원저 : 체외 수정으로 임신된 조기 출산 쌍태아와 정상 임신된 조기 출산 쌍태아의 임상적 고찰

신준헌 ( Jun Hun Shin ),남희영 ( Hee Young Nam ),이초애 ( Cho Ae Lee ),최은나 ( Eun Na Choi ),이규형 ( Kyu Hyung Lee ) 대한주산의학회 2006 Perinatology Vol.17 No.4

목적 : 본 연구의 목적은 체외 수정시술로 임신된 조기 출산 쌍태아와 자연 임신된 조기 출산 쌍태아의 신생아 예후를 알아보고자 기획되었다. 방법 : 60쌍의 체외 수정시술로 임신된 산모(체외 수정군)와 34쌍의 자연 임신된 산모(자연 임신군)의 조기 출산 쌍태아의 신생아 예후를 후향적으로 분석하였다. 산모와 산과적 특성도 비교하였다. 모든 출생아는 재태 주령 35주 미만이었고 2000년 1월부터 2004년 12월 사이에 분당차병원에서 태어났으며 모두 신생아 집중치료실에 입원했던 환아였다. 통계학적 방법으로는 Student t-검정과 χ2 검정을 시행하였다. 결과 : 산과적 특성상, 산모의 연령과 초산부의 비율이 체외 수정군에서 유의하게 높게 나타났으나 다른 특성들은(조기 진통, 조기 양막 파수, 임신성 고혈압, 임신성 당뇨, 제왕 절개 분만) 두 군간에 비슷한 양상을 보였다. 신생아 예후로는, 재태 주령, 출생 체중, 재원 기간, Apgar 점수, 신생아 사망률과 질병 이환율을 분석하였는데 자연 임신군과 비교하여 체외 수정군에서 유의한 차이를 발견하지 못했다. 결론:본 연구에서 체외 수정군이 산모의 나이와 초산부 비율을 제외하고는 산과적 특성과 신생아 예후에서 정상 임신군과 유의한 차이를 보이지 않았다. Objective : The aim of this study was to evaluate and compare neonatal outcome of premature twins conceived by in vitro fertilization (IVF) to those of naturally conceived. Methods : We retrospectively analyzed neonatal outcome of sixty pairs of premature twins conceived by IVF (IVF twin group) and 34 pairs that naturally conceived (natural twin group). Maternal and obstetric characteristics were also compared. All were born before 35 weeks of gestation between January 2000 and December 2004 at Pochon-Cha Hospital and admitted to neonatal intensive care unit. Student t-test and χ2 test were used for statistical analysis. Results : For obstetrical characteristics, maternal age and rates of nulliparous were sibnificanty twin group. But, other parameters (preterm labor, premature rupture of membranes, pregnancy-induced hypertension, gestational diabetes mellitus) were similar between two groups. For neonatal outcome, gestational age, duration of hospital stay, Apgar score, neonatal mortality and morbidity were reviewed. All parameters were no significant differences in IVF twin group compare to natural twin group Conclusions : In our study, IVF twin group had no significant differences in obstetric characteristics (except for maternal age and parity) and neonatal outcome compare to natural twin group.

건강한 고령 초산모에서 산모 연령이 임신결과에 미치는 영향

김태은 ( Tae Eun Kim ),이순표 ( Soon Pyo Lee ),박종민 ( Jong Min Park ),황병철 ( Byung Chul Whang ),김석영 ( Suk Young Kim ) 대한주산의학회 2009 Perinatology Vol.20 No.2

