임신 제 3 기에 시행한 자가수혈의 안전성에 관한 연구

김재영(JY Kim),윤재범(JB Yoon),정환욱(HW Chung),김문영(MY Kim),류현미(HM Ryu),김은성(ES Kim),한호원(HW Han),조동희(DH Cho) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.5

Autologous blood donation (ABD) is now widely appreciated as a means of eliminating the trasmission of blood borne infection such as AIDS and hepatitis. However its safety for both mother and fetus, especially in the third trimester, has not been established. The aim of this study is to determine the safety and utility of autologous blood donation in the third trimester of pregnancy. Over a period 22 months, pregnant women (N=56) in their third trimester, who had a rare blood group or a predictable risk of hemorrhage, underwent 91 phlebotomies. Phlebotomies were performed at an aversage gestational age of 36.9 weeks up to three times and donated an average of 1.6 unit of blood. Changes of fetal heart rate were redorded by electronic fetal monitoring before, during and after phlebotomy. There was no significant change in fetal heart rate except in one case with temporary decrease. Changes in mean maternal diastolic blood pressure and pulse rate were not significantly different. All fetal outcomes were good. The average interval from last donation to delivery was 11.7 day. Change in mean maternal hematocrit between the initial donation and admission day for delivery was not statistically significant (p>0.05). Only mild donor reactions occurred in three out of 91 (3%) phlebotomies. Thirteen patients received a total of 38 units of red blood cells (24 autologous, 14 homologous). Ten out of twelve patients with placenta previa used their autologous blood. We conclud that ABD in pregnant woman in third trimester is safe for mother and fetus. But further investigation is needed to determine its usefulness.

고위험 임신에서 수정된 생물리학적 계수검사법을 이용한 태아안녕평가의 유용성에 관한 연구

김동옥(DO Kim),한정열(JY Han),김은성(ES Kim),채난희(NH Chae),정영철(YC Jung),강창성(CS Kang),양재혁(JH Yang),김문영(MY Kim),류현미(HM Ryu),한호원(HW Han) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.7

Objective: Our purpose was to evaluate the effectiveness of the modified biophysical profile[MBPP] for antepartum fetal wellbeing assessment in high risk pregnancies. Materials and Methods: From Jan.1,1996, through Dec.31,1996, 2,275 tests in 1,270 patients with singletone high risk pregnancies were performed for antepartum fetal wellbeing assessment using a MBPP consisting of nonstress test[NST] with acoustic stimulation and ultrasound evaluation of amniotic fluid index[AFI] weekly or twice a week. Nonreactive NST, significant fetal heart rate deceleration, and AFI <5 were regarded as positive results. Results: Those patients were 28.0±6.4 years old in mean age and the MBPPs were performed in mean 38.1±2.7 weeks` gestation. 1,182 patients had negative MBPPs on the last test before delivery. 88 patients had positive MBPPs such as 20 nonreactive NST[22.7%], 19 significant fetal heart rate deceleration[21.6%], 5 nonreactive NST plus oligohydramnios[5.7%], and 44 oligohydramnios alone[50.0%]. Population characteristics were not significantly different between negative and positive MBPPs. Perinatal outcome parameters included 5-minute Apgar score less than 7, thick meconium stained amniotic fluid, prematurity, cesarean section for fetal distress, small for gestational age, and perinatal death. They were significantly different between negative and positive MBPPs except perinatal death. There were two perinatal death. One perinatal death resulted from cord prolapse on the 5th day after negative MBPP of the last screen test. The false negative rate was 0.4/1000. The other occurred in positive MBPP. Conclusion: The MBPP appears to be a effective primary mean of fetal surveillance in high risk pregnancies.

산전 태아진단을 위한 제대혈 천자술 154 예의 임상적 분석

채난희(NH Chae),김은성(ES Kim),류현미(HM Ryu),김문영(MY Kim),김희수(HS Kim),양광문(KM Yang),김동옥(DO Kim),최수경(SK Choi),한호원(HW Han) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.5

