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

목적 : 파종혈관내응고는 양수색전증 혹은 임상적 융모양막염과 같은 산과적 질환에 동반되는 매우 심각한 합병증이다. 파종혈관내응고는 소모응고병증을 유발하는 과도한 트롬빈 형성에 의하여 생기며, 최근에는 트롬빈이 자궁 수축 및 염증 반응에 중요한 역할을 한다는 것이 보고되고 있다. 본 연구의 목적은 양막파수 없는 조기 분만진통 임산부에서 자궁내 감염과 조산이 양수 thrombin-antithrombin Ⅲ (TAT) complex 측정으로 확인한 양수내 트 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

분만 과정에 대한 경막외 마취의 영향

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

목적: 경막외 마취가 분만 과정에 미치는 영향에 대해서 알아보고자 하였다. 연구방법: 1998년 1월부터 1998년 12월까지 본원에 내원한 산모중 자연적인 진통으로 입원한 만삭 산모로 두정위, 단태아인 경우에 국한하여 경막외 마취를 시행한 초산모 100명과 경산모 20명을 동수의 경막외 마취를 시행하지 않은 대조군과 비교 분석하였다. 분만 과정과 신생아의 안녕상태 및 출산 합병증에 대한 자료로는 입원기록과 신생아 기록을 이용하였다. 통계처리는 Student't-test와 Chi square test를 사용하였다. 결과: 경막외 마취 실험군과 대조군에 대한 비교 분석 결과는 다음과 같다. 1. 두 군간의 평균 나이, 체중, 신장, 임신 주수는 통계학적으로 유의한 차이가 없었다. 2. 분만시 oxytocin 정맥 점적 투여빈도는 초산모의 경우, 경막외 마취군에서 유의하게 높았다(p<0.05). 3. 분만 제2기의 시간은 초산모인 경우 경막외 마취군에서 유의하게 길어지는 소견을 보였다(p<0.05). 4. 기계 분만의 빈도는 초산모인 경우 유의한 차이를 보였으나(p<0.05), 태아곤란증이나 난산으로 인한 제왕절개술은 두 군 사이에 유의한 차이가 없었다. 5. 양수내 태변의 착색과 신생아 Apgar 점수, 체중은 유의한 차이가 없었다. 6. 분만시 총 실혈량에서는 유의한 차이가 없었다. 결론: 경막외 마취시 분만 제2기의 시간이 유의하게 길어지고 기계분만이 유의하게 증가하나, 제왕절개술의 빈도는 증가하지 않았으며, 출산에 따른 합병증의 증가도 없었다. 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.

태아발육지연

박교훈 ( Kyo Hoon Park ) 대한주산의학회 1999 Perinatology Vol.10 No.3

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.

A role for matrix metalloproteinase 3 in parturition, premature rupture of the membranes, and intrauterine infection

박교훈 ( Kyo Hoon Park ),( Chun Hoe Ku ),( Hun Tack Woo ),( Chul Mm Lee ),( Yong Kyoon Cho ),( Hoon Choi ),( Bok Lin Kim ),( Hong Kyoon Lee ) 대한산부인과학회 2002 대한산부인과학회 학술대회 Vol.88 No.-

The effect of premature rupture of membranes on the duration of Labor induction at term

박교훈 ( Kyo Hoon Park ),( Yong Kyoon Cho ),( Hoon Choi ),( Bok Rin Kim ),( Hyun Ju Min ),( Young Sok Choi ),( Sung Bin Son ),( Jun Woo Choi ),( Sung Shik Han ),( Chul Min Lee ),( Hong Kyoon Lee ) 대한산부인과학회 2001 대한산부인과학회 학술대회 Vol.86 No.-

Increased Thrombin in Intrauterine Infection and Preterm Parturition

박교훈 ( Kyo Hoon Park ),( You Mi Kim ),( Moon Young Kim ),( Chul Min Lee ),( Yong Kyoon Cho ),( Hoon Choi ),( Bok Lin Kim ),( Hong Kyoon Lee ) 대한산부인과학회 2002 대한산부인과학회 학술대회 Vol.88 No.-

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.

Experimentally-Induced Intrauterine Infection Causes Fetal Brain White Matter Lesions in Rabbits

박교훈 ( Kyo Hoon Park ),( Jin Choi ),( Bo Hyun Yoon ),( Jong Kwan Jun ),( Seok Tae Choi ),( Ja Nam Ku ),( Hee Chul Syn ),( Je Geun Chi ) 대한산부인과학회 1996 대한산부인과학회 학술대회 Vol.78 No.-

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

연구목적 : 본 연구의 목적은 조기양막파수된 임산부에서 첫째, 자궁내 감염의 조직학적 증거인 태반의 급성 염증성 병변(조직학적 융모양막염)과 주산기 예후를 산전에 예측하는데 양수내 interleukin-6 (IL-6) 농도 측정이 유용성이 있는지 알아보고 둘째, 양수내 감염의 진단 기준으로 생각되고 있는 양수배양 검사와 그 유용성을 비교하고자 하였다. 연구방법 : 양수천자 후 72시간 내에 분만된 조기양막파수 임산부 65명에서 경복부 양수천자에 의한 양수배양, 양수내 IL-6 농도를 측정하고, 분만후 태반의 조직학적 검사와 신생아 예후를 추적 관찰하여 그 관련성을 분석하였다. IL-6 농도 측정은 효소면역측정법 (enzyme-linked immunosorbent assay, ELISA)을 사용하였고, 통계분석은 Receiver-operator characteristic (ROC) 도표, Mann-Whitney U test, Fisher's exact test를 사용하였다. 연구결과 : 1) 조직학적 융모양막염이 존재한 임산부는 조직학적 융모양막염이 존재하지 않은 임산부보다 양수내 IL-6 농도는 유의하게 증가하였다 (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) ROC 도표에 의하여 양수내 IL-6 농도 3.2 ng/ml 이상은 조직학적 융모양막염을 산전에 예측하는데 민감도 78% (35/45) 특이도 95% (19/20)를 나타냈으며, 유의한 신생아 이환(신생아 패혈증, 호흡곤란증후군, 폐렴, 기관지 폐 이형성증, 뇌실내 출혈, 괴사성 장염 중 어느 한가지가 존재할 때로 정의)과 사망을 산전에 예측하는데 민감도 74% (25/34) 특이도 65% (20/31)를 나타내었다. 3) 조직학적 융모양막염, 유의한 신생아 이환과 사망을 산전에 예측하기 위한 양수내 IL-6 농도 측정의 민감도는 양수배양 검사의 민감도 보다 유의하게 높았으며 특이도는 두 검사 사이에 유의한 차이가 없었다 (조직학적 융모양막염: 78% vs 51%, p < 0.01; 유의한 신생아 이환과 사망: 74% vs 47%, p < 0.01). 결론 : 조기양막파수된 임산부에서 양수내 IL-6 농도 측정은 태반의 급성 염증성 병변과 주산기 예후를 산전에 예측하는데 매우 유용하며 양수내 감염의 진단 기준인 양수배양 검사보다 민감도가 더 높은 검사이다. 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.