboratory markers for preterm birth and lupus flares. Methods: 94 pregnancies of 60 patients were retrospectively evaluated from Jan 1997 to Sep 2004. We used clinical and laboratory data from the medical records and statistics analysis by Chi-square test, using SPSS 15.0 V. Results: Pregnancy resulted in 74 (78.7%) live births, 11 (11.7%) spontaneous abortions, 2 (2.1%) therapeutic abortion, and 4 (4.2%) stillbirths. Thirty-seven cases (47.4%) were delivered by cesarean section. Obstetric complications included 17.9% of preterm births, 26.9% of preeclampsia, and 20.5% of IUGR. There were 31 (39.7%) uncomplicated cases among the pregnancies over 20 gestational weeks. There were 12 of transient neonatal lupus, 2 of neonatal death due to prematurity, and 51 of normal births. Low C4, myocarditis, pleural effusion prior to pregnancy, activity at conception, antiphospholipid antibody syndrome were significantly associated with preterm birth. The maternal long-term effect of pregnancy was poor, because 44.7% were in deterioration of cardiovascular, hematologic or renal function after delivery. Lupus nephritis, proteinuria, hematuria, and activity at conception were significantly associated with lupus flare during pregnancy. Conclusion: Pregnant women with active SLE at conception should be intensively monitored with maternal and fetal surveillance. It is essential to control disease activity during pregnancy. However, adequate pregnancy follow-up and delivery care by multidisciplinary effort with experience in management of patients with SLE resulted in a better outcome of lupus pregnancy.