Percutaneous umbilical cord blood sampling under ultrasound guide to obtain fetal blood were performed in 154 fetuses between 19 and 38 weeks` gestation at Samsung Cheil hospital and women`s healthcare center from April 1994 to May 1997. Indications of sampling were rapid fetal karyotyping in 121 cases and diagnosis of fetal rubella infection in 33 cases. Pure fetal blood was successfully obtained in 153 cases among 154 procedures (99.4%). The first attempt was successful in 142 cases (92.2%) and 11 cases succeeded within second attempt. In a case of failure, fetal blood was obtained by fetal hepatic vein pucture. Puncturing was done at the placental insertion of cord (88.7%) and at floating cord (11.7%). Chromosomal abnormalities were found in 16 of 121 fetuses (13.2%). An abnormal chromosome pattern was established in 19/50 cases (18%) of structural anomalies: 6.7% (2/30) with a single structural anomaly and 35% (7/20) with multiple structural anomalies. The complications found in these pregnancies were 8 cases (5.2%): 3 cases of fetal bradycardia, 2 cases of preterm labor, 1 case of premature rupture of membranes, 2 cases of intrauterine fetal death. In conclusion, cordocentesis is very effective and safe method in prenatal diagnosis.

반복적인 임신중기 태아사망의 경력과 자가면역항체가 양성인 산모에서의 정맥내 면역글로블린 치료에 의한 성공적인 임신 1 예

류현미(HM Ryu),김문영(MY Kim),김은성(ES Kim),노건웅(GW Noh),장학철(HC Jang),전종영(JY Jun) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8

There is an association between the presence of autoantibody and the occurrence of repeated second trimester fetal losses. Many uncontrolled studies have reported with steroids, low dose aspirin, heparin, or their combination. Also, treatment failures have been reported with most of these therapeutic regimens. Immunoglobulins play a central role in immune regulation. We present a successful outcome by intravenous immunoglobulines in pregnant women with previous recurrent second trimester fetal losses and autoantibody with a brief review of the literatures.

제왕절개분만의 기왕력과 완전 전치태반과의 연관성

안현경(HK Ahn),김은성(ES Kim),한정열(JY Han),김문영(MY Kim),류현미(HM Ryu),최규홍(KH Choi),양재혁(JH Yang) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.5

Objective : To determine the relationship between previous cesarean section and subsequent development of placenta previa totalis and placenta previa totalis with accreta. Materials and Methods : A retrospective review of the case records of all women delivered with the diagnosis of placenta previa totalis during the 5-year period from August 1, 1994, to July 31, 1999, at the Samsung Cheil Hospital. Results : There were 38,215 deliveries in the study period. 237(0.62%) had placenta previa totalis and 56(23.6%) of whom had a history of previous cesarean section. The incidence of placenta previa totalis was significantly increased in those with a previous cesarean section(1.19%) compared with those with an unscarred uterus(0.54%). In the group without antecedent of cesarean section, accretism risk was 11.6%, with one section or more 32.1%. The need for cesarean hysterectomy occurred more commonly in patients who had a prior cesarean delivery, 14 of 56(25%), as compared with patients with no prior cesarean delivery, 6 of 181(3.3%). Conclusion : There is a strong association between previous cesarean section and risk of subsequent development of placenta previa totalis. Patients with an antepartum diagnosis of placenta previa who have had a previous cesarean section should be considered at high risk of developing placenta accreta. Patients with previous cesarean section have a significantly higher incidence of postpartum hemorrhage and are more likely to undergo emergency hysterectomy.

조기 양수천자술과 중기 양수천자술의 안정성에 관한 비교연구

안현경(HK Ahn),류현미(HM Ryu),김문영(MY Kim),김은성(ES Kim),송하균(HK Song),이환견(HK Lee),한정렬(JY Han),김진미(JM Kim),최수경(SK Choi),한호원(HW Han) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.1

We sought to determine whether early amniocentesis is a safe and acceptable method of genetic evaluation in early pregnancy. During the 20-month period from February 1994 to September 1995, 80 consecutive early amniocentesis were performed transabdominally at 12+3-14+6 weeks of gestation and 305 consecutive mid- second-trimester transabdominal amniocenteses were performed at 16+0- 18+0 weeks of gestation. All amniotic fluid samples were cultured using flask method. There were no significant differences between the early and mid-second- trimester amniocenteses in failed sampling, ambiguous results, pregnancy loss within 4 weeks after the procedure, pregnancy loss from 4 weeks after procedure to 28 weeks of gestation, preterm birth, and perinatal death. We may conclude that early amniocentesis is a safe and acceptable method for prenatal diagnosis.

