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박교훈 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2
Perinatal asphyxia, whether prenatal, intrapartum, or neonatal is thought to be a significant contributor to newborn morbidity and mortality as well as long-term neurological deficits. Development of an intrapartum test that can reliably identify and discriminate between varying degrees of fetal acidemia and suggest whether it is respiratory or metabolic in nature would be highly desirable. Umbilical cord blood acid-base analysis may be used to assess the condition of fetus and newborn more objectively. Newborn acid-base status is an important criterion when we attempt to define perinatal asphyxia. It also has medicolegal ramifications because it enables the documentation of the presence of a biochemical milieu that is not related to the later development of cerebral palsy. Acidemia is defined as an umbilical artery pH value less than 7.2 because most studies have used this cutoff. However, this traditional level is probably too high. Recent studies suggest that the pH cutoff should be lower, perhaps as low as less than 7.0. We anticipate future research will focus on the redefinition of acidemia and its relationship to fetal and new-born outcomes.
박교훈 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2
Rubella is also called German measles. If the fetus gets rubella during the first 12 weeks of pregnancy, it will be born with many problems including blindness, deafness or heart damage. Congenital malformations occur in around 80-90% of infants born to women who acquired primary rubella during the first 12 weeks of pregnancy. The risk of congenital malformation falls to around 10-20% by the 16th week. Problems are rare when the maternal infection occurs after the 20th week of gestation. It is usual for a termination of pregnancy to be offered if primary maternal rubella is confirmed in the 1st trimester. The virus is spread by droplet or direct contact with nasopharyngeal secretions of infected persons. The incubation period is 14-21 days. The virus is highly communicable and infected persons are infectious for about 7 days before, and at least 4 days after the onset of the rash. Infants born with congenital rubella may shed virus for months. For the determination of the patient's immune status, IgG test may be performed on a single serum. For the diagnosis of recent infection, either IgG or IgM may be measured in paired sera or a single high IgM titer may be sufficient. When the risk is more difficult to establish, prenatal diagnosis of intrauterine infection may be useful in some circumstances. Prenatal diagnosis requires invasive procedures which carry some risk to the fetus. These methods include cordocentesis to detect rubella specific IgM in fetal blood at 18-23 weeks. Detection of rubella virus in a chorionic villus sample may be possible at 10 weeks of gestation (using reverse transcription PCR techniques), but doubt has been cast on the significance of a positive result in predicting infection of the fetus itself.
박교훈,김수아,이승미 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.2
Purpose: To develop a model based on non-invasive clinical and ultrasonographic parameters for predicting the likelihood of subsequent histologic chorioamnionitis in women with preterm premature rupture of membranes (PPROM) and to determine whether the inclusion of invasive test results improves the predictive value of the model. Materials and Methods: This retrospective cohort study included 146 consecutive women presenting with PPROM (20–33 weeks). Transvaginal ultrasonographic assessment of cervical length was performed. Maternal serum C-reactive protein (CRP) levels and white blood cell (WBC) counts were measured after amniocentesis. Amniotic fluid (AF) obtained by amniocentesis was cultured, and interleukin-6 (IL-6) levels and WBC counts were determined. The primary outcome measure was histologic chorioamnionitis. Results: Risk scores based on serum CRP concentrations and gestational age (model 1) were calculated for each patient. The model was shown to have adequate goodness of fit and an area under the receiver operating characteristic curve (AUC) of 0.742. When includingAF test results (e.g., AF IL-6 levels) in model 1, serum CRP concentrations were found to be insignificant, and thus, were excludedfrom model 2, comprising AF IL-6 levels and gestational age. No significant difference in AUC was found between models 1 and 2. Conclusion: For women with PPROM, the newly developed model incorporating non-invasive parameters (serum CRP and gestationalage) was moderately predictive of histologic chorioamnionitis. The inclusion of invasive test results added no predictive information to the model in this setting.