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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
N/A 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.
이중엽(Joong Yeup Lee),심순섭(Soon Sup Shim),한수연(Soo Yeon Han),고은미(Eun Mi Ko),박중신(Joong Shin Park),전종관(Jong Kwan Jun),윤보현(Bo Hyun Yoon),신희철(Hee Chul Syn) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.8
Acardiac twin is a rare complication of multifetal pregnancy. The literatures report an incidence of 1% among monochorionic twin pregnancies, I. E. 1 of 35,000 pregnancies. The absence of identifiable fetal heart structures in one twin and reduction anomalies in many organ systems suggest the diagnosis. It has been hypothesized that in the presence of artery-to-artery and vein-to-vein anastomoses in a monozygotic placenta, blood is perfused by hemodynamically advantaged pump-twin to the recipient twin by retrograde flow. The principal perinatal problems associated with acardiac twinning are congestive heart failure of pump-twin, maternal polyhydramnios, preterm delivery and intrauterine death. The outcome is invariably fatal for the acardiac twin and 50-75% of the normal twin. Management options include observation, medical therapy, and selective termination of acardiac twin. The most appropriate intervention for the various clinical presentations of this disorder is undetermined, and conservative nonintervention is often appropriate. Long-term follow-up data on surviving pump twins are lacking. We experienced a case of acardiac twin gestation which showed satisfactory outcome with conservative management, so we present the case with a brief review of the literature.
비면역성 태아수종: 임상양상과 신생아의 생존과 관련된 예후인자
이중엽 ( Joong Yeup Lee ),손유경 ( Yoo Kyung Sohn ),심순섭 ( Soon Sup Shim ),임준희 ( June Hee Im ),심재윤 ( Jae Yoon Shim ),박중신 ( Joong Shin Park ),전종관 ( Jong Kwan Jun ),윤보현 ( Bo Hyun Yoon ),신희철 ( Hee Chul Syn ) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.12
목적 : 비면역성 태아수종의 발생빈도, 관련조건 (혹은 원인), 주산기 결과를 확인하고, 신생아 생존과 관련있는 예후인자를 밝혀내고자 하였다. 연구 방법 : 1988년 10월부터 2001년 2월까지 서울대학교병원 산부인과에서 진단된 54예의 비면역성 태아수종의 후향적 고찰을 통하여 발생빈도, 관련조건, 주산기 결과를 확인하였다. 아울러 생존하여 출산된 20예의 신생아를 28일 초과 생존한 군과 28일 이하에 사망한 군으로 구분하여 신생아 생존과 관련된 Objective : We undertook this study to find out clinical characteristics and prognostic factors of neonatal survival in nonimmune hydrops fetalis (NIHF). Methods : From Oct. 1988 to Feb. 2001, 54 cases of nonimmune hydrops fetalis diagnosed at Seoul Natio
태아 생물리학적 계수와 제대 천자를 통해 얻어진 태아 혈액 산염기 상태의 상관 관계
문정빈(Jeong Bin Moon),박중신(Joong Shin Park),전종관(Jong Kwan Jun),윤보현(By Hyun Yoon),신희철(Hee Chul Syn) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.2
목적 : 제대천자를 통해 얻어진 혈액에서의 산염기 상태와 제대천자 직전에 수행된 생물리학적 계수와의 상관관계를 알아보고, 이를 통해 산전 태아검사로서 생물리학적 계수의 생화학적 근거를 살펴보고자 한다. 연구 대상 및 방법 : 제대천자의 적응이 되는 산모 중에서 단태임신으로 정상 핵형을 가진 121명의 태아를 대상으로 하여 생물리학적 계수를 측정하고, 제대천자혈의 산염기 상태 및 가스 분석을 시행하여 생물리학적 검사 결과와 제대혈 분석 결과를 상호 비교하였다. 결과 : 1) 생물리학적 계수는 제대천자혈의 산염기 상태와 혈액가스분석의 결과와 뚜렷한 상관관계가 있었고 (p<0.001), 2) 태아 산혈증의 진단에 민감하지는 않으나 (민감도; 24%), 심한 산혈증의 상태를 잘 반영하였으며, 3) 생물리학적 계수의 각 구성 변수간에 정상에서의 pH 하한값을 비교하였을 때 태아 심박수의 반응성, 태아의 호흡 운동, 태아의 전신 운동, 태아의 근 긴장도, 양수양의 순서로 정상 반응의 pH 하한값이 낮아지는 순차적인 반응을 보였고, 4) 생물리학적 계수 중 비자극검사는 임신 주수가 진행함에 따라 보다 심한 산혈증 상태에서 비반응성 (nonreactive)을 보였다. 5) 또한, 생물리학적 계수는 태아의 기형 유무에 영향을 받기보다는 태아의 대사 상태에 따라 결정되는 것으로 나타났다. 결론 : 태아 생물리학적 계수는 태아의 대사상태를 잘 반영하는 비침습적인 검사로서 심한 산혈증의 진단에 유용하며, 임신 주수에 영향을 받으나 태아의 기형 여부에 상관없이 시행할 수 있는 유용한 산전 검사이다. Objective : Fetal biophysical profile is widely used antenatal test for fetal wellbeing, but its biochemical background is not well known. The purpose of this study is to examine the relationship of fetal biophysical profile and cord blood acid base status including gas analysis using cord blood obtained by cordocentesis, by which the biochemical background of fetal biophysical profile can be understood. Study design : 121 pregnant women received cordocentesis for various indication, of whom the fetuses were evaluated with fetal biophysical profile just before the cordocentesis. Cord blood obtained by cordocentesis was analyzed for acid-base and gas status. The results of both tests were compared by appropriate statistical method. Results : Fetal biophysical profile showed definite correlation with the results of cord blood acid-base and gas analysis (p<0.001). Fetal biophysical profile was not a sensitive study for the diagnosis of fetal acidemia, but the test could be used for the diagnosis of severe fetal acidemia. Variables of fetal biophysical profile responded to acidemia differently and there were gradual changes among the variables according to the degree of acidemia. Gestational age was important factor for the normality of nonstress test, even after adjustment of pH level. Anomaly did not affect the fetal biophysical profile and fetal biophysical profile was determined mainly by fetal metabolic status. Conclusion : Fetal biophysical profile score is a useful noninvasive antenatal test reflecting fetal acid base status, effective for the diagnosis of severe acidemia, probably affected by fetal gestational age, but not by fetal anomaly.