한국 선천성 기형 모니터링 체계 구축을 위한 다기관 공동연구

김암 ( Ahm Kim ),김소라 ( So Ra Kim ),양순하 ( Soon Ha Yang ),한정열 ( Jung Yeol Han ),김문영 ( Moon Young Kim ),양재혁 ( Jae Hyug Yang ),조용균 ( Yong Kun Cho ),김성수 ( Sung Soo Kim ),윤보현 ( Bo Hyun Yoon ),고경심 ( Kyung Sim 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.11

Objective: Our purpose was to establish a birth defects monitoring system in Korea by multi-center study. This novel study was initiated in 1999, and extended to detect the frequencies and trends of birth defects in Korea. Methods: Six centers participate

모성 연령이 일차 제왕절개술의 빈도에 미치는 영향에 대한 임상적 분석

김암 ( Ahm Kim ),이인식 ( In Sik Lee ),목정은 ( Jung Eun Mok ) 대한주산의학회 1993 Perinatology Vol.4 No.1

최신임상강좌 : 조기진통의 치료

김암 ( Ahm Kim ),마진영 ( Jin Young Ma ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.1

Premature labor remains one of the most intractable risk factors that contribute to perinatal morbidity and mortality. Tocolytics, antibiotics and corticosteroid have been used as the typical management for preterm labor. Various treatment of women with signs and symptoms of preterm labor has failed to decrease in the incidence of preterm births in the world. The management of preterm labor remains very controversial problems today. There are no clear first-line tocolytic drugs and antibiotics to prolong gestation period and improve perinatal outcome. But in Royal College of Obstetricians and gynecologists (RCOG) recommend that atosiban and nifedipine appear to be preferable as they have fewer side effects and seem to comparable effectiveness. So far there is insufficient evidence for any firm conclusions about whether or not maintenance tocolytic therapy following preterm labor is valuable. In conclusion, clinical circumstances and physician preferences should dictate treatment. Individual approach or combined treatment for preterm labor may be helpful in determining which treatment is suitable to each patient.

한국 선천성 태아기형 발생양상에 관한 다기관 공동연구

고경심(Kyung Sim Koh),김암(Ahm Kim),양순하(Soon Ha Yang),한정열(Jung Yeol Han),김은성(Eun Sung Kim),김문영(Moon Young Kim),양재혁(Jae Hyung Yang),박교훈(Kyo Hoon Park),김성수(Sung Soo Kim),윤보현(Bo Hyun Yoon) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.9

Objective : Our aim was to establish a multi-center birth defects monitoring system for evaluating the prevalence and serial occurrence of birth defects in Korea. Methods : Seven centers participated in this monitoring system. Trained nurses actively collected the 42,015 delivery records obtained from delivery units and pediatric clinics in the participating hospitals every month. Results : We observed 722 birth defects among 42,015 births including live births and stillbirths. The prevalence of birth defect was 1.7%. About one thirds of birth defects were terminated. The most frequent congenital anomalies were cleft lip and Down syndrome. The highest proportion of birth defects was 20.1% in urogenital system. The proportion of birth defects in cardiovascular system and gastrointestinal system were 17.1% and 14.1% respectively. Chromosomal anomalies and genetic syndromes represent 13.4% and 3.3% among birth defects respectively. Among chromosomal anomalies Down syndrome was at the first rank. Conclusion : We could establish multi-center active monitoring system for birth defects successfully. To check serial occurrence of birth defects, it is necessary to increase participating hospitals and to launch the nationwide multi-center study.

원인 불명의 양수과소증에서 경복부 양수주입술의 임상적 유용성

김미경 ( Mi Kyung Kim ),원혜성 ( Hye Sung Won ),신명신 ( Myung Shin Shin ),김소라 ( So Ra Kim ),정지윤 ( Ji Yoon Chung ),전대준 ( Dae Joon Jun ),이필량 ( Pil Ryang Lee ),이인식 ( In Sik Lee ),김암 ( Ahm Kim ) 대한주산의학회 2000 Perinatology Vol.11 No.4

초기임신 예후예측에 대한 혈청 황체호르몬농도 단회측정의 유용성

김재익 ( Jae Ik Kim ),김경진 ( Kyoung Jin Kim ),황운정 ( Woon Jeong Hwang ),한지수 ( Ji Soo Han ),원혜경 ( Hye Sung Won ),이필량 ( Pyl Ryang Lee ),이인식 ( In Sik Lee ),김암 ( Ahm Kim ),목정은 ( Jung Eun Mok ) 대한주산의학회 1996 Perinatology Vol.7 No.3

특발성 단독 태아 복수증에 대한 복강-양막강 문합술 1례

김숙희 ( Sook Hee Kim ),원혜성 ( Hye Sung Won ),김소라 ( So Ra Kim ),정지윤 ( Ji Youn Chung ),이필량 ( Pil Ryang Lee ),이인식 ( In Sik Lee ),김암 ( Ahm Kim ) 대한주산의학회 2001 Perinatology Vol.12 No.1

임상 ; 당뇨병 산모에서 출생한 신생아의 선천성 기형 진단에서의 산전 정밀 초음파 검사의 역할

김영아 ( Young A Kim ),임진아 ( Gin A Lim ),이병섭 ( Byong Sop Lee ),심재윤 ( Jae Yoon Shim ),원혜성 ( Hye Sung Won ),김애란 ( Ai Rhan Kim ),김기수 ( Ki Soo Kim ),이필량 ( Pil Ryang Lee ),김암 ( Ahm Kim ),피수영 ( Soo Young Pi ) 대한주산의학회 2010 Perinatology Vol.21 No.3

