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주성홍 한국모자보건학회 2018 한국모자보건학회지 Vol.22 No.1
The total fertility rate in South Korea is one of the lowest among the Organisation for Economic Co-operation and Development (OECD) countries. However, the number of advanced maternal age and high risk pregnancies are rising due to delays in marriage and increased infertility rates, resulting in a maternal mortality rate that is higher than the OECD average. The most common cause of maternal mortality has been reported to be obstetric embolism, followed by postpartum hemorrhage. Hemorrhage is a preventable condition that can be solved by expeditious initial management such as transfusion, medication, and prompt transfers to tertiary centers that are capable of managing obstetric emergencies. However, the number of maternity care hospitals in underserved areas has been falling since 2004 due to business losses stemming from low birth rates, inadequate insurance payments for obstetric services, and the shortage of obstetricians. The insufficient maternity care system for high risk pregnant women in Korea has also led to an increase in maternal mortality. Therefore, the Ministry of Health and Welfare has supported the establishment of an ‘Integrated Care Center for High Risk Pregnancy and Neonate’ for high risk maternity and neonatal cases. However, there is no systematic transfer system in place to monitor and support emergency patient transfers in the event of obstetric emergencies. Although the Disaster & Emergency Medical Operations Center is currently carrying out these tasks, it is insufficient to properly manage all obstetric transfers. Our plan is to establish an Emergency Maternal Transport Control Center that is linked with the existing Disaster & Emergency Medical Operations Center at the National Medical Center. To implement this system, cooperation from each maternity and neonatal center will be crucial to share available human and material resources. Successful implementation of this system will allow for communication not only with the regional perinatal centers, but on a nationwide scale to detect and conduct necessary transfers of high risk pregnancy patients in emergency situations. It is anticipated that this system will significantly improve maternal health care as well as obstetric infrastructure, especially in underserved areas.
주성홍(Sung Hong Joo),변상국(Sang Kug Byun),최화영(Hwa Young Choe),조용호(Yong Ho Jo),정의식(Eui Sik Jung),조성진(Sung Jin Cho) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.7
Heterotopic pregnancy, simultaneous intrauterine and extrauterine pregnancy, is an extremely rare case. The incidence of heterotopic pregnancy was about 1 to 30,000 pregnancy, but it has been increased. Ectopic pregnancy is associated with significant mortality if not promptly diagnosed. Careful pelvic examination combined serial β-hCG determinations and transvaginal sonography to evaluation the adnexal region are necessary prerequisites for early diagnosis. We report a case of discovery of heterotopic pregnancy after elective abortion with brief review of literature.
Exposure of anti-obesity drugs during pregnancy and their teratogenicity
곽호석,주성홍,최안나,한정열,정의식 한국모자보건학회 2019 한국모자보건학회 학술대회 연제집 Vol.2019 No.2
Purpose: 한국 성인의 비만 인구도 매년 증가하는 것으로 조사되었으며, 또한, 건강을 위해서 다이어트를 시도하는 사 람들도 증가하고 있다. 결과적으로 가임 성인 여성의 다이어트 비율이 증가하고 임신 초기에 anti-obesity drug이 노출 되는 빈도가 증가되고 있다. 일부 anti-obesity drug은 teratogen성분들로 알려져 있어 가임기 여성들의 다이어트 약물 사용시 주의가 요구된다. 본 연구는 임신 초기에 임신 인지 모르고 노출되는 다이어트 약물의 종류와 노출 빈도의 경 향을 파악하고자 한다. Methods: 한국 마더세이프 전문상담센터의 콜센터 약물 상담 후 구축된 2012~2018년 마더세이프 데이터베이스를 활용 하여 임신 중 약물 노출 상담자 중에서 anti-obesity drug 복용한 임신부 자료를 추출하고 노출 빈도와 종류를 확인하였다. 다른 용도의 drug이 anti-obesity drug으로 사용된 경우 투약 적응증으로 구분해서 노출 빈도와 종류를 확인하였다. Results: 전체 임신부 약물 상담 건수는 30,704명이고, 다이어트 관련 약물 상담 건수는 1,487건 (4.84%)으로 나타났다. Anti-obesity drug 상담 건수 비율은 매년 증가하는 경향으로 나타났다. 대표적으로 노출되는 anti-obesity drug 은 phentermine(33%)과 phendimetrazine(26%)으로 전체 drug의 59%를 차지하였다. 기타 drug의 전체 노출 비율은 fluoxetine(7%), acetaminophen(4%), pseudoephedrine(3%), topiramate(3%), orlistat(2%)으로 나타났다. FDA Pregnancy category X등급의 drug은 phentermine, orlistat으로 확인되었다. Conclusion: 임신 중 다이어트 약 노출 빈도는 매년 증가하는 경향을 나타낸다. 그리고 노출되는anti-obesity drug 중에 심각한 기형유발물질이 포함되어 있었다. 가임기 여성이 anti-obesity drug을 처방받는 경우에는 태아 기형이 발생할 수 있으므로 주의가 필요하다.