목적: 고령 초산모의 임신과 출산에 있어서 연령이 임신결과에 어떠한 영향을 미치는지 알아보고자 하였다. 방법: 2001년 1월부터 2008년 12월까지 본원에서 임신 21주 이후 분만한 산모 중 초산모를 대상으로 하였으며, 연령 이외에 산과적 예후에 영향을 줄 수 있는 요인을 최소화 하고자 심혈관계 기저질환이 없고, 임신 중 고혈압 질환이나 현성 및 임신성 당뇨와 같은 위험인자가 없는 건강한 초산모만으로 연구대상을 제한하였다. 이들 중 35세 이상인 산모 235명을 연구군으로 하였으며, 20세에서 34세까지의 산모 1571명을 대조군으로 하여 임상적 특징 및 산과적 예후를 후향적으로 분석하였다. 결과: 제태연령이나 출생체중은 두 군간에 유의한 차이가 없었다. 연구군에서 제왕절개의 빈도가 의미있게 높았으며(60.4% vs 39.4%, P=0.000), 제왕절개의 적응증 중 기왕 자궁수술력이 있었던 경우, 전치태반인 경우의 빈도가 연구군에서 유의하게 높았다(3.0% vs 0.2%, P=0.000, 9.4% vs 5.2%, P=0.011). 신생아 합병증에는 두 군간에 유의한 차이가 없었으며, 산전합병증은 전치태반, 자궁근종의 빈도가 연구군에서 유의하게 높게 나타났으며(6.0% vs 2.8%, P=0.010, 4.7% vs 1.2%, P=0.000), 산후합병증은 수술부위 감염의 빈도가 연구군에서 높게 나타났다(1.7% vs 0.3%, P=0.005). 결론: 심혈관계 기저질환이 없고, 임신 중 고혈압 질환이나 현성 및 임신성 당뇨와 같은 위험인자가 없는 건강한 고령 초산모에서 전치태반의 빈도 및 제왕절개의 빈도는 유의하게 증가하나 신생아 합병증은 대조군과 유의한 차이가 없었다. 산전 및 산후 합병증 중 전치태반, 자궁근종, 수술부위 감염은 유의하게 증가하였으나 조기진통, 조기양막파수, 산후출혈 등에는 유의한 차이를 보이지 않았다. 이에 고령의 초산모에서 단지 산모의 연령이 고령인 것이 산과적으로 고위험 요소는 아니며, 모든 고령 산모를 고위험 산모로 간주하는 것은 타당하지 않다고 사료된다. Purpose: To investigate the pregnancy outcomes associated with delayed first childbearing Methods: We evaluated retrospectively the clinical characteristics and pregnancy outcomes in primiparous mothers who delivered a fetus after more than 21 weeks of gestation in our hospital from January 2001 to December 2008. We enrolled only healthy primiparous mothers who have no underlying cardiovascular disease, hypertensive disorders complicating pregnancy and overt or gestational diabetes to remove the confounding factors which influence the pregnancy outcomes. Finally, 235 mothers aged 35 years and above and 1571 mothers aged 20~34 years were included in the study and the control groups, respectively. Results: There were no differences in gestational age and birth weight between two groups. There was significantly higher incidence of cesarean section in the study group. (60.4% vs 39.4%, P=0.000) The incidence of previous uterine operation history and placenta previa which were the indications of cesarean section were higher in the study group (3.0% vs 0.2%, P=0.000, 9.4% vs 5.2%, P=0.011). Antepartum and postpartum complications with the significantly higher incidence rates in study group were placenta previa and uterine myoma (6.0% vs 2.8%, P=0.010, 4.7% vs 1.2%, P=0.000) and wound complications (1.7% vs 0.3%, P=0.005), respectively. On the other hand, the neonatal outcomes and other antepartum/postpartum complications, such as the incidence of preterm labor, PROM and postpartum bleeding, of two groups were comparable (no significant differences were noted). Conclusion: Although incidence of placenta previa, cesarean section, uterine myoma and wound complication were higher in healthy old primiparous mothers, no differences were noted in neonatal outcomes compared to the young primiparous mothers. We conclude that elderly primiparous pregnancy in woman should not be considered as a high risk pregnancy on the basis of age alone.

임상; 단일 기관에서의 임신성 당뇨 검사에 따른 태아 및 산과적 예후 비교

윤성현 ( Sung Hyun Yun ),한상원 ( Sang Won Han ),이산희 ( San Hui Lee ),정용욱 ( Yong Wook Jung ),김의혁 ( Euy Hyuk Kim ) 대한주산의학회 2013 Perinatology Vol.24 No.3

