최신임상강좌 : 산후출혈의 치료를 위한 동맥색전술의 실패와 관련된 인자의 분석

소경아 ( Kyeong A So ),오윤경 ( Yoon Kyung Oh ),황효순 ( Hyo Soon Hwang ),홍혜리 ( Hye Ri Hong ),조금준 ( Geum Joon Cho ),오민정 ( Min Jeong Oh ),허준용 ( Jun Yong Hur ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.9

Objective: To investigate what factors are associated with a failed arterial embolization for postpartum hemorrhage (PPH) and to attempt to estimate efficacy of arterial embolization. Methods: Between 2004 and 2008, 60 patients at Korea University Medical Cencter underwent arterial embolization to control obstetrical hemorrhage. In all cases, arterial embolization was performed because of intractable hemorrhage unresponsive to conservative management. Medical records and angiographic results were reviewed. Arterial embolization failure was defined as the requirement for subsequent surgical procedure to control PPH with the procedure, and its results. Results: Arterial embolization was attempted in 60 of deliveries. Failures occurred in 7 of 60 cases (11.7%) and in 4 of 7 cases (57.1%) of abnormal placentation (placenta previa totalis with or without placenta accrete or increta). Comparison of the failed and successful arterial embolization groups showed no differences in maternal characteristics, clinical status, and angiographic finding. Amount of total transfusion in failed arterial embolization group were larger than successful group although hemoglobin before embolization was not different. Conclusion: The only factor significantly associated with failed arterial embolization was an abnormal placentation. Arterial embolization is a safe and highly effective method to control PPH.

쌍태임신시 태반유형 및 제대부착형태가 성장 불일치에 미치는 영향에 관한 연구

안현경(H . K . Ahn),양광문(K . M . Yang),홍성란(S . R . Hong),류현미(H . M . Rheu),김문영(M . Y . Kim),한정열(J . R . Han),최규홍(K . H . Choi),양재혁(J . H . Yang),김은성(E . S . Kim) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.11

Object : The purpose of the study is to determine whether the type of placentation and abnormal cord insertion can affect discordant growth in twin gestation. Materials and methods : We investigated 422 sets of structually normal twin delivered at our twin clinic after 26 weeks of gestation from 1995-1997. All cases of placenta were examined for pathologic evaluation during the study periods. The type of placentation was divided into four groups: monochorionic monoamniotic placenta (n=4); monochorionic diamniotic placenta (n=62); dichorionic diamniotic fused placenta (n=163); dichorionic diamniotic separate placenta(n=193). Cord insertion was also divided into three groups: both side abnormal insertion (n=17); either side abnormal insertion (n=101); both side normal insertion (n=304). Intertwin weight discordancy was classified as mild form (15-25%) and severe form (>25%) by the degree of the discrepancy. Results : The results were as follows; 1. Of these 422 twin sets, 132 (31%) consisted of twin discordancy in weight by 15% or greater (mild form 19%, severe form 12%). 2. There are no significant difference in the frequencies of discordancy between MC twins and DC twins (31.8% vs 31.2%, p=0.97). 3. The prevalence of abnormal cord insertion was 16% and much more frequent in MC placenta than DC placenta (26.5% vs 14%, p=0.001). 4. Although mean gestational age at delivery and mean birth weight were significantly lower in either side abnormal cord insertion group than both side normal cord insertion group (35.7 vs 36.7weeks, p=0.004 : 2317 vs 2475gm, p=0.01), no difference in the frequency of discordancy was observed in these two groups (37.6% vs 29%, p=0.1). Conclusion : The type of placentation and/or abnormal cord insertion were not revealed to affect discordant growth in twin gestation.

