지연임신에 관한 임상적 고찰

이윤이 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.2

We studied 123 women with uncomplicated pregnancies of 41 or more weeks' gestation. The pregnant women with a ripe cervix over Bisphop score 7 (Induction group I, 20 cases) was done with oxytocin induction. The pregnant women with an unripe cervix Bisphop score <7, there were two alternatives in management. The one group (Induction group II, 24 cases) was administer prostaglandin vaginal tablet for cervical ripening and proceeded with oxytoion induction. The other group (Monitoring group, 69 cases) was to initiate serial antepartam surveillance white waiting spontaneous labor and/or spontaneous cervical ripening. Serial antepartum surveillance consisted of nonstress test, biophysical profile (BBP) anti assessments of amnionic fluid index by twice weekly. Among 54 women in the induction group I and II, 16 (29.6%) resulted in a higher rate of cesarean section, as compared with 15 (21.7%) of 69 women in the monitoring group. But the rate of cesarean section because of fetal distress in the monitoring group was higher than the induction group I and II (8.6% versus 5.6%) This difference was not satistically significant. Thick meconiam in amnianic fluil and meconiam aspiration syndrome in the monitoring group was significantly higher than the induction group I and II (p <0.05). They occured after 43 weeks' gestation. Therefore, in postterm pregnancy, when the cervix was ripe, induction of labor at 41 weeks' gestation was appropriate. when the cervix was unripe, serial antepartum surveillance should be initiated soon after 41 weeks' gestation and prompt intervention should occur if antepartum surveiuance was abnormal. This group must be delivered until 43 weeks' gestation.

HELLP증후군의 임상양상과 예후에 관한 연구

이창환,손성경,이석수,이윤이 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.2

The syndrome of hemolysis, elevated liver enzymes and low platelet count during pregnancy (HELLP syndrome) is recognized as a serous, multisystemic disease and associated with poor maternal and perinatal outcome. The purpose of this study is to elevate the clinical appearance and the maternal and perinatal outcome with HELLP syndrome. It was a retrospective study that maternal outcome and perinatal variables and the clinical course of eight cases HELLP syndrome in 234 cases with pregnancy induced hypertension who visited the Department of Obstetrics and Gynecology, Chungnam National University Hospital from January 1995 to December 1998. The results were as follows; 1. The incidence of the HELLP syndrome among patient with pregnancy induced hypertension was 3.4%(8/234) and mean age, mean gestational age was each 29.7 year-old, 36.7 weeks and there was 3 primigravidas and 5 multipara(38% vs 62%). 2. In the abnormal elevated laboratory finding on admission, mean platelet count, sGOT, sGPT, total bilirubin, LDH, BUN, and creatinine was each as 74,000/㎣, 2231U/ℓ, 1941U/ℓ, 1.7mg/㎗, 10951U/ℓ, 22.3mg/㎗ and 2.0mg/㎗. 3. About the coagulation system, PT and aPTT were all within the normal limit but in 38% of patient with HELLP syndrome fibrinogen was decreased, in 50% FDP was increased and in 25% patient was made diagnosis of DIC. 4. The 6 cases were perceived as immediate delivery, one case was vaginal delivery only and others cesarean section and maternal complication was placenta abruption, severe pulmonary edema, acute renal insufficiency, acute toxic hepatitis and cardiomyopathy but there was no maternal mortality in all cases. 5. The mean birth weight 2,374g, 50% of fetus were delivered before 38 weeks, the IUGR was found in 25% and the perinatal mortality rate was 25%. 6. Neonatal complication was neonatal asphyxia, RDS(> 2 grade), sepsis, hyperbilirubinemia, hypermagnesemia, TTN and major handicaps of PVL. These findings suggest that infants born to HELLP syndrome mother have an increased need for resuscitation at delivery and aggressive management for mothers. Thus obstetricians should be identified promptly and need for appropriate management of nowborn infant and mothers with HELLP syndrome.