본 연구는 한국 산모에서 경구 당 부하검사(glucose challenge test, GCT) 결과에 따른 산과 및 주산기의 예후를 비교 분석하는 것을 목적으로 시행되었다. 방법 : 국민건강보험공단 일산병원에서 2007년 1월 1일부터 2012년 7월 31일까지 산전검사를 받고 분만한 산모 중 임신 중반기에 임신성 당뇨 검사로써 50 g GCT를 시행받은 1,006명의 산모를 대상으로 의무기록을 이용한 후향적 연구를 시행하였다. 대상이 되는 1,006명의 산모를 총 3개의 군으로 분류하였다; 50 g 경구 GTC가 140 mg/dL 미만인 정상군(NGT, n=826), 50 g GTC가 140 mg/dL 이상의 결과가 나왔으나 임신성 당뇨 확진 검사상 음성인 임신성 내당 불내성군(GIGT, n=128), 임신성 당뇨 확진군(GDM, n=52). 임신 전 진단받은 산모의 당뇨와 고혈압, 다태임신 산모는 연구 대상에서 제외하였다. 이들 세 군의 산모의 특성과 산과적 예후를 비교, 분석하였다. 결과 : 산모의 나이, 임신력, 임신전의 체질량 지수는 GDM군에서 높게 나타났으며, 조기분만, 임신과 합병된 고혈압 또한 NGT군에서 GIGT군, GDM군의 순서로 유병률의 증가를 보였다(13.9% vs. 18.8% vs. 25.0%, P<0.01; 1.9% vs.5.5%vs. 13.5%, P<0.01). 과출생 체중아와 신생아집중치료실 입실률 또한 NGT군에서 GIGT군, GDM군의 순서로 증가하는 결과를 보였다(6.2% vs. 15.6% vs. 15.4%, P<0.01; 12.3% vs. 24.2% vs. 38.5%, P<0.01). 하지만 태변흡입 증후군이나 신생아 가사 등 집중적 치료를 필요로 하는 심각한 합병증의 빈도는 세 군간의 차이는 없었다. 결론 : 임신성 당뇨는 제왕절개, 조기 분만, 임신과 합병된 고혈압의 위험인자이다. 임신성 당뇨가 아닌 내당 불내성군에서도 정상군에 비해 임신과 합병된 고혈압, 조기진통, 제왕절개 비율, 과출생 체중아의 증가 소견을 보였다. 따라서 임신성 당뇨 뿐만 아니라 내당 불내성군에 관한 진료지침 개발을 위한 연구가 지속되어야 할 것이다. The purpose of the study was to compare obstetric and perinatal outcomes according to glucose challenge test (GCT) in a single institution. Methods : One thousand six women, who were underwent antepartum gestational diabetes mellitus (GDM) screening by a GCT in mid-pregnancy and delivered at National Health Service between January 1, 2007 and July 31, 2012, were included in the study. The medical records of patients were analyzed retrospectively. The Subjects were categorized into three groups according to the results of 50 g oral GTC and 100 g oral GTC; normal glucose tolerance (NGT, n=826), less than 140 mg/dL; gestational impaired glucose tolerance (GIGT, n=128), more than 140 mg/dL but non-GDM ; gestational diabetes mellitus (GDM, n=52). Pre-existed maternal DM or hypertension and twin pregnancy were excluded. Obstetric and perinatal outcomes were compared among the three groups. Result : Maternal age, parity, and pre-pregnancy body mass index were higher in the GDM. The preterm delivery and gestational hypertension increased across the groups from NGT to GIGT to GDM (13.9% vs. 18.8% vs. 25.0%, P <0.01, and 1.9% vs.5.5% vs. 13.5%, P <0.01, respectively). Large for gestational age (LGA) and Neonatal Intensive Care Unit admission rate were higher in order in NGT, GIGT, and GDM (6.2% vs. 15.6% vs. 15.4%, P <0.01, and 12.3% vs. 24.2% vs. 38.5%, P <0.01), but other complications requiring intensive care were not different among the groups, including meconium aspiration syndrome and birth asphyxia. Conclusion : GDM was a risk factor of cesarean section, preterm delivery, and gestational hypertension. In addition, GIGT was positively correlated with gestational hypertension, preterm labor, cesarean section rate, and LGA. This study suggests that there is a need to develop a guideline for Korean pregnant women who were diagnosed with GIGT.

임신 20주 이상 지속된 선천성 자궁기형 환자에서의 산과적 예후

구연희 ( Yeon Hee Ku ),김건우 ( Kun Woo Kim ),한지혜 ( Jee Hye Han ),박현수 ( Hyun Soo Park ),박찬욱 ( Chan Wook Park ),박중신 ( Joong Shin Park ),전종관 ( Jong Kwan Jun ),윤보현 ( Bo Hyun Yoon ),신희철 ( Hee Chul Syn ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.5

Objective: To evaluate the pregnancy outcomes of women with congenital uterine anomaly exceeding 20 weeks of gestation. Methods: We reviewed retrospectively the birth records of the Seoul National University Hospital between January 1, 1990, and December 31, 2005. We grouped congenital uterine anomalies into five classes, namely bicornuate, didelphys, septate, arcuate, and unicornuate uterus. We compared the pregnancy outcomes with each anomaly. Results: We found 106 cases of congenital uterine anomaly within a given period of time. There were 63 cases of bicornuate uterus, 19 cases of didelphys, 16 cases of septate uterus, 5 cases of arcuate uterus, and 3 cases of unicornuate uterus. The overall preterm delivery rate was 22.6% (24/106) and cesarean section rate was 74.5% (79/106). A high cesarean section rate was due to metroplasty, abnormal fetal presentation, and uterine anomaly itself. The preterm delivery rate and cesarean section rate of each uterine anomaly did not differ statistically from one another. Five fetuses were stillborn, and one fetus died after birth because of a placenta abruption. The overall take-home baby rate was 94.3% (100/106). There was no maternal mortality and only one case was suffered from postpartum bleeding. Conclusion: Our results suggest that the most of women with uterine anomaly exceeding 20 weeks of gestation may take their baby home.

