결합 쌍태아 4 예

김세광(SK Kim),이우식(WS Lee),조재성(JS Cho),박용원(YW Park),양영호(YH Yang),송찬호(CH Song) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.7

Conjoined twins is the medical term applied to those infants who are united intimately at some point in their bodily anatomy. We experienced four pairs of conjoined twins during recent two years and discussed with regard to prenatal diagnosis, obstetric management and surgical separation.

임신중기 원인불명 모체혈청 알파태아단백치 상승 산모의 주산기 예후

김세광(SK Kim),조재성(JS Cho),김행수(HS Kim),김지수(JS Kim),박용원(YW Park),김인규(IK Kim),양영호(YH Yang),송찬호(CH Song) 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.1

We conducted this sutdy to investigate whether patients with unexplained midtrimester elevation of maternal serum alpha-fetoproten (MSAFP) are at increased risk for adverse perinatal outcomes. The inclusion criteria for patients with unexplained MSAFP elevations were a MSAFP level 2.5 or greater multiples of median (MoM), a single gestation, a confirmed gestional age, and no fetal malformation or death on ultrasonography. Patients with MSAFP levels 0.25 to < 2.5 MoM served as controls Maternal blood as drawn at 15-20 weeks estimated gestional age. Of the 1,731 patients screened, 35(2.0%) had an unexplained elevated MSAFP level. 21 of 29 patients with unexplained MSAFP elevations accepted genetic amniocentesis and the fetal karyotypes were normal in all cases. Patients with unexplained MSAFP levels had significantly higher incidence of fetal congenital malformation (6.9% versus 1.0% ; P<.05) and fetal death (13.8% versus 0.4% ; P<.001) than those with normal MSAFP. But no significant differences were observed in the incidence of preterm delivery, intrauterine growth retardation, low birth weight, and pregnancy-induced hypertension. This study suggests that patients with unexplained midtrimester elevations of MSAFP are incresed risk for fetal congenital malformation and fetal death. Careful clinical follow-up elevations is warranted in these patients.

Achondrogenesis Type I 태아 1 예

김세광(SK Kim),이보연(BY Lee),박용원(YW Park),조재성(JS Cho),양영호(YH Yang),송찬호(CH Song) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.9

Achondrogenesis is a rare lethal form of congenital micromelic dwarfism in which there is a defect in enchondral ossification. A 22-year-old multiparous woman was referred to our hospital at 19 weeks gestation because of a malformed fetus. An ultrasound examination showed fetal hydrops, omphalocele, and extremely short extremities. The pregnancy was terminated with the delivery of a grossly malformed stillborn male fetus. Radiololgical and pathological examination of the fetus confirmed the diagnosis of achondrogenesis type I.

산전 세포유전진단 시행에 있어서 유전상담의 효과

김세광(SK Kim),양영호(YH Yang),송찬호(CH Song) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.12

Analysis of prenatal genetic services was undertaken to identify the influence of genetic counseling on performance of prenatal cytogenetic diagnosis. From September 1, 1990 to September 30, 1991, there were 2,255 ddeliveries at Severance Hospital, Yonsei University College of Medicine, of which 190 (8.4%) patients had indications for prenatal cytogenetic diagnosis. The most common indication for prenatal cytogenetic diagnosis was advanced maternal age(75.8%). The rate of acceptance of prenatal cytogenetic tests in patiens who had indications was very low(26.3%). The main reasons for patients not receiving prenatal cytohenetic tests were omission of genetic counseling (67.1%) and late registration (16.4%). Every obstetrician should provide appropriate genetic counseling to eheir patients who have increased risk of having a fetus with chromosmal abnormalities. Screening for fetal chromosomal abnormality with maternal serum markers such as alpha-fetoprotein, unconjugated estriol, human chorionic gonadotropin should be prososed during genetic counseling for women under 35. A liberal application of rapid cytogenetic tests such as cordocentesis or transabdominal placental biopsy in the late second or early third trimesters of pregnancy also be considered for patients who register late.

