Simplified protocol of nuchal translucency measurement: Is it still effective?

전종관 ( Jong Kwan Jun ),( Sun Min Kim ) 대한산부인과학회 2014 대한산부인과학회 학술대회 Vol.100 No.-

Objective: Nuchal translucency (NT) is the most powerful screening tool for Down syndrome and congenital cardiac anomaly, therefore strict guidelines were established to get accurate NT values. However, to stick to the guideline in all pregnant women is time-consuming and superfluous in majority of low risk population. We undertook this study to investigate whether the simplified protocol enables to select low risk group and is effective in them even if we skip the suggested NT measurement. Methods: NT and crown-rump length (CRL) were measured prospectively. First, CRL was measured in the ordinary view that was mid-sagittal section of fetus in neutral position, and NT was measured at the same frozen screen (first measured value, 1MV). Then, NT was measured again according to the Fetal Medicine Foundation (FMF) guideline (second measured value, 2MV). Results: There was good correlation between 1MV and 2MV in each case (r = 0.83, P < 0.001). All of the NT values over the 95th percentile in 2MV also belonged to over the 95th percentile in 1MV. NT value of 2 mm in 1MV could be used as a cut-off to obtain over the 95th percentile 2MV by receiver operating characteristic curve (sensitivity 100%, specificity 80.5%). The proportion of 1MV ≥ 2 mm was only 23.8% of all cases, namely we had only to measure 2MV in 23.8% patients. Every 95th percentile or more 2MV could be detected with this simplified protocol. Conclusion: If NT is less than 2 mm at ordinary CRL view, we may skip suggested NT measurement according to FMF guideline.

자궁내 태아 발육 부전의 진단과 처치

전종관 ( Jong Kwan Jun ) 대한주산의학회 2005 Perinatology Vol.16 No.4

임신 토끼에서 항생제 투여시 지속된 자궁내 감염이 주산기 예후에 미치는 영향

전종관(Jong Kwan Jun),윤보현(Bo Hyun Yoon),신희철(Hee Chul Syn),이홍균(Hong Kyoon Lee),박교훈(Kyo Hoon Park) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.2

Objective: In a rabbit model using hysteroscopy-guided inoculation of E.coli with antibiotic administration, we determine the effects of persistent intrauterine infection on perinatal outcome including fetal death, congenital sepsis, and abnormal fetal-placental growth and amniotic fluid volume in live fetuses. Methods: Rabbits with timed pregnancies underwent hysteroscopy at 20 to 21 days of gestation(70%). Animals were inoculated with E. coli (0.2 ml containing 10 cfu/ml) and administered ampicillin-sulbactam(100 mg/kg/day; Unasyn; Pfizer) every 8 hours beginning 30 minutes after microbial inoculation until they were killed 5 days after hysteroscopy. In the first study, the following outcome parameters were evaluated between fetuses with and without pe#rsistent intrauterine infection: fetal survival, congenital sepsis, maternal morbidity, and placental pathology. In second study was performed in 16 rabbits having only both live fetuses with and without persistent intrauterine infection in a rabbit simultaneously. We evaluate the effects of persistent intrauterine infection on fetal-placental weight and amniotic fluid volume in live fetuses. Results: 1) Fetuses with persistent intrauterine infection had significantly fewer live fetuses, more positive cord blood cultures than those without (live fetuses: 44% vs 82%, p<0.000001; positive cord blood cultures: 44% vs 3%, p<0.000001, respectively; Fishers exact test). However the rates of maternal morbidity and placental inflammatory lesions were similar between the two groups. 2) The placental weight and amniotic fluid volume were significantly less in live fetuses with than in those without persistent intrauterine infection. Moreover the fetal weight was decreased in live fetuses with persistent intrauterine infection, but it was not statistically significant(placental weight: p<0.05; amniotic fluid volume: p<0.05; fetal weight: p 0.051, respectively; Wilcoxon matched-pairs signed ranks test). Conclusion: Fetal complications including fetal death, congenital sepsis, and decreased fetal-placental weight and amniotic fluid volume wae produced in utero when pasistent intrauterine infection was present with antibiotics administration after inoculstion of E. coli. Therefore, when treating with antibiotics in intrauterine infection, it is needed to observe and monitar the presence of persistent intrauterine infection, and if it is peristent, delivery may be considered for the improvement of pregnancy outcome.