35세 이상 고령 산모의 산과적 예후

박희진 ( Hee Jin Park ),이숙환 ( Sook Hwan Lee ),차동현 ( Dong Hyun Cha ),김인현 ( In Hyun Kim ),전혜선 ( Hye Sun Jun ),이경진 ( Kyoung Jin Lee ),송송아 ( Song Ah Song ),박혜리 ( Hey Ri Park ),정창조 ( Chang Jo Chung ),이정노 ( Ch 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.10

Objective: To estimate the effect of maternal age on obstetric outcomes, a retrospective analysis was done. Methods: Twenty six hundred and forty six women who delivered a singleton baby at our hospital from January 1, to December 31, 2004 were enrolled in this study. Subjects were divided into 3 age groups; 1) less than 35 years, 2) 35-39 years, and 3) 40 years and older. Chi-square test was used to assess the effect of age on obstetrics outcome. Then the odds ratio was calculated to represent clinically meaningful risk. Results: A total of 2646 women with complete data were available; 2245 (84.9%) less than 35 years of age; 350 (13.2%) 35-39 years; and 51 (1.9%) 40 years and older. Increasing age was significantly associated with chromosomal abnormalities (OR 3.9and 8.8 for ages 35-39 years and age 40 years and older, respectively), Preterm premature rupture of membranes (OR 1.3 and 3.2) and cesarean delivery (OR 2.0 and 5.5). Patients aged 35-39 years were at increased risk for placenta previa (OR 1.8) and congenital anomaly (OR 2.8) but these were not statistically significant. The rate of the preterm delivery was increased by age (OR 1.3 and 1.9 for ages 35-39 years and age 40 years and older, respectively) but it was not statistically significant (p=0.121). We did not find advanced maternal age to be associated with a statistically increased risk for preeclampsia, congenital anomaly, gestational diabetes, placenta abruption, low birth weight, macrosomia, neonatal morbidity (NICU admission), and perinatal loss. Conclusion: In conclusion, although the likelihood of adverse outcomes increases with maternal age, patients and obstetric care providers can be reassured that overall maternal and fetal outcomes are favorable in this patient population.

쌍태 임신의 예후; 체외수정술과 자연 임신

임재현 ( Jae Hyun Lim ),김행수 ( Haeng Soo Kim ),황경주 ( Kyung Joo Hwang ),양정인 ( Jeong In Yang ),김미란 ( Mee Ran Kim ),이희종 ( Hee Jong Lee ),임종찬 ( Jong Chan Lim ),오기석 ( Kie Suk Oh ),유희석 ( Hee Sug Ryu ) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.12

Objective : To compare the obstetrical and perinatal outcomes of twin pregnancies after IVF-ET with those of twin pregnancies conceived spontaneously. Methods : Two hundred and six cases of IVF-ET twin pregnancies (IVF group) were compared with 229 sponta

보조생식술시 원인불명 불임환자의 산과적 결과에 대한 고찰

조연경 ( Yeon Kyung Cho ),허걸 ( Kuol Hur ),김선희 ( Sun Hee Kim ),차승희 ( Seung Hee Cha ),조준형 ( Jun Hyung Cho ),김진영 ( Jin Yeong Kim ),양광문 ( Kwang Moon Yang ),전종영 ( Jong Young Jun ),궁미경 ( Mi Kyoung Koong ),강인수 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.6