임신 34주전에 제대동맥혈류속도파형이 소실되거나 역전된 경우의 임상적 영향

이윤이(Yun Ee Rhee),홍달수(Dal Soo Hong) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.5

N/A Objective : To investigate the clinical impact of absent or reversed end-diastolic (ARED) umbilical artery flow detected before the 34th week of pregnancy in high-risk pregnancies. Methods : Fifty-eight singleton pregnant women with high-risk factors were included in this retrospective study. Based on the umbilical artery Doppler finding, pregnant women were divided into 3 groups: group 1 (12 subjects) with normal Doppler systolic/diastolic (S/D) ratios; group 2 (30 subjects) with significant abnormal umbilical artery S/D ratios, and group 3 (16 subjects) with ARED flow in the umbilical artery between the 25+0 and 33+6 gestational weeks. Incidence of intrauterine growth retardation (IUGR) and pregnancy-induced hypertension, detection week, diagnosis-to-delivery interval, birth weight and gestational ages at delivery, Apgar scores, emergency cesarean section, neonatal intensive care unit (NICU) admission, admission-to-discharge interval, perinatal mortality (PNM) and morbidity, and neonatal morbidity were registered. Perinatal outcomes were assessed. The data was analyzed using the Mann-Whitney U-test and X-square test. A significant difference was considered present if p was<0.05. Results : The PNM in group 3 in the study was 25% (4/16). Sixteen had ARED flow. Our study shows that fetuses with ARED flow tend to be more severely growth-retarded. Our results also show ARED flow to be associated with poor perinatal outcome. There was a higher incidence of cesarean section for fetal distress, neonatal intensive care unit admission, and lower Apgar scores. Birth weight and gestational age at delivery were lower. The diagnosis-to-delivery interval was shorter. The admission-to-discharge interval was longer. Conclusion : An early ARED finding before the 34th week in the umbilical artery is a very serious sign of likely fetal compromise. The perinatal mortality and morbidity rate were high, and there was evidence of acute or chronic hypoxia in most fetuses. It is an indication that extremely careful surveillance should be followed but not necessarily an indication for an emergency delivery.

발육 지연 태아에서 제대 동맥 혈류 속도 파형 분석

이윤이(Yun Ee Rhee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.3

N/A Objective: To evaluate perinatal outcomes in high risk pregnancy fifty-four women who were delivered of small for gestational age infants were studied antenatally by serially umbilical artery doppler velocimetry in our unit. Five study subjects with loss of end diastolic velocities were excepted. Methods: Forty-nine study subjects were separated with normal (group I, 12 subjects) and abnormal (group II, 37 subjects) systolic/diastolic (A/B) ratio of umbilical artery. Perinatal outcomes were compared with normal and abnormal group. Fisher's exact test and student t test were used for statistical analysis Results: The group with an abnormal A/B ratio had a signifiamtly higher incidence cesarean section for fetal distress, admission into the neonatal intensive care unit, perinatal death, and adverse perinatal outcome. these data suggest that small for gestational age fetus with normal ratio is at significantly lower risk than are those with abnonnal ratio. Conclusion: An abnormal Doppler umbilical artery A/B ratio is a strong predictor of adverse perinatal outcome in small-for-gestational-age-fetuses.

치료적 자궁경관봉축술후 질초음파단층법을 이용한 자궁 경관의 길이 변화와 만삭 임신의 예측

이윤이(Yun Ee Rhee) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.6

N/A Objective : To determine the change in cervical length after cerclage and whether a transvaginal ultrasonographic measurement about change in cervical lengthening after cerclage is predictive of term delivery Methods : Twenty-nine single pregnant women were suspected as cervical incompetence by using a serial transvaginal ultrasonography. When a shortening of the cervix was substantial before 25 weeks' gestation, a therapeuric McDonald cerclage was applied. The 29 pregnant women had a transvaginal ultrasonographic measurement of the cervix within 48-72 hours before and after cerclage. At each examination, the first measurement was discarded, and the mean of the subsequent three measurements was calculated. Statistical analysis was performed by use of SAS with the significance set at the 5% level. Results : In the 29 single pregnancies examined, the mean cervical length (distance between internal os and external os) before cerclage was 30.0±4.5 mm. A cerclage was applied at the mean gestational age of 16.76±3.02 weeks. After the cerclage the mean cervical length increased significantly (r=0.895, p=0.0001) to 34.1±4.5 mm. There was a significant relation between the gestational age at delivery and the length of postoperative upper cervix (endocervical canal length above suture) (r=0.378, p=0.043). But there was no significant relation between the gestational age at delivery and the following measurements; preoperative cervical length (r=0.348, p=0.064), postoperative cervical length (r=0.279, p=0.143), cervical lengthening (postoperative cervical length - preoperative cervical length) (r=-0.156, p=0.420), length of postoperative lower cervix (endocervical canal length below suture) (r=-0.003, p=0.999). Conclusion : Therapeutic McDonald cerclage results in a longer cervical length as measured by transvaginal ultrasonography. The increase in cervical length after cerclage is not a predictive term delivery. But the Length in upper cervix after cerclage correlated with gestational weeks at delivery

