Risk factors associated with fetal Losses after midtrimester amniocentesis

정진훈 ( Jin Hoon Chung ),( Jae Hyug Yang ),( Myoung Jin Moon ),( Ha Jung Lim ),( June Seek Choi ),( Joo Oh Kim ),( Joong Sik Shin ),( Hyun Kyong Ahn ),( Jung Yul Han ),( Moon Young Kim ),( Hyun Mee Ryu 대한산부인과학회 2003 대한산부인과학회 학술대회 Vol.89 No.-

쌍태아간 수혈증후군의 진단과 처치

정진훈 ( Jin Hoon Chung,) 대한주산의학회 2010 Perinatology Vol.21 No.4

Twin-to-twin transfusion syndrome (TTTS) is a severe complication of monochorionic twin pregnancies, characterized by the development of unbalanced chronic blood transfer from one twin, Defined as donor twin, to the other, defined as recipient, through placental anastomoses. The incidence of TTTS in monochorionic diamniotic gestations is approximately 10% to 20%. The natural history of severe TTTS is well established with mortality approaching 80% to 100% if left untreated, especially when it presents at less than 20 weeks` gestation. This review presents overview of what is known about the pathophysiology and the diagnosis of TTTS, the markers for early detection of TTTS, treatment options available for TTTS, and complications of treatment for TTTS.

다운증후군의 산전진단을 위한 초음파를 이용한 선별검사

문명진 ( Myoung Jin Moon ),류현미 ( Hyun Mee Ryu ),정진훈 ( Jin Hoon Chung ),임하정 ( Ha Jung Lim ),최준식 ( June Seek Choi ),김주오 ( Joo Oh Kim ),신중식 ( Joong Sik Shin ),안현경 ( Hyun Kyong Ahn ),한정렬 ( Jung Yul Han ),김문영 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.8

목적: 다운증후군으로 진단된 태아 중 임신 중기에 정밀초음파를 시행한 59예의 초음파 소견을 분석하여, 유전학적 초음파 검진의 유용성을 평가하는데 필요한 단독 유사비를 얻고자 하였다. 연구 방법: 1993년 1월부터 2002년 12월까지 성균관대학교 삼성제일병원 산부인과에서 산전 염색체검사를 통하여 다운증후군으로 진단된 태아 중 본원에서 임신중기 정밀 초음파 (level II sonography)를 시행한 총 59예를 대상으로 임상기록 및 초음파 기록을 Objective: To determine the risk of Down syndrome in fetuses with sonographic markers using the likelihood ratios and individual risk assessment. Methods: We retrospectively evaluated the midtrimester genetic sonographic features of fetuses with Down synd

태아의 염색체의 수적 이상을 유발하는 모계 위험인자로서 5, 10-Methylentetrahydrofolate Reductase (MTHFR C677T)와 Methionine Synthase Reductase (MTRR A66G) 유전자의 다형성 연구

김도진(Do Jin Kim),김신영(Shin Young Kim),박소연(So Yeon Park),김진우(Jin Woo Kim),김문영(Moon Young Kim),한정렬(Joung Yeol Han),양재혁(Jae Hyug Yang),안현경(Hyun Kyong Ahn),최준식(Jun Seek Choi),정진훈(Jin Hoon Chung),류현미(Hyun Me 대한의학유전학회 2008 대한의학유전학회지 Vol.5 No.2

