Ultrasound assessment of cervical length and volume: comparison of transabdominal and transvaginal approaches

위정하,위지선,길기철,이영,신종철,박인양 대한산부인과학회 2015 대한산부인과학회 학술대회 Vol.101 No.-

자궁 경부 전암 병변 및 자궁 경부암 환자에서의 HPV 감염 양상 및다중감염의 분포

위정하,이태성,오훈규,박관규,성효정,최윤석 대한부인종양학회 2006 Journal of Gynecologic Oncology Vol.17 No.1

Objective : To evaluate the distribution of HPV subtype and multiple HPV infection in cervical cancer and percancerous lesion with HPV DNA chip in Korean women. Method : We recruited a total of 145 women diagnosed with cervical cancer or cervical intraepithelial neoplasia (CIN), and 404 normal women as control between Dec. 2004 and Sept. 2005. We investigated the distribution of HPV subtype and the multiple infection according to cervical lesion. Result : Of the 145 women, 132(91.0%) showed HPV infection and 111(76.6%) showed high risk HPV infection by HPV DNA chip. HPV 16(48/145, 33.1%) was the most common type, and followed by HPV 58, 18, and 33 in CIN or cervical cancer than control (p<0.05). Multiple infections were more common in CIN or cervical cancer than control. There was no correlation between the incidence of multiple HPV infection and cervical lesion in young women (<35 years). In women over 36 years of age, however, multiple infections were the most frequently detected in CIN. Conclusion : The types of HPV 16, 58, 18, 33 were common in cervical precancerous or cancer lesion by order of frequency. Multiple infections were common in women under 35 years of age, and in women with CIN over 36 years of age. 목적 : HPV DNA chip을 이용하여 자궁 경부 상피내 병변 및 자궁 경부암에서의 HPV 아형에 따른 감염 빈도 및 다중 감염의 분포를 알아보고자 하였다. 연구방법 : 2004년 12월부터 2005년 9월까지 본 병원에서 자궁경부 세포 검사 및 HPV DNA chip을 이용하여 HPV 아형 검사를 받은 여성들을 대상으로 자궁 경부 상피내 병변 및 자궁 경부암으로 진단된 145명의 환자와 정상으로 진단된 404명을 대상으로 HPV 검사 결과를 후향적으로 조사하였다. 결과 : 전체 145예 중 132예(91.0%)가 HPV 양성소견을 보였으며 111예(76.6%)가 고위험 HPV 감염 양성으로 나타났다. HPV 아형에 따라서는 16, 58, 18, 33형의 순으로 빈도가 높았으며, 다중감염의 경우도 상피내 종양과 침윤암에서 대조군에서 더 많이 관찰되었다. 다중 감염의 빈도를 35세를 기준으로 연령별 분포를 살펴 보았을 때, 35세 이하의 연령군에서는 36세 이상의 연령군에 비해 다중 감염의 빈도는 높으나 (18.4% vs 10.4%, P<0.05), 조직학적 병변의 정도와 무관한 분포를 보였고, 36세 이상의 연령군에서는 상피내 종양에서 통계학적으로 유의하게 많이 관찰되었다. 결론 : 자궁경부암 및 전암성 병변에서는 HPV 16, 58, 18, 33의 순으로 감염 빈도가 높은 것으로 나타났다. 다중 감염은 35세 이하의 젊은 여성에서 발생 빈도는 높았으나 조직학적 병변에 따른 발생 빈도의 차이를 보이지는 않았고, 36세 이상의 여성에서는 상피내 종양에서 주로 발견되었다. 중심단어: 자궁경부암, 인유두종바이러스, DNA chip, 다중감염, 감염빈도

Torsion of a pedunculated subserosal myoma: a rare cause of acute abdomen in pregnant women

