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조기 양막파수된 임산부에서 자궁내 감염의 산전 진단과 주산기 예후 예측에 있어 양수내 IL-6 측정과 양수배양 검사의 비교 연구
박교훈(Kyo Hoon Park),윤보현(Bo Hyun Yoon),김미하(Mi Ha Kim),김길자(Gil Ja Kim),김데리샤(Teresa Kim),이홍균(Hong Kyoon Lee),신희철(Hee Chul Syn) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.6
Objectives : Our purpose was (1) to determine whether amniotic fluid concentrations of interleukin-6 are of value in the diagnosis of histologic chorioamnionitis of preterm placenta and in the prediction of significant perinatal morbidity and mortality in patients with preterm premature rupture of membranes and (2) to compare the diagnostic performance of amniotic fluid interleukin-6 with that of amniotic fluid microbial culture for these outcome variables.Method : The relation among placental histologic finding, perinatal outcome, amniotic fluid culture, and amniotic fluid interleukin-6 concentrations were examined in 65 patients with preterm premature rupture of membranes who delivered preterm neonates within 72 hours after transabdominal amniocentesis. Interleukin-6 level was determined by enzyme-linked immunosorbent assay. Receiver-operator characteristic curve, Mann-Whitney U test, and Fisher's exact test were used for analysis. Results : 1) Patients with acute histologic chorioamnionitis had significantly higher median amniotic fluid interleukin-6 concentrations than those without histologic chorioamnionitis (median 12.6 ng/ml, range 0.03 to 142.2 ng/ml vs median 0.5 ng/ml, range 0.03 to 16 ng/ml; p < 0.0001). 2) Amniotic fluid having interleukin-6 concentrations higher than 3.2 ng/ml had a sensitivity of 78% (35/45) and specificity of 95% (19/20) in the diagnosis of acute histologic chorioamnionitis and sensitivity of 74% (25/34) and specificity of 65% (20/31) in the prediction of significant neonatal morbidity and mortality. 3) These sensitivities were significantly higher than those of amniotic fluid culture, but there were no significant difference in specificities between amniotic fluid interleukin-6 and culture (histologic chorioamnionitis: 78% vs 51%, p<0.01; significant neonatal morbidity and mortality: 74% vs 47%, p<0.01, respectively).Conclusion : Test of amniotic fluid interleukin-6 is of value and more sensitive than amniotic fluid culture for the antenatal diagnosis of histologic chorioamnionitis and for the prediction of perinatal outcome in patients with preterm premature rupture of membranes.
박교훈(Kyo Hoon Park),이홍균(Hong Kyoon Lee),이혁(Hyeok Lee),한정훈(Jeong Hoon Han),조용균(Yong Kyoon Cho),최훈(Hoon Choi),김복린(Bok Rin Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.11
Objective: Our purpose was to evaluate the effect of epidural anesthesia on labor course. Methods: Between January 1998 and December 1998, we evaluated pregnant women at term with singleton fetus in vertex presentation and with spontaneous onset of labor at our hospital. Comparison of 120 women (100 cases of primiparous women, 20 cases of multiparous women) who received epidural anesthesia in labor with 120 women (100 cases of primiparous women, 20 cases of multiparous women) who did not receive epidural anesthesia was performed. Adverse pregnancy outcomes were obtained from hospital delivery records and neonatal records. Statistical analysis were performed by Student's t-test and Chi square test. Results: The results of this study were as followings; 1. There was no significant difference in mean age, body weight, height, and gestational age between epidural anesthesia group and control group (P>0.05). 2. The frequency of oxytocin augmentation was significantly greater in the primiparous epidural anesthetic group than in primiparous control group (p<0.05). 3. The effect of epidural anesthesia on the first stage of labor revealed no significant difference in both group. 4. Prolongation of second stage of labor was noticed in nullipara of epidural anesthesia group compared to control group (P<0.05). 5. The incidence of instrumental delivery was significantly increased in the primiparous epidural group than in the primiparous control group(p<0.05). 6. The meconium-stained amnionic fluid, Apgar score and birth weight were similar in both groups. 7. The maternal blood loss was similar in both groups. Conclusion: Epidural anesthesia, significantly prolongs second stage of labor in induced patients. While instrumental delivery was more prevalent in these parturients, C-section rate and intra-partum complications were not increased in these patients.