목적: 다운증후군을 비롯한 염색체의 수적이상은 태아의 유산이나 정신박약의 가장 큰 요인으로 알려져 있다. 이에 본 연구에서는 엽산 대사에 관련된 효소의 다형성(MTHFR C677T, MTRR A66G)을 조사하여 태아의 염색체 수적이상과 유전적인 연관성을 알아보고자 한다. 대상 및 방법: 염색체 수적이상이 확인된 태아를 임신한 37명의 산모와 유산이나 비정상적인 임신을 한 경험이 없고 2명 이상의 건강한 아이를 출산한 78명의 여성을 정상군으로 하여 혈액으로부터 DNA를 추출하고 PCR-RFLP를 이용하여 각 지역의 다형성 여부를 확인하였다. 결과: MTHFR C677T 유전자형은 CC, CT, TT에 대해 각각 30.7%, 48.7%, 20.6%였으며, 환자군에서 각각 37.8%, 48.6%, 13.5% 였다. 정상군과 환자군 사이 모든 조합에서 유의한 차이를 보이지 않았다. 대립유전자의 비율 역시 대조군과 환자군에서 각각 44.9%, 37.8%였으며, 통계적 유의한 차이는 없었다. MTRR A66G 유전자형은 대조군에서 AA, AG, GG에 대해 각각 50.0%, 46.1%, 3.9%였으며, 환자군에서는 각각 13.5%, 81.1%, 5.4%였다. MTRR의 정상 유전자형인 AA와 이형접합성 변이형인 AG 유전자형을 비교하였을 때 유의한 차이를 보였으며(OR: 6.5, 95% CI: 2.3-18.6, P<0.05), 정상이 아닌 모든 다른 유전자형(AG/GG)과 비교하였을 때에도 역시 유의한 차이를 보였다(OR: 6.4, 95% CI: 2.3-18.1, P<0.05). 결론: 본 연구에서는 MTHFR 677번째 염기의 다형성은 염색체 비분리로 인한 태아 염색체의 수적이상과 연관성이 없는 것으로 확인하였으나, MTRR 66부위의 경우 염기의 다형성이 태아 염색체의 수적이상을 유발하는 유전적 요소로서의 가능성을 제시하고 있다. Purpose: Aneuploidy is the cause of diseases such as Down syndrome or Edward syndrome and, more generally, is a major cause of mental retardation and fetal loss. The purpose of this study was to evaluate the association between MTHFR (C677T) or MTRR (A66G) polymorphisms and fetal aneuploidy. Materials and Methods: Data was collected from 37 women who had a fetus with aneuploidy (cases) and 78 women who had previously delivered at least two healthy children without aneuploidy and did not have a history of miscarriage or abnormal pregnancy (controls). The MTHFR (C677T) or MTRR (A66G) polymorphisms were analyzed by PCR-restriction fragment length polymorphism assay. Results: The frequencies of the MTHFR 677 CC, CT, and TT genotypes were 30.7%, 48.7%, and 20.6% in the control group and 37.8%, 48.6%, and 13.5% in the case group, respectively. There were no significant differences in genotype frequencies between the two groups. For the MTRR A66G polymorphism, the frequencies of the AA, AG and GG genotypes were 50%, 46.1%, and 3.9% in the control group and 13.5%, 81.1%, and 5.4% in case group, respectively. The frequency of the MTRR AG mutant was significantly increased in the case group, with an odds ratio of 6.5 (95% CI: 2.3-18.6, P<0.05). Conclusion: The results of this study suggest that mother carriers with the MTRR G allele have an increased risk of fetal aneuploidy, while the MTHFR T allele is not associated with increased risk of fetal aneuploidy. The MTRR A66G polymorphism may be a risk factor for producing a child with chromosomal aneuploidy.

질식 분만된 조산아에서 아프가 점수 , 제대 동맥혈 가스분석의 임상적 의의

박지용(Ji Yong Park),정진훈(Jin Hoon Chung),박교훈(Kyo Hoon Park),조용균(Yong Kyoon Cho),최훈(Hoon Choi),김복린(Bok Rin Kim),이홍균(Hong Kyoon Lee),고수진(Su Jin Ko),서정식(Joung Sik Seo),유태환(Tae Hwan Yoo) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.11

N/A Objective: The Apgar score has long been used to determining birth asphyxia and assessing early neonatal status and long-term outcome. Unfortunately, some components of this system depend upon subjective interpretation. Also, although, low Apgar score, Most of newborns are relatively healthy. The objective of our studt is attempt to assure the linical significance of Apgar score and umbilical cord blood gas analysis on assessing status of uncomplicated preterm infants delivered vaginally. Methods: The present study was performed in attempt to compare umbilical arterial blood gas values for uncomplicated preterm infants delivered vaginally with low 1 and 5 minutes Apgar score (<7) with those for term or preterm infant with normal 1 and 5 minutes score (>7), each other, The present study included 82 uncomplicated term infants delivered vaginally and 24 preterm infants. Inclusion criteria of our study is as follows: 1) Singleton neonate with vertex presentation, 2) No congenital malformation, 3) Infants whose mother had no obstetrical and medical complications, 4) Immediately after delivery, umbilical arterial blood was sampled, before first breathing of neonate, 5) Infants applied Apgar score at I minute and again 5 minutes after birth, and 6) Infants whose mothers gestational age was estimated by ultrasonography during first-trimester of pregnancy. The statistical analysis was performed by Mann-Whitney U test and Fishers exact test. Results: 1) There was no significant difference in umbilical arterial blood gas values between uncomplicated preterm infants delivered vaginally with low 1 and 5 minutes Apgar score (<7) and term infants with normal score (>7). 2) There was no significant difference in umbilical arterial blood gas values between uncomplicated preterm infants delivered vaginally with low 1 and 5 minutes Apgar score (<7) and preterm infants with normal score (>7). 3) There was significant difference in frequency of lower Apgar score (<7) between term (2%[2/82]) and preterm infants (38%[9/24]), but not in frequency of acidemia (defined as less than pH 7.2) (28%[23/82] Vs 33%[8/24]). Conclusion: The Apgar score is not a reliable indieator of well-being in preterm neonate. We recommend umbilical arterial blood sampling at delivery of preterm infant with low Apgar score, because umbilical cord blood gas indices on objective means of assessing birth status of the newbarn and more useful than Apgar score in ruling out birth asphyxia.