Implantation in Ruminants: Changes in Pre-Implantation, Maternal Recognition of Pregnancy, Control of Attachment and Invasion - Review -

Nagaoka, K.,Yamaguchi, H.,Aida, H.,Yoshioka, K.,Takahashi, M.,Christenson, R.K.,Imakawa, K.,Sakai, S. Asian Australasian Association of Animal Productio 2000 Animal Bioscience Vol.13 No.6

As high as 50% of pregnancies are known to fail and the majority of such losses occur during the peri-implantation period. For the establishment of pregnancy in mammalian species, therefore, implantation of the conceptus to the maternal endometrium must be completed successfully. Physiological events associated with implantation differ among mammals. In ruminant ungulates, an elongation of the trophohlast in early conceptus development is required before the attachment of the conceptus to the uterine endometrium. Moreover, implantation sites are restricted to each uterine caruncula where tissue remodeling, feto-maternal cell fusion and placentation take place in a coordinated manner. These unique events occur under strict conditions and are regulated by numerous factors from the uterine endometrium and trophoblast in a spatial manner. Interferon-tau (IFN-${\tau}$), a conceptus-derived anti-Iuteolytic factor, which rescues corpus luteum from its regression in ruminants, is particularly apt to play an important role as a local regulator in coordination with other factors, such as TGF-${\beta}$, Cox-2 and MMPs at the attachment and placentation sites.

식물형태학에서 사용하는 피자식물의 꽃 구조에 관한 한글 용어의 분석

이규배 조선대학교 기초과학연구원 2009 조선자연과학논문집 Vol.2 No.2

분만기 주위에 실시한 응급 자궁 절제술에 대한 연구

박혜원 ( Hye Won Park ),이경훈 ( Gyeong Hun Lee ),김석영 ( Seok Yeong Kim ),이순표 ( Soon Pyo Lee ) 대한주산의학회 2008 Perinatology Vol.19 No.3

목적: 분만기 주위 응급 자궁 절제술의 산과적 특징 및 위험 인자를 분석하여 출혈량에 미치는 영향을 알아보고자 하였다. 방법: 1995년 1월 1일부터 2005년 12월 31일까지 시행된 159예의 분만기 주위 응급 자궁절제술에 대해 출혈 양에 따라 2,000 mL 미만 (A군), 2,000~4,000 mL (B군), 4,000 mL 이상(C군)으로 분류하였고, 각 군의 발생 빈도, 산모 나이, 출산력, 분만 주수, 분만방법, 수혈량, 입원기간, 자궁 절제술의 적응증 및 모성 합병증을 분만대장 및 의무기록을 검토하여 후향적으로 통계, 분석하였다. 결과: 분만기 주위 응급 자궁절제술의 빈도는 0.34% (159/46,666)로, 제왕 절개술 후에 0.47% (120/25,591), 질식 분만 후에 0.19% (39/21,075)를 보였다. 출혈량에 따라 분류한 각 군간의 산모 나이, 출산력, 분만 주수, 입원 기간에서는 유의한 차이를 보이지 않았다. 출혈량이 많을수록 제왕절개 분만 후 자궁절제술의 빈도가 높았다(p<0.05). A군에서 가장 많은 적응증은 자궁 무력증(47.19%)이었고, B군과 C군에서는 유착 태반(48.08%, 50.0%)이었다. 다량 실혈로 인한 수술 중 및 수술 후 합병증이 증가하였고 범발성 응고 장애, 폐렴, 비뇨기계 손상 등이 관찰되었다. 결론: 분만기 주위 응급 자궁 절제술은 제왕절개를 포함한 기왕 자궁내 손상에 따른 태반 유착과 관련이 있었으며 나아가 출혈량의 증가를 동반함을 확인할 수 있었다. Objective: To investigate the clinical characteristics and associated risk factors for emergency peripartum hysterectomy classified by the amounts of blood loss. Material and Methods: We reviewed the medical records of 159 cases of peripartum hysterectomy among 46,666 deliveries, from Jan. 1995 to Dec. 2005 at the Dept. of Ob. & Gy. of Graduate School of Medicine, Gachon University of Medicine and Science. We divided the 159 cases into three groups based on the amounts of blood loss, which were group A as less than 2,000 mL of blood loss, group B as 2,000 to 4,000 mL of blood loss, and group C as more than 4,000 mL. The incidence, the type of delivery, the amounts of transfusion, the operative indication and the complications of peripartum hysterectomy were evaluated. Results: The incidence of peripartum hysterectomy was 0.34% (159/46,666) and 0.47% in cases of cesarean section and 0.19% in vaginal delivery, respectively. There was no meaningful correlation between maternal age, parity, gestational age, hospital stay and amount of blood loss. The increments of blood loss correlated to the frequency of peripartum hysterectomy after cesarean section (p<0.05). The most common operative indication in group A was uterine atony (47.19%), and those in group B and C were adherent placentation (48.08%, 50.00%). Intraoperative and postoperative complications according to excessive bleeding were increased, and DIC, pulmonary infection, urethral and bladder injury were observed more frequently in group C than in group A. Conclusion: The emergency peripartum hysterectomy was related to adherent placentation and was accompanied with increased blood loss.