경막외마취에 의한 제왕절개술시 발생한 일시적 저혈압이 제대혈 pH 및 가스상태에 미치는 영향
박교훈 ( Kyo Hoon Park ),윤보현 ( Bo Hyun Yoon ),신희철 ( Hee Chul Syn ) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.12
Objective: To determine if maternal hypotension developed after the induction of epidural anesthesia is associated with changes in umbilical cord arterial blood pH and acid-base status in healthy term neonates. Study Design: We compared umbilical cord arterial blood acid-base status at birth in healthy term newborns delivered by elective cesarean section without labor and by epidural anesthesia according to the occurrence of maternal hypotension or not. Healthy term neonates were identified by a reactive nonstress test, absence of oligohydramnios, and normal fetal biophysical profile score (≥8/10) within 12 hours before elective cesarean section. Two groups of patients were identified after the induction of epidural anesthesia: 1-maternal hypotension(n=27) defined as systolic blood pressure lower than 100 mmHg or a greater than 30 % decrease from baseline; 2-normotensive mother(n=68). Maternal hypotension was promptly corrected by intravenous infusion of additional fluids and ephedrine. Umbilical cord arterial pH and blood gas status and Apgar scores were compared between the two groups of patients using contingency table analysis or Mann-Whitney U tests. Results: 1) Neonates born to women with transient maternal hypotension had significantly lower umbilical arterial pH and higher pCO2 values than did not develop hypotension(pH; median 7.26, range 7.15-7.34 vs. median 7.29, range 7.11-7.39, p<0.005, pCO2; median 56 mmHg, range 36-66 vs. median 52 mmHg, range 32-68, P<0.001, respectively). 2) The prevalence of fetal acidemia(cord arterial pH <7.20) was significantly higher in newborns of maternal hypotension than that in newborns of normotensive mothers(22 % [6/27] vs. 3 % [2/68]), p<0.01). 3) However, the prevalence of low Apgar score(<7) was similar between the two groups. 4) Most neonates born with acidemia after epidural associated maternal hypotension were vigorous at birth(prevalence of low Apgar score at 1 min. was 17 % [1/6], at 5 min. was 0 % [0/6], respectively). Conclusion: Although transient maternal hypotension during epidural anesthesia can induce acidemia in healthy neonates, most fetuses are vigorous.
자궁내 감염과 조산에서 양수 트롬빈 활성화에 관한 연구
박교훈 ( Kyo Hoon Park ),조용균 ( Yong Kyoon Cho ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.2
Objective : Disseminated intravascular coagulation (DIC) is a serious and life-threatening complication of amniotic fluid embolism and chorioamnionitis. DIC results from excessive thrombin activity leading to a consumptive coagulopathy. The mechanisms res
중증 자간전증에서 양수 융모성 성선자극 호르몬, 알파 태아단백에 관한 연구
박교훈(Kyo Hoon Park),박경미(Koung Mee Park),조용균(Yong Kyoon Cho),최훈(Hoon Choi),김복린(Bok Rin Kim),이홍균(Hong Kyoon Lee) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.5
Objective : Unexplained elevations of midtrimester human chorionic gonadotrophin(hCG) or alpha fetoprotein(AFP) have known to be at increased risk for a variety of third trimester pregnancy complication, such as preeclampsia. The causes of these were thought to be made by impaired placental function, as a reflection of impaired uteroplacental circulation. Our purpose was to determine if amniotic fluid total -hCG and AFP levels are elevated in women with severe preeclampsia and if these levels correlated with other laboratory features of disease severity. Methods : Seventeen women with severe preeclampsia were matched with 16 women with the diagnosis of either preterm labor and intact membranes(n=10) or preterm premature rupture of membranes(n=6) who met the following criteria: 1) singleton gestation 2) absence of congenital anomaly 3) absence of active labor 4) confirmed getational age by ultrasonography 5) transabdominal amniocentesis performed to obtain amniotic fluid to assess fetal lung maturity. Amniotic fluid total -hCG and AFP were measured by double antibody radioimmunoassay(RADIM, Italy). Mann-Whitney U test and multiple linear regression analysis were used. Results: 1) Concentrations of amniotic fluid total -hCG but not amniotic fluid AFP, maternal blood total -hCG and AFP were significantly higher in severely preeclamptic women than in their matched controls(amniotic fluid total -hCG; median 28.5, range 4.3-120.3 IU/ml vs. median 9.4, range 2.7-99 IU/ml, p < 0.01). 2) Amniotic fluid total -hCG levels correlated positively with maternal blood BUN(blood urea nitrogen) levels(r= 0.66, regression coefficients 5.57, standard error 2.4021, p< 0.05, multiple linear regression) after correction for known confounding variables(i.e., maternal weight, gestational age at sampling, hematocrit). Conclusion: Amniotic fluid total -hCG levels are elevated in women with severe preeclampsia and correlate closely with maternal blood BUN levels. These observation suggest that the pathologic changes of preeclampsia might occur in the placenta and involve in change of a significantly secretory reaction of the placenta.