모체혈청 알파태아단백치의 임신초기와 중기사이의 상관관계

김세광(SK Kim),서경(K Seo),송찬호(CH Song) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.3

Second-trimester maternal serum alpha fetoprotein (MSAFP) screening is well established as a valuable tool in the prenatal detection of neural tube defects and chromosomal abnormalities. We have investigated whether a significant correlation exists between the results of first-and second-trimester MSAPP screening tests. One hundred fifty-nine normal gravidas had paired first (10-12 weeks) and second(15-20 weeks) trimester MSAFP screening tests performed. The level of MSAFP was determined using the Enzygnost-AFP enzymimmunoassay kt. There was a significant correlation between the paired first-and trimester MSAFP test values for the entire study population (r=0.219, p=0.003). A significant correlation was also demonstrated when the results at 10 (n=35, r=0.376, p=0.031), 11(n=48, r=0.340, p=0.009) and 12 weeks (n=76, r=0.243, p=0.017) were analyzed separetely. The difference of posotive predictive value for second-trimester MSAFP levels at or above 2.0 multiples of the median (MOM) between gravidas having first-trimester MSAFP levels at or above 2.0 MOM (28.6%) and those having levels belo 2.0 MOM(10.0%) was significant(p=0.046). In contrast, the difference of positive predictive value for second-trimester MSAFP levels below 0.6 MOM(18.4%) and those having levels at or above 0.6 MOM(7.4%) was not significant (p=0.098). The sensitivity and positive predictive value of first trimester MSAFP values for both elevated or low second-trimester results were not high. In conclusion, maternal serum alpha fetoprotein values in the first trimester cannot be used to predict those values in the second trimester.

임신중기 모체혈청 베타 인체융모 성선자극홀몬치를 이용한 염색체이상 태아의 산전 선별검사

김세광(SK Kim),송찬호(CH Song) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.5

A commercially available radioimmunoassay kit was used to measure the b-subunit of human chorionic gonadotropin (hCG) in maternal serum from 1341 normal singleton pregnancies and 5 chromosomally abnormal pregnancies (four cases of 45,X and one 45,X/46, XX). The purpose of this study was to investigate maternalserum screening with b-hCG as a screening with b-hCg as a screening test for fetal chromosomal abnormalities. The b-hCG levels decreases with each week of gestation from 15 to 20 weeks. The median values of b-hCg for each week of gestation were as follows: 17.0(15wk), 15.0(16wk), 11.2(17wk), 9.7(18wk), 8.8(19wk) and 7.9(20wk) IU/ml respectively. The b-hCg levels of 4 cases with 45, X were 6.2, 2.1, 1.7, 1.2 multiples of the median (MoM), respectively. The b-hCG level in the one case of 45, X/46, XX was 0.2 MoM. Our median b-hCG values in the second trimester can be used for selecting high-risk patients for fetal chromosomal abnormalities. Further evaluation for the efficiency of b-hCG in screening for other aneuploidies is needed.

Methotrexate로 치유된 경관임신

김세광(SK Kim),이병석(BS Lee),서경(K Seo),박용원(YW Park),김재욱(JU Kim),박찬규(CK Park),송찬호(CH Song),신동환(DH Shin) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.5

A successful use of methotrexate(MTX) in the treatment of a cervical pregnancy is presented. The patient was treated with four doses of methotrexate (50mg, intramuscularly) followed by four doses of leucovorin (50mg, intramuscularly) because of her desire to maintain subsequent fertility potential. The patient was followed up with serum beta hCG and sonography. Resolution was diagnosed 78 days after ocmpletion of 2nd course of methotrexate treatment.

