임상 ; 자궁내 태아사망의 모성 및 출생전후기 위험인자에 관한 연구

송태복 ( Tae Bok Song ),김윤하 ( Yoon Ha Kim ),김종운 ( Jong Woon Kim ),조혜연 ( Hye Yeon Cho ),김은경 ( Eun Kyoung Kim ),조아라 ( Ah Ra Cho ),김현정 ( Hyun Jung Kim ),송은송 ( Eun Song Song ),최영륜 ( Young Yun Choi ) 대한주산의학회 2010 Perinatology Vol.21 No.3

목적: 자궁내 태아사망률은 줄어드는 추세이지만 여전히 전체 주산기 사망의 많은 부분을 차지하고 있고, 아직도 자궁내 태아사망의 원인을 모르는 경우가 많아 이의 위험인자들을 조사하여 향후 산전관리에 도움을 주고 궁극적으로는 자궁내 태아사망의 발생률을 낮추는데 기여하고자 본 연구를 시행하였다. 방법: 2003년 1월부터 2007년 12월까지 5년 동안 전남대학교병원 산부인과에서 분만한 임산부에서 단태아이면서 임신 28주 이상인 경우 중 자궁내 태아사망이 있었던 경우(연구군)와 없었던 경우(대조군)에 대하여 임상기록을 토대로 발생빈도를 알아보고, 임신부와 태아의 임상적 특성에 대한 고찰을 시행하여 통계적으로 유의한 자궁내 태아사망의 위험인자들을 교차비, Student t 검사, 카이제곱 검정을 통하여 조사하고 또한 찾아낸 태아사망 위험 인자들에 대해 로지스틱 회귀분석을 통해 기여도가 높은 위험인자를 산출하였다. 결과: 연구기간동안 임신 28주 이상 총 분만 3,637예 중 단태분만은 3,298예이었고 이중 자궁내 태아사망은 53예로 발생빈도는 1.6%이었다. 태아사망군의 임신부 연령분포는 25-29세에 20예(37.7%)로 가장 많았고, 임신28-32주가 22예(41.5%)로 가장 많았으며, 미산부가 23예(43.4%)이었다. 자궁내 태아사망은 20세 미만 전체의 5.3%에서, 40세 이상 전체의 3.0%에서 발생하여 20세 미만과 40세 이상 연령군에서 다른 연령군의 1.3-1.8%보다 더 많았다. 통계적으로 유의한 태아사망 위험 인자로는 분만직전 체중이 적은 경우, 임신 중 체중증가가 작은 경우, 모체 키가 작은 경우, 그리고 태반조기박리이었다. 이 인자들 중 로지스틱 회귀분석에 의한 기여도가 높은 위험인자로는 태반조기박리(β=-0.067, P=0.000)와 임신 중 작은 체중증가(β=0.002, P=0.000) 이었다. 결론: 임신 28주 이상 단태임신에서 자궁내 태아사망의 위험인자는 분만직전 체중이 적은 경우, 임신 중 체중증가가 작은 경우, 모체 키가 작은 경우, 그리고 태반조기박리 등이었으며 이 중 기여도가 높은 위험인자는 태반조기박리와 임신 중 작은 체중증가이었다. Purpose: The purpose of this study was to identify the risk factors for intrauterine fetal death (IUFD). Methods: We carried out a case control retrospective study, at the Chonnam National University Hospital, Korea. We included all pregnant women diagnosed as singleton IUFD in pregnancies of 28 weeks of gestation or more, admitted to the hospital from Jan 2003 to Dec 2007. There were 53 cases of singleton IUFD and 3,298 cases of singleton live birth during that period. The incidence, age distribution, and prevalent gestational weeks were analysed. The risk factors were analyzed by using odds ratio, Student`s t test, and Chisquare test. Logistic regression analysis was applied to determine independent risk factors. Results: The overall incidence of IUFD was 1.6%. The age distribution of mother with IUFD was highest in the age group of 20 year old or less (5.3%). IUFD was the most prevalent at 28-32 weeks of gestation (41.5%). Significant risk factors were maternal body weight just before delivery, weight gain during pregnancy, and abruptio placentae. The independent risk factors were weight gain during pregnancy (β=0.002, P=0.000) and abruptio placentae (β=-0.067, P=0.000). Conclusion: Lower maternal body weight just before delivery, lower weight gain during pregnancy, and abruptio placentae are factors significantly associated with IUFD. Further investigations are needed to understand the complex etiology of stillbirth.