유산물, 융모막 조직, 양수 세포 및 태아 혈액에서 나타나는 염색체 이상 핵형에 대한 다기관 연구

전종관(Jong Kwan Jun),최진(Jin Choe),최영민(Young Min Choi),황도영(Do Yeong Hwang),오선경(Sun Kyung Oh),문신용(Shin Yong Moon),이진용(Jin Yong Lee) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.7

Objectives : Chromosomal anomalies are common disease entity among genetic diseases. But there are scanty reports about the status of chromosomal abnormalities in Korean. In addition, the comprehensive multi-center study of chromosomal abnormalities in Korean has never been performed. Methods : We have collected 1,793 cases (394 abortuses; 198 chorionic villi; 1,060 amniotic fluid cells; 141 fetal blood), which showed abnormal karyotype results from twenty three cytogenetic centers in Korea from the year of 1977 to 1999. Results : In abortuses, numerical chromosomal abnormalities was 85%, and structural abnormalities was 13% and the most frequent anomaly was trisomy 16. In chorionic villi, numerical anomaly was 60.0% and structural anomaly was 31.3% and the most frequent karyotype was Down syndrome. In amniotic fluid cells, structural anomaly exceeded the number of numerical anomaly and the most frequent anomaly was Down syndrome. In fetal blood, numerical anomaly was 63.8% and the most frequent karyotype was trisomy 18 (23.4%) Conclusion : This may be the first comprehensive and multi-center study in Korea. The proportion of the abnormal karyotypes in each specimens was different from each other. Based on this study, the more comprehensive study should be performed to all the Korean population.

Pregnancy-induced arthralgia and arthritis in small joints of hands

전종관 ( Jong Kwan Jun ),( Hyo Jin Choi ),( Jung Chan Lee ),( Chan Wook Park ),( Yoo Kyung Sohn ),( Soo Young Oh ),( Soon Sup Shim ),( Eun Bong Lee ),( Joong Shin Park ),( Yeong Wook Song ),( Bo Hyun Yoo 대한산부인과학회 2004 대한산부인과학회 학술대회 Vol.90 No.-

최신임상강좌 : 임신 중 고혈압 질환 처치의 최신 지견

전종관 ( Jong Kwan Jun ) 대한산부인과학회 2005 Obstetrics & Gynecology Science Vol.48 No.3

Hypertensive diseases during pregnancy have a critical impact on morbidity and mortality of mother and fetus. They consist of gestational hypertension, preeclampsia-eclampsia, preeclampsia superimposed on chronic hypertension and chronic hypertension. Mat

생식세포 난관내이식시 잉여난자의 체외수정 결과에 따른 임신 예측도

김석현,전종관,신창재,김정구,문신용,이진용,장윤석,Kim, Seok-Hyun,Jun, Jong-Kwan,Shin, Chang-Jae,Kim, Jung-Gu,Moon, Shin-Yong,Lee, Jin-Yong,Chang, Yoon-Seok 대한생식의학회 1992 Clinical and Experimental Reproductive Medicine Vol.19 No.1