Objective : This study was aimed to evaluate the obstetric and perinatal outcomes of women with unexplained infertility following assisted reproductive technology (ART). Methods : From January 1999 to February 2002, a total of seventy-nine singleton pregnancies which progressed beyond 20 weeks gestation following embryo transfer in women finally diagnosed as unexplained infertility by diagnostic laparoscopy were enrolled in this study. The matched control was spontaneously conceived 172 singleton pregnancies. Retrospectively, we analyzed the obstetric outcome and compared gestational age at delivery, birth weight, Apgar score, and the incidence of perinatal mortality, preterm labor, preeclampsia, gestational diabetes mellitus, and oligohydramnios between two groups. Results : The mean gestational duration of study group was shorter than control group (38.2±0.5 vs. 39.4±0.1 weeks, p=0.001). The incidence of gestational diabetes mellitus was significantly higher in the study group (7.6% vs. 1.2%, p=0.001). There was no significant difference in the mean birth weight (3088.1±86.1 g vs. 3243.8±37.2 g), the incidence of small for gestational age (10.1% vs. 11.6%), preeclampsia (3.8% vs. 2.3%), oligohydramnios (3.8% vs. 5.8%), preterm labor (7.6% vs. 5.2%), cesarean delivery (45.6% vs. 41.3%), and perinatal mortality (1.3% vs. 0.6%) between the two groups. Conclusion : The gestational duration of women with unexplained infertility after IVF-ET was shorter, but the incidence of preterm birth was not increased. And the incidence of gestational diabetes mellitus of study group was higher than that of spontaneously conceived pregnancies.

시험관 아기 시술후 쌍태 임신의 결과에 대한 임상적 고찰

김철홍(Cheol Hong Kim),이여길(Yu Il Lee) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.9

Objectives : This study compares the obstetric complications and perinatal outcomes of twin pregnancies after In Vitro Fertilization and Embryo Transfer to twin pregnancies conceived spontaneously.Methods : One hundred sixteen cases of twin pregnancies were reviewed. All deliveries were performed between March 1996 and July 1999 at Chonnam National University Hospital. The study group(n=46) consisted of IVF-ET twin pregnancies and the control(n=70) consisted of spontaneous twin pregnancies delivered within the same time period. Clinical data were examined by age, parity, antenatal care, gestational age at delivery, method of delivery, type of chorioamnionicity, fetal presentation, obstetric complications, as well as perinatal outcomes. Observed obstetric complications included premature rupture of membrane, pregnancy induced hypertension, preterm labor, prematurity, gestational diabetes, placenta previa, placenta abruption and anemia. Results : The women in the IVF-ET group were significantly older than those in the spontaneous group(32.7±3.9 and 28.2±3.6 years, respectively). The proportion of primiparous patients was higher in the IVF-ET group(89.1%) than in the spontaneous group(54.3%). Method of conception did not influence the frequency of obstetric complications. No differences were seen in birth weight, rate of low birth weight, rate of intrauterine growth restriction and perinatal mortality.Conclusions : There is no difference in obstetric complications or perinatal outcomes between the groups. In light of the higher frequency of obstetric complications in twin pregnancies, the rematching task is to reduce the frequency of twin pregnancies in IVF-ET induced pregnancies.

체외 수정시술에 의한 쌍태 임신과 정상 쌍태 임신의 임신 결과와 신생아 예후 비교

김병욱(Byung Wook Kim),이건영(Geon Young Lee),이영진(Young Jin Lee),홍민(Min Hong),이정렬(Jeong Yel Lee),이준희(Jun Hee Lee),정인배(In Bai Chung) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.11

Objective : To compare the obstetric complications and perinatal outcomes of twin pregnancies conceived by In Vitro Fertilization and Embryo Transfer to twin pregnancies conceived naturally. Methods : Maternal and neonatal data were reviewed for all twin pregnancies. All twin pregnancies(n=116) were divided into IVF twin pregnancyes group(n=43) and naturally conceived twin pregnancyes(n=72). The obstetric and perinatal outcomes were compared and analysed. Statistical analysis was performed using student's t-test, χ2 test, and Fisher exact test. Statistical significance was defined as p<0.05. Results : There were no significant differences in maternal age and gestational age between two groups but nulliparity was higher in IVF-ET twin group than naturally conceived twin group. Also no differences of obstetrics and perinatal outcomes were seen between two groups. Conclusion : Although twin pregnancies following IVF-ET are more likely to result in bad prognosis, in this study obstetric and perinatal outcomes are comparable to those of naturally conceived twin pregnancies.

Hyrtl 문합 형태와 그에 따른 산과적 영향

서경아 ( Seo Gyeong A ),김민정 ( Kim Min Jeong ),이귀세라 ( Lee Gwi Se La ),신종철 ( Sin Jong Cheol ),김수평 ( Kim Su Pyeong ),나종구 ( Na Jong Gu ),김사진 ( Kim Sa Jin ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.1

Objective : This study was conducted to investigate the presence and pattern of Hyrtl anastomosis, and to examine the effect that each type has on obstetrical outcome. Methods : This study was carried out from January of 2001 to May of 2003 on 904 randoml