Objective: Infants of diabetic mothers have higher incidence of congenital malformations compared with those of non-diabetic mothers. We investigated the usefulness of prenatal level II or “targeted” ultrasonography (TUS) as a diagnostic tool to identify congenital abnormalities in infants of diabetic mothers. Methods: We retrospectively reviewed the medical records of 218 mothers diagnosed as pregestational or gestational diabetes in whom prenatal TUS was performed in Asan Medical Center between 2004 and 2009. The prenatal TUS findings were compared with the congenital abnormalities found in the infants (n=226) of the diabetic mothers by physical examination and ultrasonography (including echocardiography). Maternal risk factors associated with congenital anomalies were also investigated. Results: The incidence of congenital anomalies was 14.2% (n=32) in prenatal TUS and 15.5% (n=35) postnatally, respectively. Only 7 cases (3.6%) out of the 194 infants with normal prenatal TUS findings were found to have congenital abnormalities diagnosed postnatally. All of the abnormalities in these 7 infants could be detected or suspected by physical examination after birth. Maternal fasting glucose level >120 mg/dL and insulin therapy were significant risk factors for predicting congenital abnormalities in infants of diabetic mothers. Conclusion: Prenatal TUS performed by experienced obstetricians had a good reliability in the diagnosis of congenital anomalies in infants of diabetic mothers. Need for universal screening of ultrasound or echocardiography in these infants should be questioned especially in the cases in which prenatal TUS was performed.

융모막 융모채취술의 임상적 분석

김지선 ( Ji Sun Kim ),원혜성 ( Hye Sung Won ),백수진 ( Su Jin Baek ),최은선 ( Eun Sun Choi ),심재윤 ( Jae Yoon Shim ),김성훈 ( Sung Hoon Kim ),김정훈 ( Jung Hoon Kim ),이필량 ( Pil Ryang Lee ),김암 ( Ahm Kim ) 대한주산의학회 2008 Perinatology Vol.19 No.1

Objective: The aims of this study were 1) to evaluate the indications of chorionic villus sampling CVS and the positive predictive value for fetal chromosomal abnormalities, 2) to evaluate the reliability of CVS at Asan Medical Center, 3) to find out the risk factors of procedure-related fetal loss, 4) to find out the risk factors of culture failure, and 5) to compare transabdominal with transvaginal approaches. Methods: Medical records of the 429 out of 461 patients in whom the CVS for prenatal cytogenetic diagnosis were performed were reviewed retrospectively for the period of June 1998 to June 2006. Results: (1) The most common indications of CVS were abnormal ultrasonic findings including increased nuchal translucency (153/429, 35.7%), a previous history of cytogenetically abnormal baby (125/429, 29.1%), old maternal age (100/429, 23.3%), family history of genetic disease (22/429, 5.1%), and parental abnormal karyotype (11/429, 2.6%). (2) The positive predictive value of abnormal karyotyping according to the indication of CVS was highest in the cases showing abnormal USG findings, including increased fetal nuchal translucency (28.3%). (3) The trial success rate of CVS was 99.5%(427/429). Culture failure rate was 1.9%. (4) Of the 427 cases, normal karyotype was revealed in 349 cases (81.7%), abnormal karyotype in 66 cases (15.2%), maternal cell contamination in 6 cases (1.4%), and pseudomosaicism and confined placental mosaicism (CPM) in 6 cases (1.4%). (5) Procedure-related fetal loss rate was 1.6% (7/419). (6) The significant risk factor of fetal loss was presence of preprocedure vaginal bleeding. (7) The significant risk factor of culture failure was a small amount (less than 10 mg) of tissue. (8) The gestational age at procedure was significantly different between transabdominal and transvaginal methods. In the transabdominal approach group, the incidence of fundal location of placenta was significantly more common. Conclusion: If CVS is performed by an expert operator and at a good quality of genetic laboratory, CVS is a very safe and reliable procedure for prenatal genetic diagnosis.

정상 자궁 동맥 Doppler 파형을 보이는 자궁내 성장지연 임신에서 양수내 Nitric Oxide 및 제대혈액 내 태아 성장인자의 농도 측정

김소라 ( So Ra Kim ),김종수 ( Jong Soo Kim ),정지윤 ( Ji Youn Chung ),원혜성 ( Hye Sung Won ),이필량 ( Pil Ryang Lee ),이인식 ( In Sik Lee ),김암 ( Ahm Kim ) 대한주산의학회 2002 Perinatology Vol.13 No.2

Objective:Our purpose was to evaluate the relationship between amniotic fluid nitric oxide(NO) and fetal blood IGF-I, IGFBP-1, and cortisol in pregnancies complicated by intrauterine growth restriction(IUGR), but showing normal uterine artery doppler waveform. Methods:From July 1999 to March 2000, 18 pregnant women with IUGR and 18 normal pregnancies were studied. Both group showed normal uterine artery doppler waveform. Amniotic fluid samples were collected to measure NO, and fetal blood samples were collected from umbilical vein to measure fetal growth factors. The definition used to identify cases of IUGR depended on three criteria: clinical evidence of suboptimal growth, ultrasonographic evidence of deviation from an appropriate growth percentile, and individualized birth weight ratios <10th percentile. Results:Overall median NO values in amniotic fluid were lower in IUGRs than in controls, but there was no statistical significance. However, IUGR newborns showed significantly lower(p<0.05) concentrations of IGF-I, and greater(p<0.05) concentrations of IGFBP-1 and cortisol than did controls. Conclusion:These result suggest that cord blood IGF-I, IGFBP-1, and cortisol, but not amniotic fluid NO may act major regulating factor in idiopathic IUGR without placental insufficiency.