모유수유가 모체의 고혈압 예방에 미치는 효과: 체계적 고찰
전혜지,주성홍,최안나,한정열,정의식,신혜정,김재윤 한국모자보건학회 2019 한국모자보건학회지 Vol.23 No.3
Purpose: The purpose of this study is to clarify the relevance of breastfeeding and its preventive effect on maternal hypertension as well as to evaluate the theoretical mechanism behind of it through systematic evaluation of existing articles. Methods: For systematic evaluation of literatures in recent 5 years, 5 most suitable articles were selected with the key words, (breastfeeding or breastfeed or lactation) AND (hypertension or high blood pressure or hypertensive disorders) from PubMed, EMBASE, and Cochran Library, and carefully reviewed by 2 researchers. Results: Breastfeeding women have less frequently developed hypertension in their later life. Depending on the duration of breastfeeding, compared to nonbreastfeeding women, breastfeeding women’s odds ratio for developing hypertension are 0.87 (95% confidence interval [CI], 0.76–0.99), 0.83 (95% CI, 0.68– 1.00), and 0.79 (95% CI, 0.65–0.97) each for 0–6 months, 6–12 months, and greater than 12 months of breastfeeding. As the number of breastfeeding children increases, the incidence of maternal hypertension decreases. In addition, both partial and exclusive breastfeeding lower the risk of developing maternal hypertension. Though the mechanism of prophylactic effect of breastfeeding on hypertension is not conclusive, reset hypothesis, oxytocin release, the increase of ghrelin and protein peptide YY, as well as epigenetic programming are considered to be relevant to the etiology of the condition. Conclusion: Breastfeeding prevents maternal hypertension later in life. Studies show dose-response relationship of breastfeeding as the duration matters. In addition, both partial and exclusive breastfeeding have preventive effect on maternal hypertension. Numerous mechanisms are continuously being reported and further studies are needed for clarification.
최화영 ( Hwa Young Choe ),주성홍 ( Sung Hong Joo ),김예진 ( Ye Jin Kim ),조성진 ( Sung Jin Cho ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.1
Complete testicular feminization syndrome (androgen insensitivity syndrome) is the most common form of male pseudohermaphroditism, transmitted by means of maternal X-linked recessive gene. This syndrome is marked by unique combination; Normal female pheno
Pregnancy and neonatal outcomes after periconceptional exposure to isotretinoin in Koreans
차은환,김내리,곽호석,한혜지,주성홍,최준석,천경철,김영아,고재환,한정열 대한산부인과학회 2022 Obstetrics & Gynecology Science Vol.65 No.2
ObjectiveIsotretinoin should not be used during pregnancy because of the risk of birth defects. Most pregnant women exposedto isotretinoin choose voluntary pregnancy termination due to concerns about birth defects. However, birth outcomedata supporting the termination of pregnancy are lacking. This study aimed to evaluate pregnancy and neonataloutcomes after periconception exposure to isotretinoin. MethodsThis was a prospective cohort study. We evaluated pregnancy and neonatal outcomes after exposure to isotretinoin in151 pregnant women. Among 1,026 callers at the Korean Teratology Information Service from 2001 to 2017 exposedto isotretinoin during the periconception period, 151 pregnant women who received counseling on teratogenic riskafter visiting the clinic were included. ResultsAmong the 151 participants who visited the clinic, only 42 were evaluated using ultrasonography until approximately20 weeks of gestation. Ultimately, 23 patients were included in the study. The average gestation period during the lastexposure to the drug was 2 weeks, and the average daily exposure dose was 12 mg. There were two cases of majorbirth defects in the exposure group. Spontaneous abortion rates were 17.7% and 8.7% in the exposure and nonexposuregroups, respectively (P=0.035). There was no significant difference between the exposure and non-exposuregroups in terms of pregnancy and neonatal outcomes. ConclusionThere was no significant difference in pregnancy and neonatal outcomes, including birth defects, between theexposure and non-exposure groups. Further studies with larger sample sizes are required to validate our findings.