응급 주산기 자궁적출술의 5 년간 경험

안현경(H . K . Ahn),김은성(E . S . Kim),한정열(J . Y . Han),김문영(M . Y . Kim),류현미(H . M . Ryu),최규홍(K . H . Choi),양재혁(J . H . Yang) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.12

Objective : To review the cases of peripartum hysterectomy in women delivered at a Hospital. Methods : This is a retrospective study of all cases of emergency peripartum hysterectomy performed between August 1994 and July 1998. Results : During the study period a total of 35 emergency peripartum hysterectomy was performed. The overall incidence was 0.9/1,000 deliveries. The mean age of patients was 33.7±0.8 years old, the median gravidity was 5 and mean gestational age was 37.7±0.4 weeks. The main indications for hysterectomy were massive bleeding due to abnormal placental adhesions or uterine atony. There was no maternal death, However, maternal morbidity was 34.3%. Conclusions : The data show abnormal adherent placentation as the primary cause for gravid hysterectomy. The data illustrate how the incidence of emergency peripartum hysterectomy increases significantly with increasing parity, especially when influenced by a current placenta previa or a prior cesarean section. Maternal morbidyity remained high although no maternal deaths occurred.

Case Reports : A case of huge placental Lake in a pregnancy succeeding a selective uterine arterial embolization for a pseudoaneurysm of the uterus

( Sang Wook Yi ),( Jung Mi Paek ),( Dae Woon Eom ) 대한산부인과학회 2009 Journal of Womens Medicine Vol.2 No.4

Placental lakes were observed in only 2.2% and are not considered a common sonographic finding in pregnant women. A 28-year-old woman with a large placental lake that was prenatally diagnosed underwent an emergency cesarean section due to a severe form of preeclampsia. A selective uterine arterial embolization for a pseudoaneurysm of the uterus had been performed 3 years before. The patient had an uneventful postoperative recovery and was discharged on the fifth postoperative day. Some authors showed the presence of lakes was associated with adverse pregnancy outcomes. However, the adverse effects of large placenta lakes on pregnancy outcomes are uncertain. The jet flow of the large lake is considered that of the maternal artery. It is assumed that uterine arterial embolization is implicated in the pathogenesis of myometrial damage and abnormal placentation. With this assumption, this placental lake seems to correlate with the uterine arterial embolization.

태반 조기박리에서 주산기 예후와 관련된 산과적 요인에 대한 연구

정희정 ( Hee Jung Jung ),정은하 ( Eun Ha Jeong ),이경 ( Kyung Lee ),정희라 ( Hee Ra Jung ),김명환 ( Myoung Hwan Kim ),고지경 ( Ji Kyung Ko ),조용균 ( Yong Kyoon Cho ),최훈 ( Hoon Choi ),김복린 ( Bok Rin Kim ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.10

Objective: To evaluate obstetric variables in the placental abruption that affect on perinatal mortality. Methods: We reviewed clinical data of all singleton deliveries complicated with placental abruption between January 2000 and December 2007, in Department of Ob. & Gyn., Sanggye Paik Hospital. Results: Placental abruption complicated 54 cases (0.55%) of all deliveries (n=9,903) from January 2000 to December 2007. The peak age was 26-30 years (42.1%). The most common symptom was vaginal bleeding (57.4%) and intrauterine fetal death had already occurred in 9.3%. Perinatal mortality rate was 13.0% and there was no maternal death. 38.9% of placental abruption occurred between 33 to 36weeks of gestational age. 38.9% of placental abruption was diagnosed before delivery with ultrasonography and 9.3% was chronic placental abruption. 33.3% of placental abruption was associated with preeclampsia, and then associated with PPROM (24.1%), uterine myoma (3.7%), chronic hypertension (1.9%) and smoking (1.9%). When the hypertensive disorders were associated, fetal distress rate was higher than normotensive pregnancy (63.2% vs 20.0%, P-value: 0.005). Mean gestational age (days) (194±32.8 vs 248.12±28.0, P-value<0.001) and the severity of placental abruption (P-value: 0.005) affect perinatal mortality in placental abruption. The most common complication of placental abruption was DIC (16 cases, 29.6%), followed by Couvelaire uterus (4 cases, 7.4%) and uterine rupture (1 case, 1.9%). Conclusion: Obstetric variables that affect perinatal mortality were gestational age at the diagnosis and the severity of placental abruption.