임신 31주 산모의 복부 자상으로 인해 발생한 태아 두부 손상

송은송 ( Eun Song Song ),김수영 ( Soo Young Kim ),최영륜 ( Young Youn Choi ),김윤하 ( Yoon Ha Kim ),송태복 ( Tae Bok Song ) 대한주산의학회 2009 Perinatology Vol.20 No.3

Penetrating trauma in a fetus is uncommon but may cause potentially life-threatening injuries. We experienced a case of preterm infant who delivered by C-section and showed two deep laceration wounds on face, facial nerve palsy, skull fracture and intracranial hemorrhage due to penetrating injury of an abdominal stab wound in a 31 weeks pregnant woman.

조기분만진통 임부와 만삭 전 조기양막파열 임부의 정맥혈장내 산화 스트레스 지표

김윤하 ( Yoon Ha Kim ),노은지 ( Eun Ji Noh ),백주아 ( Ju A Back ),김종운 ( Jong Woon Kim ),송태복 ( Tae Bok Song ) 대한주산의학회 2015 Perinatology Vol.26 No.4

목적: 조기분만진통 및 만삭 전 조기양막파열 임부의 정맥혈장내 산화능과 항산화능의 차이를 비교하고 산화 스트레스가 조기양막파열의 병태생리에 어떤 역할을 하는가를 규명하고자 하였다.방법: 75명의 임부를 대상으로 정맥혈을 채취하고 원심분리 후 혈장을 얻었다. (1) A군, 정상 임부 24명, (2) B군, 조기분만진통 임부 25명, (3) C군, 만삭 전 조기양막파열 임부 26명. thiobarbituric acid 반응을 이용하여 지질과산화물 농도를 측정하였고, 2,4-dinitrophenylhydrazine 방법을 이용하여 단백질의 carbonyl 기 함량을 측정하였으며, oxygen radical absorbance capacity assay (ORAC)로 총 항산화능을 측정하였다. Mann-Whitney U test, Kruskal Wallis test를 이용하여 분석하였다. 결과: B군과 C군의 정맥혈장내 지질과산화 치는 A군에 비해 의미있게 높았으며(B군: 4.59±0.30, C군: 5.40±0.22 vs. A군: 3.90±0.26 nmol/mg protein, P<0.05), C군의 정맥혈장내 지질과산화 치는 B군에 비해 의미있게 높았다. C군의 정맥혈장내 carbonyl기 함량은 A군에 비해 의미있게 높았으며(C군: 5.68±0.42 vs. A군: 5.43±0.41 nmol/mg protein, P<0.05), A군과 B군간의 carbonyl기 함량에는 차이가 없었다. 항산화능에 있어서는 B군과 C군이 A군에 비해 의미있게 낮았으며(B군: 117.91±0.48, C군: 111.68±1.23 vs. A군: 119.14±1.12 mM/mL, P<0.05), C군이 B군에 비해 의미있게 낮았다(P<0.05). 결론: 만삭 전 조기양막파열시 조기분만진통에 비해 정맥혈장에서 산화적 변화가 증가되어 있었으며 항산화능은 감소되어 있었다. 이는 조기양막파열시 산화적 스트레스가 증가되어 있을 가능성을 시사한다. Purpose: This study was performed to investigate the oxidation and antioxidation capacity in the maternalvenous plasma of preterm labor with intact membranes, and premature rupture of membranes (PPROM), andalso to evaluate their roles in the pathophysiology of PPROM. Methods: Seventy five women in the following categories had venous blood retrieved: (1) Group A, normal pregnancy (n=24). (2) Group B, preterm labor with intact membranes (n=25). (3) Group C, preterm premature rupture of membranes (n=26). Malondialdehyde (MDA) levels as a marker of lipid peroxidation by thiobarbituric acid reaction, protein carbonyl content by 2,4-dinitrophenylhydrazine reaction, and total antioxidant capacity by oxygen radical absorbance capacity assay (ORAC) were measured. Mann-Whitney U test, Kruskal-Wallis test were used for statistical analysis. Results: Lipid peroxide levels in the venous plasma of group B and C were significantly higher than those of group A (group B: 4.59±0.30, group C: 5.40±0.22 vs. group A: 3.90±0.26 nmol/mg protein, P<0.05). Lipid peroxide levels in the venous plasma of group C were significantly higher than those of group B (P<0.05). Protein carbonyl levels in the venous plasma of group C were significantly higher than those of group A (group C: 5.68±0.42 vs. group A: 5.43±0.41 nmol/mg protein, P<0.05). There was no significant difference of protein carbonyl levels in the venous plasma between group A and B. ORAC levels in the venous plasma of group B and C were significantly lower than those of group A (group B: 117.90±0.48, group C: 111.68±1.23 vs. group A: 119.14±1.12 mM/mL, P<0.05). ORAC levels in the venous plasma of group C were significantly lower than those of group B (P<0.05). Conclusion: In the blood of the women with preterm premature rupture of membranes, the lipid peroxidation was increased and the antioxidant capacity was decreased compared to women with normal pregnancy and preterm labor with intact membranes. These results suggest that oxidative stress was increased in preterm premature rupture of membranes.