쌍태임신에서 임신중기 양수천자 후 태아 손실률

서백경 ( Back Kyoung Seo ),정진훈 ( Jin Hoon Chung ),양재혁 ( Jae Hyug Yang ),신중식 ( Joong Sik Shin ),김문영 ( Moon Young Kim ),류현미 ( Hyun Mee Ryu ),김민지 ( Min Ji Kim ),이현정 ( Hyun Jung Lee ),유영 ( Young Yu ),최준식 ( J 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.6

목적: 두 융모막성 쌍태임신에서 임신중기 양수천자에 따른 태아 손실률을 알아보고자 하였다. 연구 방법: 2002년 1월부터 2004년 12월까지 본원 산부인과에서 산전진찰을 받은 두 융모막성 쌍태임신 임산부 중, 임신중기 양수천자를 시행 받은 132명을 연구 대상으로 하였다. 같은 기간 양수천자를 하지 않은 두 융모막성 쌍태임신군 595명과 동일한 날, 동일한 시술자에 의해 양수천자를 시행 받은 단태임신군 402명을 대조군으로 하였다. 쌍태임신에서 태아 손실은 임신 28주 이전 양측태아 모두에서 손실이 발생한 경우를 태아 손실로 분류하였다. 결과: 임신 중기 양수천자 후 시술 후 4주 이내에 발생한 태아손실은 쌍태임신군에서 1예 (0.75%), 단태임신군에서 2예 (0.49%, P=.729) 이었고, 같은 임신 주수에서 양수천자를 시행 받지 않은 쌍태임신군 8예에서 태아 손실이 발생하였다. (1.34%, P=.581) 임신 28주 이내에 발생한 태아 손실은 양수천자를 시행 받은 쌍태임신군에서 4예(3.03%), 양수천자를 시행 받지 않은 쌍태 대조군에서 16예(2.69%, P=.83) 단태 대조군에서 2예 (0.49%, P=.017)이었다. 결론: 쌍태임신 시 임신 중기 양수천자 후 태아손실률은 단태임신에 비해 상대적으로 증가함을 알 수 있었다. 하지만 양수천자를 시행 받은 쌍태임신군의 태아 손실률은 양수천자를 시행 받지 않은 쌍태임신군의 태아 손실률과 비교하여 유의한 차이를 보이지는 않았다. Objective: To assess the fetal loss rate among dichorionic twin gestations undergoing genetic amniocentesis compared with singletons undergoing the procedure and untested twins. Methods: From January 2002 through December 2004, total 132 pregnant women with dichorionic twin gestation with mid-trimester amniocentesis at Hospital were included in this study. In control group, 595 women with untested dichorionic twins during the same period and 402 women with singleton pregnancies with amniocentesis performed by the same physician at the same date of study group were selected. Excluded were fetuses with known structural anomalies, cases in which amniocentesis was done in only one fetus, and cases of which pregnancies were terminated due to fetal chromosomal abnormalities. Fetal loss was defined as the loss of both fetuses and subdivided into two categories: within 4 weeks after amniocentesis and before 28 gestational weeks. Results: Up to 4 weeks after the procedure, one case (0.75%) in the tested twin group, two cases in post-procedure singleton group (0.49%, P=.729), and eight cases in the untested twin control group (1.34%, P=.581) were aborted spontaneously. Up to 28 gestational weeks, four fetal losses occurred in post-amniocentesis twins (3.03%), sixteen cases in untested twins (2.69%, P=.83), and two cases in the singleton pregnancies with amniocentesis (0.49%, P=.017). Conclusion: The risk of fetal loss in twin underwent mid-trimester amniocentesis appears to be higher than that of tested singletons in this study. However, there was no significant difference in the fetal loss rates between amniocentesis twin group and untested twin group.