The significance of placental ratios in pregnancies complicated by small for gestational age, preeclampsia, and gestational diabetes mellitus

( Hee Sun Kim ),( Soo Hyun Cho ),( Han Sung Kwon ),( In Sook Sohn ),( Han Sung Hwang ) 대한산부인과학회 2014 Obstetrics & Gynecology Science Vol.57 No.5

Objective This study aimed to evaluate the placental weight, volume, and density, and investigate the significance of placental ratios in pregnancies complicated by small for gestational age (SGA), preeclampsia (PE), and gestational diabetes mellitus (GDM). Methods Two hundred and fifty-four pregnant women were enrolled from August 2005 through July 2013. Participants were divided into four groups: control (n=82), SGA (n=37), PE (n=102), and GDM (n=33). The PE group was classified as PE without intrauterine growth restriction (n=65) and PE with intrauterine growth restriction (n=37). Birth weight, placental weight, placental volume, placental density, and placental ratios including birth weight/placental weight ratio (BPW) and birth weight/placental volume ratio (BPV) were compared between groups. Results Birth weight, placental weight, and placental volume were lower in the SGA group than in the control group. However, the BPW and BPV did not differ between the two groups. Birth weight, placental weight, placental volume, BPW, and BPV were all significantly lower in the PE group than in the control group. Compared with the control group, birth weight, BPW, and BPV were higher in the GDM group, whereas placental weight and volume did not differ in the two groups. Placental density was not significantly different among the four groups. Conclusion Placental ratios based on placental weight, placental volume, placental density, and birth weight are helpful in understanding the pathophysiology of complicated pregnancies. Moreover, they can be used as predictors of pregnancy complications.

메틸수은 노출이 흰쥐의 태반 효율과 태아 성장에 미치는 영향

이채관(Chae Kwan Lee) 한국환경보건학회 2020 한국환경보건학회지 Vol.46 No.4

Objectives: Some animal studies have reported that methyl mercury causes developmental toxicities such as placental and fetal weight loss, but the mechanism is still unclear. This study aimed to investigate the developmental toxicities of methyl mercury, focusing on placental endocrine function and fetal growth retardation in rats. Methods: Positively same-time-mated female Sprague-Dawley rats were purchased on gestational day (GD) eight and treated with 0, 5, 10 and 20 ppm of methyl mercury (n=5) dissolved in tap water from GD eight through 19. During treatment, the drinking water (methyl mercury) intake and body weight of each pregnant rat was measured daily. On day 19, caesarean sections were performed and blood samples were collected. Developmental data such as placental and fetal weights, fetus numbers, and placental efficiency (fetal weight/ placental weight) were also collected. Placental prolactin-growth hormone (PRL-GH) family, such as placental lactogen (PL) -Iv, II, and prolactin-like protein (PLP) -B, levels in serum were analyzed by ELISA. Also, placental tissues were assigned to histochemistry. Results: The mean cumulative methyl mercury exposure for the 5, 10, and 20 ppm groups were 2.37, 4.63, and 9.66 mg, respectively. The mean daily exposure of the 5, 10, and 20 ppm groups were 0.24, 0.47, and 0.97 mg, respectively. Maternal body weight increased in accordance with GD. There was no significant difference in weight gain among the experimental groups. Histopathologic changes were not observed in placental tissues among the experimental groups. However, mean placental and fetal weights were lower in the 10 and 20 ppm exposed groups compared to the control. Placental efficiency was also lower in the 10 and 20 ppm exposed groups compared to the control. Serum PL-Iv and II levels were lower in the 10 and 20 ppm exposed groups than the control, in accordance with the changing pattern of placental and fetal weights and placental efficiency. Conclusion: The inhibitory effects of methyl mercury on the serum levels of placental PRL-GH family such as PL-Iv and II may be secondary leads to the reduction of placental efficiency and fetal growth retardation in rats.