By means of the results of In vitro fertilization(IVF) of supernumerary oocytes, the possibility of predicting a pregnancy outcome following gamete intrafallopian transfer(GIFT) and the prognostic implications for future pregnancy were evaluated in 46 GIFT cycles excluding simultaneous program of GIFT and IVF from February, 1989 to July, 1991. IVF of supernumerary oocytes were identified in 21 cycles, but not in remaining 25 cycles. There was no significant difference in age, duration and etiologic factors of infertility, and serum levels of FSH, LH and $E_2$ on MCD #3 and $E_2$ on the day of hCG injection between fertilized(N=21) and unfertilized group(N=25). The number of oocytes retrieved was similar in both groups. The number of supernumerary oocytes available for IVF after transfer was $5.43{pm}2.95$ ranging from 2 to 12. The prenancy rate in fertilized group, 33.3%(7/21), was higher without statistical significance, compared with 8.0%(2/25) in unfertilized group. Using IVF of supernumerary oocytes as a test of pregnancy following GIFT, sensitivity was 77.8 %; specificity, 61.2%; positive predictive value(PPV), 33.3%; negative predictive value(NPV), 92%. The fertilization rate of supernumerary oocytes in pregnant group, $86.4{\pm}22.8%$ was significantly higher compared with $56.1{\pm}20.2%$ in nonpregnant group. In cases with fertilization rate ${\geq}80%$, pregnancy was expected with PPV of 85.7%. In conclusion, IVF of supernumerary oocytes in GIFT program can be a profitable method as a prognostic indicator of pregnancy following GIFT. More aggressive diagnostic and therapeutic measures should be performed in cases with failure in IVF of supernumerary oocytes.

임신 중기의 리스테리아 감염으로 인한 자궁내태아사망

신재준 ( Jae Jun Shin ),최지영 ( Ji Young Choe ),김선민 ( Sun Min Kim ),이승미 ( Seung Mi Lee ),오경준 ( Kyung Joon Oh ),박찬욱 ( Chan Wook Park ),박중신 ( Joong Shin Park ),전종관 ( Jong Kwan Jun ),박성혜 ( Sung Hye Park ),신희철 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.3

Listeriosis is an infectious disease caused by Listeria monocytogenes, a gram positive, facultatively anaerobic bacterium. Listeriosis occurs primarily in newborn infants, elderly patients, immunocompromised patients and pregnant women. One third of the patients are pregnant women, and complications of this disease include miscarriage, stillbirth and preterm labor. We experienced a case of listeriosis in a singleton pregnancy at 23rd week of gestation that presented with fever, chill, lower abdominal pain, backache, and eventually resulted in fetal death in utero. Autopsy results of the stillborn baby, as well as blood and amniotic fluid culture of the mother confirmed Listeria monocytogenes infection. Proper antibiotics therapy thereafter led to clear recovery of the infected mother. We report this case with a brief review of literature.

산전초음파로 진단된 태아 일측성 폐무발생

이희준 ( Hee Jun Lee ),김선영 ( Sun Young Kim ),박정우 ( Jeong Woo Park ),김우오 ( Woo Oh Kim ),박찬욱 ( Chan Wook Park ),박중신 ( Joong Shin Park ),전종관 ( Jong Kwan Jun ),신희철 ( Hee Chul Syn ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.12

Unilateral pulmonary agenesis is a very rare developmental malformation that is often associated with other anomalies. The prognosis of pulmonary agenesis varies from stillbirth, to neonatal death, to survival without any symptoms depending on the presence of associated congenital malformations. Therefore, it is very important to perform a prenatal diagnosis of unilateral pulmonary agenesis. We describe a case of unilateral pulmonary agenesis diagnosed in the second trimester by transabdominal ultrasound.