위정하,김주연,최세경,고현선,신종철,박인양 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-

A 31-year-old gravid 1, para 0 women at 19 6/7 weeks gestation was referred to our emergency department with complaints of severe lower abdominal pain. A transabdominal sonogram revealed pedunculated solid mass expected ovarian mass torsion. A MRI revealed subserosal myoma at the right pelvic cavity. The patient underwent an diagnostic laparoscopy and this mass revealed torsion of pedunculated myoma. On gross inspection, the resected myoma was ischemic, and both focal hemorrhage and necrosis were noted in the pathology report

유산의 기왕력이 폐경기 이후 자살 사고 및 우울증의 유병율에 미치는 영향 - 국민 건강 영양 조사 자료 기반 연구

위정하,윤항구,최세경,고현선,신종철,박인양 대한산부인과학회 2016 대한산부인과학회 학술대회 Vol.102 No.-

목적: 유산의 기왕력에 따른 폐경기 이후의 자살사고 및 우울증등 정신건강에 미치는 영향을 알아보고자 한다. 방법: 2010-2012 제 5차 국민건강영양조사 자료로 유산의 기왕력이 있는 환자의 폐경기 이후 자살사고 발생 빈도를 확인해 보고, 우울증 발병율. 스트레스 인지정도, 우울감 정도를 비교해 보았다. 결과: 기간내 폐경여성 은 5133명이 었으며 그들중 26.6%가 최근 1년간 자살과 관련된사고의 경험이 있는 것으로 확인되었다. 자살사고가 있는 있는군은 나이가 평균 65.3세로 자살사고가 없었던 군 (62.1세)보다 높았으며 p<0.001 가구 소득 하위 25% (29.1% vs 45.3%, p <0.001), 교육정도 하위 25%(55.0% vs 27.3% p<0.001), 배우자 유무(73.9% vs 63.7% p<0.001), 현재흡연율(4.1% vs 8.5% p<0.001), 고혈압(39.23 vx46.7% p <0.001), 당뇨(12.5% vs 16.0% p=0.015), 골관절염(35.6% vs 49.6% p<0.001) 의 유병율이 높은 것으로 조사되었다. 자살사고가 있았던 군은 이전 유산 경험이 많은 것으로 확인되었는데 3회이상 유산 경험이 있는 경우가 유의하게 더 높았다. (23.3% vs 27.9% p0.012) 전체 유산중 자연유산의 경우는 유산여부와 유산 빈도에 따라 자살사고의 차이가 없었고(0.717), 인공유산의 경우는 유산횟수가 많을 수록 자살사고를 보이는 빈도가 높았다. (p 0.005) 두군간 규칙적 운동여부(p 0.33) 각종암 유별율(p 0.11), 여성호르몬제 복용여부(p 0.90)는 차이가 없는 것으로 확인되었다. 연력 소득, 교육정도, 배우자 유무, 현재 흡연율, 고혈암, 암, 골관절염 유병율로 보정하였을때 전체 유산 경험이 없는 경우 에 비해 3회이상 유산경험이 있는 경우(aOR 1.504(1.166~1.941)가 자살사고를 보일 위험도가 높은 것으로 확인되었다, 자연유산의 경우는 상관관계가 없었으며 (p 0.50), 인공유산의 경우가 위험도가 높게 조사되었다. (aOR 1.531(1.207~1.941)) 3회이상 유산 경험 이 있는 경우가 우울증 (aOR 1.926(1.225~3.029)), 스트레스 인지정도(1.355(1.085~1.693)), 우울감을 경험할 위험도(1.92(1.496~2.464)) 가 높았으며 이는 자연유산의 경우에는 관련성이 없는 것으로 확인되었다. 결론: 3회 이상 유산 경험이 있는 여성이 폐경기 이후 자살사고나 우울증 발생 위험도가 높았으며 이는 인공유산의 경우에 국한되었다. 자연유산의 경우는 유산경험 유무 및 유산 횟수가 증가함에 따른 폐경기 정신건강에 영향을 미치지는 않았다.