한국 임신부의 풍진감염시 중합효소 연쇄반응 ( Polymerase chain reaction ) 을 이용한 선천성 풍진감염의 산전진단

류현미(HM Ryu),문인걸(IG Moon),조동희(DH Cho),김문영(MY Kim),김은성(ES Kim),한호원(HW Han),이승호(SH Lee),유한기(HK Yoo) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.2

Objectives; Rubella viral infection in pregnant women is frequently transmitted to the fetus, resulting in the fetal damage. Fetal rubella infection have been diagnosed by detection of rubella specific IgM in fetal blood. However this has been limited because the fetal IgM is not developed before 22 weeks of gestation. The purpose of this study was to determine accuracy of PCR for rubella virus to diagnose congenital rubella infection. Methods; In this study, 85 amnionic fluid and 30 fetal blood samples were obtained from 85 pregnant women, whose serum rubella IgM were positive. Viral RNA from clinical specimens was reverse transcribed and the produced cDNA was amplified by nested polymerase chain reaction(nested PCR)using a set of primers, the outer primer pair defining a 591 bp sequence and the inner primer pair defining a 321 bp sequence within the former one. Results; A reverse transcription nested PCR by detection of RNA extracted from 10-1 50% tissure culture infective dose of live attenuated rubella vaccine was sensitive method. The identity of PCR product were verified by direct sequencing using fluorescent dideoxy-termination to confirm the target sequence. RT-PCR detected rubella virus RNA in bloods from 4 children who were confirmed rubella infection serologically. Rubella virus was detected from 2 of 15 products of conceptus which was obtained from pregnant women with rubella specific IgM. Among 85 pregnant women, there were typical skin rashes in 15 cases(18%). In only one case of 55 amnionic fluid obtained in 13∼19 weeks of gestation from pregnant women with rubella specific IgM, rubella PCR was positive. Rubella virus was detected by RT-PCR in only 1 case among 30 fetal blood obtained by cordocentesis from another pregnant women with rubella specific IgM. But, in one case, the results were not concordent, that is, PCR was negative and rubella specific IgM was positive in fetal blood obtained in 22 weeks of gestation. There was no statistical significance between maternal clinical symptoms, such as rashes, and incidence of fetal infection. Among delivered 56 neonates whose prenatal rubella PCR and IgM results were negative, 3 neonates showed positive for postnatal rubella specific IgM, but showed no congenital rubella up to 8∼9 months follow up. Among total 85 cases, presently 19 were ongoing pregnancy, 56 went to term and resulted in healthy babies except 2 anomaly with unrelated congenital rubella infection, while 19 pregnancies are progressing normally and 4 were failed to follow up and one was preterm birth and 5 were electively terminated. Incidence of congenital rubella infection which was diagnosed prenatally or postnatally was relatively low, 7%(6/85). Coclusion; PCR for rubella virus was earlier, faster and more accurate method for detection of fetal rubella infection in amnionic fluid and/or fetal blood than rubella specific IgM in fetal blood, when rubella specific IgM was positive in early pregnant women. Appropriate detection for fetal rubella infection should be carried out by direct etiologic diagnosis such as PCR. This method will become an valuable approach to provide prenatal counselling following rubella virus infection for prevention of unnecessary termination of pregnancy.

양수과소증에서 경복부 양수주입술의 임상적 유용성에 관한 고찰

박선희(SH Park),황우열(WY Hwang),홍수정(SJ Hong),노성훈(SH Roh),김은성(ES Kim),김문영(MY Kim),류현미(HM Ryu),한호원(HW Han) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.9

Oligohydramnios poses not only a diagnostic challenge but also a dilemma of management for the obstetrician. The general outcome is usually poor, no matter what causes the oligohy- dramnios. Recent preliminary studies have suggested that antepartum transabdominal amnioinfusion has both diagnostic and therapeutic roles in oligohydramnios. To evaluate the safety and efficacy of this procedure, we performed 19 antepartum amnioi- nfusion in 12cases of pregnancy complicated by oligohydramnios. Infusion(mean volume 494 ml, range 200∼800 ml) significantly increased the deepest pool of amniotic fliud to a mean of 5.71 cm(p<0.005). We confirmed vaginal leakage indicating ruptured membranes in 3patients among 5cases of unknown cause of oligohydramnios. Twelve serial infusions were performed in 5 patients in order to prolong gestation long enough to improve neo- natal outcome. In neonatal outcome after serial infusions, all except one showed neonatal survival. Overall, only two of 19 infusions(10.5 %) were complicated by chorioamnionitis and transient bra- dycardia, respectively. Our findings support that antepartum transabdominal infusion seems to be a relatively safe procedure and may offer marginal clinical benefits to perinatal outcome in selected cases.