조기분만진통 임산부에서 양수 tumor necrosis factor-α 와 조직학적 융모양막염 및 선천성 패혈증과의 관련성에 관한 연구
박교훈(Kyo Hoon Park),윤보현(Bo Hyun Yoon),전중관(Jong Kwan Jun),박중신(Joong Shin Park),김길자(Gil Ja Kim),이홍균(Hong Kyoon Lee),신희철(Hee Chul Syn) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.5
Objective : Our purposes were (1) to determine whether amniotic fluid concentrations of tumor necrosis factor-α are of value in the diagnosis of histologic chorioamnionitis of preterm placenta and in the prediction of congenital sepsis in patients with preterm labor and intact membranes and (2) to compare the diagnostic performance of placental histologic finding and amniotic fluid culture with that of amniotic fluid tumor necrosis factor-α for this outcome variable. Methods : The relations among placental histologic finding, perinatal outcome, amniotic fluid culture, and amniotic fluid tumor necrosis factor-α concentrations were examined in 61 consecutive patients with preterm labor and intact membranes who delivered preterm neonates within 72 hours after transabdominal amniocentesis. Tumor necrosis factor-α was determined by enzyme-linked immunosorbent assays. Mann-Whitney U test, Fisher's exact test, receiver-operator characteristic curve, and multiple logistic regression were used for analysis. Results : 1) Women with acute histologic chorioamnionitis had significantly higher median amniotic fluid tumor necrosis factor-α concentrations than those without histologic chorioamnionitis (median 83.2 pg/ml, range 1.4 to 7241 pg/ml vs median 1.6 pg/ml, range 0 to 59.9 pg/ml, p <0.0001). Amniotic fluid tumor necrosis factor-α concentrations ≥4.6 pg/ml had a sensitivity of 88% (28/32) and specificity of 80% (23/29) in the diagnosis of acute histologic chorioamnionitis. 2) Amniotic fluid concentrations of tumor necrosis factor-α were significantly higher in neonates with congenital sepsis than in those without congenital sepsis (median 227.5 pg/ml, range 1.2 to 7241 pg/ml vs median 3.8 pg/ml, range 0 to 735 pg/ml, p <0.0005). Amniotic fluid tumor necrosis factor-α concentrations ≥41 pg/ml had a sensitivity of 82% (23/29) and specificity of 79% (38/48) in the prediction of congenital sepsis. 3) Multiple logistic regression indicated that elevated amniotic fluid tumor necrosis factor-α (≥41 pg/ml) was the only independent predictor of congenital sepsis (odd ratio 12.9, 95% confidence interval 1.3 to 125.3, p <0.05) after correction for known confounding variables [i.e., low gestational age at birth (≤32 weeks), positive amniotic fluid culture, histologic or clinical chorioamnionitis, low Apgar score (<7)]. Conclusion : Test of amniotic fluid tumor necrosis factor-α is of value in the antenatal diagnosis of histologic chorioamnionitis and congenital sepsis in patients with preterm labor and intact membranes. Amniotic fluid tumor necrosis factor-α is a better independent predictor of congenital sepsis than placental histologic finding or amniotic fluid culture.