Prenatal Diagnosis of Congenital Heart Diseases and Associations with Serum Biomarkers of Aneuploidy: A Multicenter Prospective Cohort Study

위정하,한유정,김수현,김문영,조희영,이미영,정진훈,이성미,오수영,이준호,부혜연,조금준,권한성,김병재,박미혜,류현미,고현선 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.8

Purpose: We assessed prenatal detection rates of congenital heart disease (CHD) and associations between maternal serum bio markers and non-chromosomal CHD in singleton pregnancies. Materials and Methods: This study was conducted as a secondary analysis of data obtained during a multicenter prospective co hort study that investigated the cost-effectiveness of prenatal testing for fetal aneuploidy. We analyzed the prenatal detection rateand accuracy for CHD screening via ultrasound during the second trimester, as well as associations between serum biomarkersand CHDs, in singleton newborns without chromosomal abnormalities. Results: Among 6715 women, 142 (2.1%) newborns were born with CHDs, of which 67 (1.0%) newborns had major CHDs. Theprenatal detection rate for all CHDs and major CHDs were 34.5% and 58.2%, respectively. After excluding isolated ventricular sep tal defects, the detection rate for critical CHDs was 85.9%. Women with low pregnancy-associated plasma protein A (PAPP-A) (<0.4multiples of the median, MOM) face increased risks of non-chromosomal CHDs [adjusted odds ratio (aOR) 2.76; 95% confidenceinterval (CI) 1.36–5.13] and major CHDs (aOR 7.30; 95% CI 3.18–15.59), compared to those without CHDs. A higher inhibin A level(≥2.5 MOM; aOR 4.84; 95% CI 1.42–12.46) was associated with non-chromosomal major CHDs. Conclusion: Ultrasonography performed during the second trimester by obstetricians detected over 85% of critical CHDs. Low maternal serum PAPP-A or high inhibin-A was associated with non-chromosomal CHDs. These results may contribute to an im provement in prenatal diagnosis of CHDs.

OB-23 : Predictive value of gestational sac and yolk sac volume in early pregnancy loss

위정하,최세경,고현선,신종철,박인양 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.99 No.-

We proposed that by calculating the volume of yolk sac in the first trimester using 3D transvaginal sonography, the nomograms of their normal development could be created and used as a basis for predicting adverse reproductive outcomes. This study has been carried out between April 2009 and November 2012, involving 201 singletone pregnancies with gestational age (GA) from 5 to 9+6 weeks. We performed 3-dimensional (3D) transvaginal ultrasonography and calculated gestaional sac volume (GSV) and yolk sac volume (YSV) on the visit to our outpatient clinic. 168 women delivered their babies at term and other 33 women lost their babies in the first trimester. GSV and YSV are calculated by 3D ultrasonography using extended imaging virtual organ computer-aided analysis (XI VOCAL) method. We excluded multiple pregnancy and fetal chromosomal and structural anomaly. The relation of GSV and YSV to missed abortion was evaluated by independent t-tests and chi-square tests. GSV was significantly small in missed abortions (p<0.00). YSV was not significantly different between miscarriage and normal pregnancy. But, in subgroup analysis, there was a very high proportion of large YSV (0.6% vs 30.3%, p<0.00) in the missed abortion group. The enlarged yolk sac volume was defined as above 2SD. After excluding large YSV, YSV were small in missed abortion than normal pregnancies (p=0.049). In missed abortions, GSV was smaller than normal pregnancy. YSV was significantly small in the missed group excluding large YSV. There were a marked high risks of missed abortion given the large YSV. The reference intervals established in the present study can be used as normal parameters in future studies of assessing cases of risks for early pregnancy losses.