자간전증에서 제대정맥혈장내 interleukin-6, tumor necrosis factor-α, 및 항산화제 농도

김윤하 ( Yoon Ha Kim ),송태복 ( Tae Bok Song ),박소정 ( So Jeong Park ),박지노 ( Ji No Park ),정광필 ( Kwang Pil Jeong ),김종운 ( Jong Woon Kim ),김석모 ( Seok Mo Kim ),김철홍 ( Cheol Hong Kim ),조문경 ( Moon Kyoung Cho ),김기민 ( 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.7

Objective: Our purpose was to investigate Interleukin-6 (IL-6), tumor necrotic factor-α (TNF-α), lipid peroxide levels, oxygen-radical absorbance capacity (ORAC), and antioxidant levels in umbilical venous blood plasma and to evaluate the roles of them in the pathophysiology of preeclampsia. Study design: Samples of umbilical venous plasma were obtained from 20 normal and 20 preeclamptic women between 33 and 40 weeks gestation. IL-6 and TNF-α was assayed by an enzyme -linked immunoassay. Lipid peroxide levels were measured by thiobarbituric acid reaction. The ORAC values were measured by Cao`s method. Ascorbic acid, retinol, α-tocopherol, and γ-tocopherol were measured by high performance liquid chromatography. Results: There was no significant differences of IL-6 levels in umbilical venous plasma between women with normal and preeclampsia (2.79±0.21 vs. 2.94±0.17 ng/ml). TNF-α levels in umbilical venous plasma of women with preeclampsia were significantly higher than that of women with preeclampsia (3.04±0.01 vs. 1.40±0.01 ng/ml, p<0.01). Lipid peroxide levels in umbilical venous plasma of women with preeclampsia were significantly higher than that of women with normal pregnancy (7.32±0.09 vs. 5.18±0.14, p<0.01). The ORAC values in umbilical venous plasma of women with preeclampsia were significantly lower than that of women with normal pregnancy (12,836.5±249.4 vs. 10,490.2±276.9 U/ml, p<0.05). Ascorbic acid levels in umbilical venous plasma of women with preeclampsia were significantly lower than those of women with normal pregnancy (320.2±48.5 vs. 538.5±68.2 nmol/ml, p<0.05). Conclusion: The above results in umbilical venous plasma suggest that the imbalance of lipid peroxidation and antioxidant activity in placenta is involved in the pathophysiology of preeclampsia. Increased TNF-a in the umbilical venous plasma showed inflammatory reaction in the placenta would be one of the cause of preclampsia. An antioxidant vitamin, ascorbic acid, may act an important antioxidant factor in preeclampsia

유도분만의 성공 예측인자로서 자궁경부 길이, 부피, 히스토그램의 평가

김윤하 ( Yoon Ha Kim ),김종운 ( Jong Woon Kim ),김철홍 ( Chul Hong Kim ),조문경 ( Moon Kyoung Cho ),조혜연 ( Hye Yon Cho ),조아라 ( Ah Ra Cho ),강우대 ( Woo Dae Kang ),김석모 ( Seok Mo Kim ),송태복 ( Tae Bok Song ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.5