실험 : 자간전증 발생과 Methylentetrahydrofolate Reductase, Angiotensinogen, Vascular Endothelial Growth Factor 유전자들의 단일염기다형성 유전자형 조합의 연관성

박현수 ( Hyun Soo Park ),전종관 ( Jong Kwan Jun ) 대한주산의학회 2009 Perinatology Vol.20 No.4

목적: 자간전증은 대표적인 임신 합병증 중 하나로 다양한 형태의 임상적 양상을 보이므로 한 가지 이상의 유전자가 발생에 관계할 것으로 추정된다. 본 연구에서는 자간전증과의 관련성이 보고된 복수의 유전자에서 자간전증 산모에서 자주 나타나는 특정 유전자형 조합이 있는 지를 알아보고자 하였다. 방법: 자간전증이 발생했던 162명의 산모와 정상 혈압을 보였던 199명의 산모를 대상으로 하였다. 자간전증의 중증도를 판정하였고, 발생 시기에 따라 조발형(early-onset: 31주 전에 발생)과 지발형(late-onset: 31주 이후에 발생)으로 분류하였다. Methylenetetrahydrofolate reductase (MTHFR) C677T, angiotensinogen (AGT) M235T, vascular endothelial growth factor (VEGF) C936T 다형성을 대상으로 중합효소 연쇄반응-제한절편길이다형성을 이용하여 유전형의 빈도를 측정하였다. 환자군 및 대조군에서 각 유전자의 단일염기 다형성 대립유전자형(allele), 유전자형(genotype)을 비교하였으며 유전형 조합과의 관련성도 알아보았다. 통계적 방법으로는 일원배치 분산분석, t-검정, 카이제곱검정, Fisher`s Exact test, 로지스틱 회귀분석 등을 사용하였으며 p<0.05를 의미 있는 것으로 간주하였다. 결과: MTHFR C677T 유전자 다형성은 전체 자간전증 산모와 조발형 자간전증에서는 차이가 없었으나 지발형 자간전증군과 대조군에서는 유전형에서 차이를 보였다(CC+CT/TT, OR: 1.82, P<0.05). AGT M235T (TT vs MT/MM, OR: 1.22 NS) 및 VEGF C936T (T vs C, OR: 1.04, NS)는 전체 자간전증 및 하위군에서도 차이를 보이지 않았다. 세 가지 유전자형 조합은 모두 20개가 있었고 각 조합의 빈도는 유의한 차이를 보이지 않았다. 결론: MTHFR C677T 유전자 다형성이 지발형 자간전증의 발생과 관련이 있을 가능성을 보여주었다. 그러나 자간전증의 발생과 관련성을 보여준 MTHFR C677T, AGT M235T, VEGF C936T 유전자형의 조합은 없었다. Purpose: Preeclampsia is one of the most frequent complications in pregnancy. Because many different phenotypes are seen with this disease, more than one gene is thought to be involved in the pathogenesis of preeclampsia. This study was conducted to investigate if there exists any genotype combination of multiple single nucleotide polymorphism(SNP)s which are frequently found in preeclampsia patients. Methods: One hundred and sixty two preeclampsia patients and 199 normotensive pregnant women were included. Severity was assigned and the patients were re-classified as early-onset (less than 31 weeks) and late-onset (31 weeks or beyond) disease. Genotype was measured with polymerase chain reaction-restriction fragment length polymorphism for Methylenetetrahydrofolate reductase (MTHFR) C677T, Angiotensinogen (AGT) M235T, and Vascular endothelial growth factor (VEGF) C936T. Case-control study for each SNP was done and the frequencies of genotype combinations were compared. ANOVA, t-test, chi-square test, Fisher`s exact test and logistic regression analysis were used for statistical analysis. A P value of <0.05 was considered significant. Results: Genotypes of MTHFR C677T polymorphism showed significant difference between late onset preeclampsia and control (CC+CT/TT, OR: 1.82, P<0.05) but AGT M235T and VEGF C936T polymorphism did not show statistically significant difference between any SNP combinations. Of the possible 27 genotype combinations, only 20 genotype combinations were found and there was no statistical difference in frequency of genotype combinations between case and control group. Conclusion: MTHFR C677T polymorphism might be associated with the development of preeclampsia, However combination of MTHFR C677T, AGT M235T and VEGF C936T polymorphisms were not associated with the development of preeclampsia.