태반조기박리가 동반된 임신성 고혈압 임산부와 정상혈압 임산부에서의 주산기 예후에 대한 비교 분석

박지용(Ji Yong Park),정진훈(Jin Hoon Chung),조용균(Yong Kyoon Cho),최훈(Hoon Choi),김복린(Bok Rin Kim),이홍균(Hong Kyoon Lee),유태환(Tae Hwan Yoo),고수진(Soo Jin Ko),박교훈(Gyo Hoon Park),서정식(Jeong Sik Seo) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.11

N/A Objective: The objective of this study was to compare perinatal outcomes of pregnancy-induced hypertensive and normotensive women experiencing abruptio placentae, Our hypothesis is that pregnancy-induced hypertensive women have a less favorable perinatal outcome than do normotensive women. Methods: Women with the diagnosis of abruptio placentae delivered between August 1,1989 and December 1,1996, composed the study group (n-92) in this case-control study. The women with abruptio placentae were divided according to their hypertensive (n 37) or normotensive (n 55) status. Maternal and neonatal medical records were reviewed and abstracted for demographic variables, antepartum complications, delivery route, abruptio placentae grade, neonatal gender, birth weight, Apgar score and perinatal mortality. We compared these perinatal outcome variables between the pregnancy-induced hypertensive and normotensive pregnant women. Results: The incidence of abruptio placentae was 0.35%. The two groups of woman wne similar with regard to age and parity. Abruptio placentae grades 2 occurred more often in hypertensive women (P=0.0053). Pregnancy-inducedhypertensive women were similar to normotensive women with regard to antenatal complications. The mean gestational age of delivery, delivery route, neonatal weight and sex were similar between two groups of women. Neonates from pregnancy-induced hypertensive women were no more likely to have low 1 and 5-minute Apgar score or to die than those from normotensive women. Statistical analysis was performed with two-tailed independent t-test and Kruskal-Wallis analysis. Conclusion: Although pregnancy-induced hypertensive women experiencing abruptio placentae are more likely to have grade 2 abruptio placentae with fetal distress, the overall perinatal outcome was not significantly different from that of normotensive women experiencing abruptio placentae.

초음파상 자궁경부가 짧은 무증상 임신부에서 조산예방을 위한 자궁경부 원형결찰의 효용성

김민형 ( Min Hyoung Kim ),정진훈 ( Jin Hoon Chung ),최준식 ( June Seek Choi ),안현경 ( Hyun Kyung Ahn ),한정열 ( Jeong Yeol Han ),류현미 ( Hyun Mee Ryu ),김문영 ( Moon Young Kim ),양재혁 ( Jae Hyug Yang ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.11