임신 중기 산모혈청 삼중 표지자를 이용한 다운증후군 태아의 선별검사 결과 위양성 산모의 임신 예후

김세광(SK Kim),조재성(JS Cho),김석영(SY Kim),최형민(HM Choi),임종철(JC Lim),김인규(IK Kim),양영호(YH Yang),송찬호(CH Song),김재욱(JU Kim) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.3

Objective: Our purpose was to study the pregnancy outcome in women whose triple marker screening [maternal serum AFP, unconjugated estriol, hCG, and maternal age] indicating an increased risk for Down syndrome [more than 1 : 270] was not confirmed by amniocentesis [false-positive result]. Methods: Between January 1995 and August 1997, 1,070 pregnant women undergoing second trimester triple marker screening for Down syndrome who gave birth at our institution were evaluated. The pregnancy outcomes of 56 women with false-positive screens for Down syndrome were compared with 1,014 screen negative controls. The pregnancy outcomes were obtained from hospital delivery records. Pregnancies with fetal chromosomal and structural anomalies were excluded from the study Results: An adverse pregnancy outcome occurred in 6 of 56 women [10.7%] with false-positive screens for Down syndrome, compared with 80 of 1,014[7.9%] in the screen negative controls [p=0.291]. The study group was not significantly different from the control group in the incidence of preterm delivery [5.4% vs. 3.5%], preeclampsia [0% vs. 1.8%], abruptio placentae [0% vs. 0.2%], intrauterine growth retardation [5.4% vs. 2.0%], and fetal death [0% vs. 0.5%]. Among six women with adverse pregnancy outcome in the study group, low uE3 level[≤ 0.75 MoM] and high hCG level [≥ 2.0 MoM] were more frequently associated with adverse pregnancy outcome than low AFP level[≤ 0.4 MoM]. Conclusion: Women with false-positive screens for Down syndrome do not appear to be associated with adverse pregnancy outcomes.

산모 적혈구 불규칙 항체의 유병률 및 임상적 의의

김세광(SK Kim),김현욱(HW Kim),조재성(JS Cho),김행수(HS Kim),김경수(KS Kim),김태윤(TY Kim),송찬호(CH Song),김재욱(JU Kim) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.8

This study was undertaken to determine both the prevalence of the red cell irregular antibodies and the clinical significance of such antibodies in pregnant women. Among 1.047 patients who received complete prenatal care at the Severance Hospital, Yonsei Medical Center, 22(2.1%) were found to have irregular antibodies. The encountered irregular antibodies in order of frequency were : anti-D(7), anti-Le^a(5), anti-E(2), anti-Le^b(2), anti-E+c(1), anti-Le^a+b(1), anti-Jr^3(1), warm auto(1), cold(1), and unidentified(1). The antecedent maternal risk factors for development of irreaular antibodies such as previous abortion, Cesarean birth, or blood transfusion were observed in 17 patients(77.3%). Seven of the 22(31.8% 0 patients with irregular antibodies delevered infants with hemolytic disease. Only one of these seven required an exchange transfusion. Of the remaining 15 pregnancies with irregular antibodies, they showed normal perinatal outcomes. Our data suggests that irregular antibody screening in all prenatal patients is clinically useful for predicting the likelihood of hemolytic disease of the newborn.

자간증에 관한 임상적 고찰

김세광(SK Kim),황익하(IH Whang),이상용(SR Lee),홍순배(SB Hong),박찬규(CK Park),정순오(SO Chung) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.9