Objective: The aim of this study was to evaluate whether the Bishop score, length, volume and gray-scale histogram of the cervix has a predictive value of assessing the rate of success in trial of induction. Methods: Forty-one nulliparous patients with its Bishop score six or less were enrolled for this prospective study. All were on prostaglandin E2 (PGE2, Propess(R); Controlled Therapeutics Ltd) pessary. Three-dimensional transvaginal ultrasound scans of the cervix were performed on the ACCUVIX XQ (Medison) to measure length, volume, and gray-scale histogram. Bishop score was determined by digital examination. The successful induction was defined as the ability to achieve the active phase of labor corresponding to a cervical dilatation of ≥4 cm within 12 hours of removing the PGE2 pessary. The receiver operating characteristics (ROC) curves were also used to estimate an optimal cutoff point for the Bishop score, length, volume, and gray-scale histogram of the cervix. Logistic regression analysis was used for statistical analyses. Results: The overall successful rate of labor induction was 73.2% (30/41). Multiple logistic regression analyses demonstrated that the value of anterior lip histogram was significantly associated with the successful labor induction. ROC curve for anterior lip histogram value in predicting success of induction indicated a significant relationship with successful induction. The best cutoff value was 69.4. Conclusion: The value of anterior lip histogram associates significantly with the prediction of successful induction in nulliparous women. But, Bishop score and other sonographic measurement of cervical length, volume, and posterior lip histogram have no predictive values for successful induction.

정상과 자간전증 임부의 태반내 지질과산화치와 항산화능

김윤하(Yoon Ha Kim),송태복(Tae Bok Song),안봉환(Bong Whan Ahn),양성렬(Sung Yeul Yang),이소윤(So Yoon Lee),김석모(Seok Mo Kim),정광필(Kwang Pil Jeong),변지수(Ji Soo Byun),조문경(Moon Kyoung Jo) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.8

Objective : Our purpose was to investigate lipid peroxide levels, total peroxyl radical-trapping antioxidative parameter (TRAP) values, and antioxidant vitamin levels in placental tissues of women with preeclampsia and to evaluate their roles in the pathophysiology of preeclampsia. Study Design : Samples of placental tissue homogenates were obtained from 23 normal and 18 preeclamptic women between 33 and 40 weeks gestation. TNF-α was assayed by an enzyme-linked immunoassay. Lipid peroxide levels measured by thiobarbituric acid reaction. The TRAP values were measured by modified Wayners method. Ascorbic acid, uric acid, retinol, α-tocopherol, and γ-tocopherol were measured by high performance liquid chromatography (HPLC) CoulArray detector. Results : TNF-α levels in placental tissue homogenates of women with preeclampsia were significantly higher than that of women with preeclampsia (21.4±3.39 vs. 10.3±1.06 pg/㎖, p<0.05). Lipid peroxide levels in placental tissue homogenates of women with preeclampsia were significantly higher than that of women with preeclampsia (6.65±0.57 vs. 4.98±0.37 nmol/㎎ protein, p<0.05). TRAP values in placental tissue homogenates of women with preeclampsia were significantly lower than that of women with normal pregnancy (0.24±0.02 vs. 0.31±0.03 mM, p<0.05). Ascorbic acid levels in placental tissue homogenates of women with preeclampsia were significantly lower than that of women with normal pregnancy (217.0±21.0 vs. 333.3±32.8 nmol/㎖, p<0.05). Conclusion : The above results suggest that increased oxidative stress in placenta is involved in the pathophysiology of preeclampsia and ascorbic acid may act as an important preventive factor in the development of preeclampsia.

선행제왕절개 임부의 유도분만

김윤하(Yoon Ha Kim),송태복(Tae Bok Song),김형춘(Hyoung Choon Kim),김기민(Ki Min Kim),이경철(Kung Chol Lee),김석모(Seok Mo Kim),변지수(Ji Soo Byun) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.2

Objective : To determine the efficacy and safety of labor induction in patients previously delivered by a low transverse cesarean section. Method : A retrospective review was done at Chonnam National University Hospital, Kwangju, Korea. All patients with a previous cesarean section who required labor induction from April, 1986 to June, 1999 were identified. Outcome of labor induction, including mode of delivery, maternal and perinatal morbidity, and birth trauma were evaluated. Results : Trial of labor was undertaken by 1256 women(55.8%) who had previously been delivered by a low transverse cesarean section. 973 patients(77.5%) with a previous cesarean birth had a spontaneous onset of labor. Labor was induced in 283 patients(22.5%) with a previous cesarean birth. Successful vaginal delivery rate were 82.9%(807/973) in spontaneous labor and 79.2%(224/283) in induced labor group (p= NS). There were no differences in uterine dehiscence and rupture rate, perinatal and maternal mortality rate, and the rate of infants with low 1 or 5-minute Apgar scores between patients attempting a trial of labor after cesarean, spontaneous and induced. Conclusion : we conclude that labor induction in patients with a previous low transverse cesarean section is a safe procedure requiring close peripartum maternal and fetal surveillance.