Effects of Oncostatin M on Invasion of Primary Trophoblasts under Normoxia and Hypoxia Conditions

위정하,고현선,최세경,박인양,김아영,김호식,신종철 연세대학교의과대학 2018 Yonsei medical journal Vol.59 No.7

Purpose: To investigate the effect of oncostatin M (OSM) on protein expression levels and enzymatic activities of matrix metalloprotainase(MMP)-2 and MMP-9 in primary trophoblasts and the invasiveness thereof under normoxia and hypoxia conditions. Materials and Methods: Protein expression levels and enzymatic activities of MMP-2 and MMP-9 in primary trophoblasts undernormoxia and hypoxia conditions were examined by Western blot and zymography, respectively. Effects of exogenous OSM onthe in vitro invasion activity of trophoblasts according to oxygen concentration were also determined. Signal transducer and activatorof transcription 3 (STAT3) siRNA was used to determine whether STAT3 activation in primary trophoblasts was involved inthe effect of OSM. Results: OSM enhanced protein expression levels and enzymatic activities of MMP-2 and MMP-9 in term trophoblasts under hypoxiacondition, compared to normoxia control (p<0.05). OSM-induced MMP-2 and MMP-9 enzymatic activities were significantlysuppressed by STAT3 siRNA silencing under normoxia and hypoxia conditions (p<0.05). Hypoxia alone or OSM alone didnot significantly increase the invasiveness of term trophoblasts. However, the invasion activity of term trophoblasts was significantlyincreased by OSM under hypoxia, compared to that without OSM treatment under normoxia. Conclusion: OSM might be involved in the invasiveness of extravillous trophoblasts under hypoxia conditions via increasingMMP-2 and MMP-9 enzymatic activities through STAT3 signaling. Increased MMP-9 activity by OSM seems to be more importantin primary trophoblasts.

쌍태임신에서의 지연분만

위정하 ( Jeong Ha Wui ),장민정 ( Min Jeong Jang ),오수영 ( Su Young Oh ),한금수 ( Keum Soo Han ),최윤석 ( Youn Seok Choi ),홍성연 ( Seong Yun Hong ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.1

The impact of applying Asian obesity criteria on the predi ction of preeclampsia in Korea

윤여녕,위정하,김연희,조윤선,신재은,최세경,길기철,김수미,고현선 한국모자보건학회 2023 한국모자보건학회 학술대회 연제집 Vol.2023 No.2

Optimal Timing of Delivery Based on the Risk of Stillbirth and Infant Death Associated with Each Additional Week of Expectant Management in Multiple Pregnancies: a National Cohort Study of Koreans

고현선,최세경,위정하,박인양,박용규,신종철 대한의학회 2018 Journal of Korean medical science Vol.33 No.10

Background: The purpose of this study was to compare the fetal/infant mortality risk associated with each additional week of expectant management to that associated with immediate delivery in women with multiple gestations. Methods: This was a retrospective national cohort study of 94,170 multiple deliveries, 92,619 (98.4%) twin and 1,352 (1.44%) triplet pregnancies, between 32 0/7 and 42 6/7 weeks of gestation recorded in the Korean vital statistics database. We investigated the risks of stillbirth and infant death after birth in Korea according to the week of gestation in twin and triplet pregnancies. Results: The risk of stillbirth significantly increased between 34 and 35 weeks of gestation and between 37 and 38 weeks of gestation in twin pregnancies and between 34 and 37 weeks of gestation in triplet pregnancies. The risk of infant death following delivery gradually decreased as pregnancies approached full term. Week-by-week differences were statistically significant between 33 and 34 weeks, with decreasing risks of infant death at advancing gestational ages in twin pregnancies. At 37 weeks of gestation, the relative risk of mortality was significantly higher with expectant management compared with immediate delivery (relative risk, 3.00; 95% confidence interval, 1.41–6.38). Conclusion: In twin pregnancies, delivery at 37 weeks of gestation can minimize the risks of stillbirth and infant death in uncomplicated cases, although individual maternal and fetal characteristics must be considered when determining the optimal timing of delivery. In multiple pregnancies, close fetal surveillance is needed after 34 weeks of gestation.