목적: 임신 중기 초음파상 자궁경부 길이는 짧지만 조기진통의 증상이 없는 임신부에서 시행한 자궁경부 원형결찰이 조산 예방에 대한 효과가 있는지 알아보고자 하였다. 방법: 1996년 1월부터 2005년 12월까지 제일병원에서 산전 진찰을 받은 단태아 임신부들의 의무 기록을 조사하여 임신 중기 초음파에서 자궁경부 길이가 25 mm 이하로 기록된 산모를 대상으로 하였다. 초음파 당시 조기 진통의 증상이 있어 입원한 산모는 제외하였다. 조기진통의 증상이 없이 초음파상 자궁경부 길이 단축이 진단된 후 1주일 이내에 바로 자궁경부 원형결찰을 시행받은 산모를 원형결찰군에 포함시켰으며, 수술을 시행하지 않고 관찰한 경우를 기대요법군에 포함시켰다. 연구의 1차 결과로는 34주 미만의 조산의 빈도를 비교하였으며, 2차 결과로는 25 mm 이하의 짧은 자궁경부 길이를 보이는 임신부에서 조산과 가장 연관있는 요인을 분석하였다. 결과: 총 111명의 임신부가 연구대상에 포함되었으며, 평균 임신 주수는 21.6주였다. 자궁경부 원형결찰을 받은 군은 26명, 기대요법군은 85명이었다. 두 군 사이의 34주 이전에 조산한 산모의 빈도 [10예 (38.5%) vs 17예 (20.0%), P=0.069]는 차이는 없었다. 자궁경부 길이가 25 mm 이하인 경우, 조산과 연관성이 있는 요인으로는 단변량 분석에서는 15 mm 이하의 매우 짧은 경부길이와 깔때기화가 연관 있는 요인이었으나, 다변량 분석에서는 이 중 15 mm 이하의 경부 길이만이 수정 승산비가 3.67 (95% CI 1.2~10.56)로 34주 이전의 조산과 가장 연관성이 있었다. 결론: 임신 중기 초음파상 자궁경부 길이가 25 mm 이하로 짧은 임신부에서 바로 시행하는 자궁경부 원형결찰은 조산에 대한 예방효과가 기대요법과 차이가 없으며, 15 mm 이하의 자궁경부 길이를 보인 임신부는 조산에 대한 집중 관리가 필요하다. Objective: To investigate the clinical efficiency of the cervical cerclage for preventing preterm birth in asymptomatic women who showed a shortened cervix at the second trimester ultrasound Methods: From January 1996 to December 2005, we retrospectively reviewed the medical records of pregnant women who received routine second trimester ultrasound (16~24 gestational weeks) without abdominal pain or bleeding at Cheil general hospital. Women with a short cervical length ≤25 mm were classified into cerclage and expectant group. Women who received cervical cerclage within 1 week after detection of cervical shortening without any change of cervical length and shape were included in cerclage group. Primary outcome was the frequency of delivery before 34 weeks` gestation. Secondary outcome was the most important risk factor for preterm delivery in pregnant women with short cervix. Chi-square test, t-test, and multiple logistic regression analysis were used for statistical analysis. P<0.05 was considered statistically significant. Results: The mean gestational age at ultrasound was 21.6 weeks` gestation. A total of 111 women had short cervix, including 26 that were treated by cerclage and 85 managed expectantly. The proportion of preterm delivery before 34 weeks` gestation was higher in the cerclage group [38% (10 of 26)] than that of the expectant group [20% (17 of 85)], but there was no significant difference (P=0.069). In the univariate analysis, funneling (38% vs 16%, P=0.012) and cervical length ≤15 mm (47% vs 15%, P=0.069) were associated with preterm delivery before 34 weeks` gestation. In the multiple logistic regression analysis, a cervical length ≤15 mm had an adjusted odd ratio of 3.7 (95% CI 1.3~10.6) for preterm delivery before 34 weeks`s gestation. Conclusions: These data suggest that cerclage in asymptomatic woman with a short cervix in the second trimester ultrasound does not prevent preterm delivery before 34 weeks of gestation. Woman with extremely shortened cervical length ≤15 mm needs intensive management for prevention of preterm delivery.

임신 중기 원인불명 모체혈청 인간 융모성 성선자극호르몬이 상승된 임부에서의 임신 예후

박지용(Ji Yong Park),정진훈(Jin Hoon Chung),고수진(Su Jin Ko),박교훈(Kyo Hoon Park),서정식(Jung Sik Seo),유태한(Tae Hwan Yoo),조용균(Yong Kyoon Cho),최훈(Hoon Choi),김복린(Bok Rin Kim),이홍균(Hong Kyoon Lee) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.11

N/A Objective: Our purpose was to determine whether unexplained elevation in maternal serum human chorionic gonadotropin without abnormal elevation in matemal serum alpha-fetoprotein (MSAFP) in the second trimester may be associated with adverse pregnancy outcomes. Methods: Between January 1997 and December 1997, we evaluated 906 pregnant women undergoing second trimester triple marker screening tests who delivered at our hospital. Multiple pregnancy, fetal anomaly, intrauterine fetal death before 20 completed weeks of gestational age, insulin dependent diabetes mellitus and maternal serum alpha-fetoprotein level greater than 2.0 multiple of the median (MoM) were excluded fiom the study. Seventy-two women with hCG level greater than 2.0 MoM were included in the study group while 809 women with hCG level less than 2.0 MoM served as the control group. Adverse pregnancy outcomes were obtained from hospital delivery records and neonatal records. Statistical analysis were performed by students t-test and chi square test. Results: Women with unexplained elevation of human chorionic gonadotropin level showed increased risks for intrauterine growth retardation (P<0.01) and pregnancy induced hypertension (P<0.05). There were no significant differences between study and control groups with respect to preterm delivery, placental abruption, fetal anomaly and intrauterine fetal death. Conclusion: Unexplained elevation of human chorionic gonadotropin in the second trimester was associated with intrauterine growth retardation and pregnancy induced hypertension.

무통분만을 위한 경막외마취가 분만과정의 지연 및 신생아 예후에 미치는 영향

이시원 ( Si Won Lee ),양재혁 ( Jae Hyug Yang ),조혜진 ( Hye Jin Cho ),홍달수 ( Dal Soo Hong ),김문영 ( Moon Young Kim ),류현미 ( Hyun Mee Ryu ),최준식 ( June Seek Choi ),정진훈 ( Jin Hoon Chung ),지영석 ( Young Suck Jee ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.10