만삭전 조기양막파열 산모의 양수내 항산화능

김윤하(Yoon Ha Kim),안봉환(Bong Whan Ahan),양성열(Sung Yeul Yang),김현주(Hyun Joo Kim),이경철(Kyung Chul Lee),김석모(Seok Mo Kim),송태복(Tae Bok Song),변지수(Ji Soo Byun) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.4

Objective : This study was to determine the levels of cytokines, lipid peroxides, and total peroxyl radical-trapping antioxidative prameter (TRAP) values of amniotic fluid in pregnant women with preterm premature rupture of membranes (PPROM). Method : Amniotic fluid samples were obtained by amniocenteses for chromosomal analyses and other indications(control, n=26). Amniotic fluid samples were also obtained by amnioceteses from pregnant women with preterm premature rupture of membranes (n=22). Amniotic fluid cytokines(IL-6, IL-8) were determined by enzyme-linked immunosorbent assay (ELISA). Lipid peroxide levels of amniotic fluid were measured by thiobarbituric acid (TBA) reaction. The TRAP value of amniotic fluid was assessed by measuring the rate of oxygen consuming during controlled lipid peroxidation by 2,2'-azobis-2-amidinopropane hydrochloride, a water soluble peroxyl radical generator. Ascorbic acid and uric acid were measured by high performance liquid chromatography (HPLC) CoulArray detector of water-soluble antioxidants. Retinol, α-tocopherol, and γ- tocopherol were measured by HPLC-CoulArray detector of fat-soluble vitamins. Results : Cytokine levels of amniotic fluid in pregnant women with PPROM(IL-6: 23.37±10.61 ng/ml, IL-8: 10.23±3.04 ng/ml) were significantly higher than those in normal pregnant women(IL-6: 0.62±0.32 ng/ml, IL-8: 0.55 ± 0.15 ng/ml), (p<0.05). Lipid peroxide levels of the amniotic fluid in pregnant women with PPROM(10.42±1.11 nmol/mg protein) were significantly higher than those in normal pregnant women (7.32±0.65 nmol/mg protein), (p<0.05). The amniotic fluid obtained from pregnant women with PPROM showed significantly lower TRAP values (0.46±0.04 mM) than those from normal pregnant women(0.62±0.03 mM), (p<0.01). Amniotic fluid ascorbic acid levels in pregnant women with PPROM (52.1±15.1 nmol/ml) were significantly lower than in normal pregnant women(231.9±33.9 nmol/ml), (p<0.01). There were no significant differences of amniotic fluid uric acid, retinol, α-tocopherol, and γ-tocopherol levels between these groups. Conclusions : This findings suggest that a low antioxidant activity in amniotic fluid may cause PPROM and demonstrate that antioxidant vitamin, ascorbic acid, may act an important factor in the prevention of PPROM.

자궁내 발육지연 태아의 제대정맥 혈액가스 및 중뇌동맥과 신장동맥의 혈류속도 파형

김윤하 ( Yoon Ha Kim ),송태복 ( Tae Bok Song ),김경선 ( Kyoung Seon Kim ),임소이 ( So Yi Rim ),김석모 ( Seok Mo Kim ),변지수 ( Ji Soo Byun ) 대한주산의학회 2001 Perinatology Vol.12 No.2

임신중기의 모체혈청 α-Fetoprotein, Human Chorionic Gonadotropin 및 Unconjugated Estriol을 이용한 염색체이상 태아의 산전 선별검사

김윤하 ( Yoon Ha Kim ),신진옥 ( Jin Ok Shin ),송태복 ( Tae Bok Song ),변지수 ( Ji Soo Byun ),송호천 ( Ho Chun Song ) 대한주산의학회 1995 大韓周産醫學會雜誌 Vol.6 No.4