1965년 1월부터 1976년 12월까지 만 12년간 연세대학교 의과대학 부속 세브란스병원 산부인과에 입원, 분만하였던 산모 총 21,704명중 224예의 자간증을 대상으로 의무기록부의 자료를 중심으로 임상통계학적으로 분석을 하여 다음과 같은 결과를 얻었다. 1) 총분만수에 대한 자간의 발생빈도는 1000분만당 10.3이었고, 연도별로는 특기할만한 변화가 없었다. 2) 임신자간, 분만자간, 산욕자간의 빈도는 각각 70.1%, 19.2%, 10.7%였다. 3) 연령별 분포는 분만수가 제일 많은 25-29세군에서 38.9%로 가장 많았다. 4) 경산회수별 분포는 초산부가 66.5%, 경산부가 33.5%였다. 5) 계절별로는 동계에 29.4%로 가장 많았고 춘계, 추계, 하계의 순이었다. 6) 임신기간에 따른 분포는 37-40주군이 66.5%로서 가장 많았고, 평균임신기간은 37.7주였다. 7) 산전관리를 받지 않았던 경우가 86.1%로 대부분을 차지하였다. 8) 경련회수는 1회가 29.5%로 가장 많았으며, 경련과 분만사이의 시간은 25-72시간군이 38.5%로서 가장 많았다. 9) 동반된 질환은 조기파막이 27.1%로서 가장 많았고, 빈혈이 22.9%, 쌍태아와 만성고혈압성 혈관질환이 각각 14.3%였다. 10) 분만방식은 질식분만이 88.9%, 제왕절개술이 11.1%였으며, 질식분만중 자연분만이 49.1%로서 가장 많았으며 제왕절개술의 적응증중 아두골반불균형이 6.2%로서 가장 많았다. 11) 질식분만의 마취는 회음부 차단마취가 52.2%로서 가장 많았으며, 국소마취와 전신마취가 각각 12.9%, 1.4%였으며, 제왕절개술시의 마취방법은 대부분이 전신마취였다. 12) 모성사망율은 자퇴하거나 전과시킨 경우를 제외하고는 자간증의 병발증으로 인하여 4명의 사망환자를 기록하여 모성사망율은 100,000 생아출생당 19였으며, 모성사망의 원인으로서는 패혈증, 뇌졸증, 폐부종 및 급성신부전증이었다. 13) 출생시 태아체중에 따른 예후는 사산이 11예, 신생아사망 8예로서 사산율은 1,000 출생당 48.2, 신생아사망율은 1,000 생아출생당 36.9로서 그 주산기사망율은 1,000 출생당 83.3이었다. 14) 태반의 무게는 600-699gm 군이 41.7%로서 가장 많았다. 15) 입원시에 혈압은 수축기혈압이 160-199mmHg군이 48.3%, 이완기혈압이 110-129mmHg군이 49.5%로서 가장 많았다. 16) 입원시 혈색소는 12.0-13.9gm%군이 49.1%로 가장 많았고, 10.0gm% 미만인 경우도 7.1% 있었으며, 혈구용적지표는 36.0-41.9%군이 48.7%로서 가장 많았다. 17) 혈액의 주요 화학적 검사소견인 Na, In order to study a variety of epidemiological and clinical aspects of ecalamptic patients, a retrospective survey of obstetric records of 224 eclamptic patients, who were admitted between 1965 and 1976, was carried out in the Yonsei University Medical Center. The results were as follows: 1. The incidence of eclampsia was 10.3 per 1,000 deliveries. 2. The distribution of antepartal, intrapartal, and postpartal eclampsia was 70.1%, 19.2%, and 10.7% respectively. 3. 38.9% of the patients were in the age 25-29, which was most prevalent childbirth group. 4. 66.5% of the patients were primigravids. 5. 29.4% of the patients occurred in winter which was followed by spring, autumn, and summer in order. 6. 66.5% were in the gestational period 37-40 weeks. The average duration of gestation was 37.7 weeks. 7. 86.1% of the patients received no antenatal care. 8. 29.5% of the patients had a single convulsion, which was most frequent number of convulsion. 38.5% of the patients convulsed within 25-72 hours before and after delivery. 9. Among the associated diseases, the incidence of SPRM was 27.1% and anemia, twins, chronic hypertensive vascular disease were 22.9%, 14.3%, 14.3% respectively. 10. 88.9% of the patients were delivered vaginally, 11.1% were performed cesarean section. Among the vaginal delivery, 49.1% delivered spontaneously. The most frequent indication for cesarean section was CPD(6.2%). 11. 52.2% of the patients received pudendal blocks. In case of cesarean section the majority had general anesthesia. 12. The maternal mortality from eclampsia managed in YUMC was 19 per 100,000 live births. 13. The stillbirth rate was 48.2 per 1,000 births and the neonatal mortality rate 36.9 per 1,000 live births. The overall perinatal mortality rate was 83.3 per 1,000 births. 14. 41.7% of the patients were in the placental weight 600-699, grams. 15. 48.3% of the patients were in the systolic BP 160-199mmHg on admission and 49.5% the diastolic BP 110-129mmHg. 16. 49.1% of the patients were in the hemoglobin level 12.0-13.9gm%