임신중기의 모체혈청표지물질을 이용한 태아의 산전 선별검사

이윤이 최신의학사 1997 最新醫學 Vol.40 No.6

흰쥐의 난포 폐쇄과정에서 난포내 대식세포의 분포와 역할

양윤석 ( Yun Seok Yang ),노흥태 ( Heung Tae Noh ),이윤이 ( Yun Ee Rhee ),손성경 ( Sung Kyong Son ),조근자 ( Keun Ja Cho ),최희인 ( Hee In Choi ),김수일 ( Soo Il Kim ),김원식 ( Won Sik Kim ) 대한산부인과학회 2005 Obstetrics & Gynecology Science Vol.48 No.10

폐경후 증후군 환자에서 Estradiol Patch치료의 유효성

노흥태,이윤이,남상륜,강길전 충남대학교 의과대학 지역사회의학연구소 1991 충남의대잡지 Vol.18 No.2

The most dramatic endocrine event associated with aging in women is the cessation of normal, cyclic ovarian activity. The loss of ovarian function is reflected by alterations in ovarian steroid secretion, which result in the discontinuation of menstruation (menopause) and appear to be related to some of the classic features of the climacteric, such as hot flushes, altered repeoductive tract histology, and accelerated bone loss. Oral estrogen therapy might provoke endometrial hyperplasia and carcinoma in addition to systemic side effects. Transdermal estrogen therapy is more favorable for the delivery of estradiol to maintain serum concentration without those side effects and risks of oral therapy. The purpose of this study of this study is to investigate the clinical efficacy and safety for estrogen patch therapy (β-ESTRO, estradiol 1mg/patch) in 30 patients with vasomotor symptoms and postmenopausal syndrome for 2 weeks. The results were as follows: 1. The most common symptom of postmenopausal patients was fatigue(93.3%). 2. The efficacy rate after treating with estradiol patch was 84.6 % in hot flush, 78.6 % in insomnia, 73.1 % in swearing, 71.4 % in fatigue and 61.5 % in urge to urination. 3. Side effects observed with estradiol patch therapy were mainly mild symptoms of local skin irritation such as hyperemia and itching, breast tingling sensation, vaginal spotting, headache, nausea. But those disappeared spontaneosly or with symptomatic treatment and tolerable in all. These data suggest that estradiol patch therapy is effective in patients with postmenopausal syndrome.

인삼이 항암제 투여 환자의 부작용에 미치는 임상적 연구

노홍태,이윤이,최영배,박현정 최신의학사 1992 最新醫學 Vol.35 No.2

Case Report : Unexpected Acute Aortic Dissection After Elective Cesarean Section Delivery: Report of a case and Review of the Literature

( Byung Hun Kang ),( Min A Lee ),( Yun Ee Rhee ),( Heung Tae Noh ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.11

Acute aortic dissection may indeed be a rare complication of pregnancy, and the majority of aortic dissections usually occur during the third trimester of pregnancy. Most aortic dissections occur as a result of systemic hypertension or connective tissue disorders. Without any treatment, more than 50% of patients die within the initial 48 hours, and the 3-month mortality rate is as high as 90%. Because the pain in puerperal women is uncertain and diffi cult to discriminate from physiologic pain, the diagnosis of aortic dissection is complex and requires a high index of suspicion. We experienced a case of unexpected acute aortic dissection that occurred after elective cesarean section delivery in a young woman without any known risk factors. This case of aortic dissection was managed medically. In postpartum patients complaining of chest pain, the suspicion of aortic dissection is important for prompt diagnosis and better prognosis.