조기진통 임신부에서 7일 이내의 조기분만의 예측에 있어 질식 초음파를 통한 자궁경부길이 측정의 유용성

정희라 ( Hee Ra Jung ),이경 ( Kyung Lee ),김명환 ( Myoung Hwan Kim ),고지경 ( Ji Kyung Ko ),이철민 ( Chul Min Lee ),조용균 ( Yong Kyoon Cho ),최훈 ( Hoon Choi ),김복린 ( Bok Rin Kim ) 대한주산의학회 2009 Perinatology Vol.20 No.3

목적: 조기진통이 있는 임신부에서 7일 이내의 조기분만의 예측에 있어 질식 초음파를 이용한 자궁경부 길이의 유용성을 알아보고자 하였다. 방법: 2001년 1월부터 2006년 12월까지, 임신 24주에서부터 33주 6일까지 조기진통으로 인제대학교상계백병원 산부인과에 입원한 환자들을 대상으로 후향적으로 분석하였다. 입원 당시 질식 초음파를 이용하여 자궁경부 길이를 측정하였으며 연구의 일차적 성과의 판단기준(primary outcome measure)은 7일 이내의 분만으로 정하였다. 결과: 전체 연구 대상자 140명 중 7일 이내의 분만은 11/140 (7.9%)에서 발생하였다. ROC curve 분석 결과 7일 이내의 조기 분만을 예측하는 가장 적절한 자궁경부 길이의 기준치는 25 mm였으며 이는 민감도 94%, 특이도 75%를 나타내었다. 자궁경부 길이가 25 mm 이하인 경우 전체 46명 중 10명(21.7%), 자궁경부 길이가 25 mm 초과인 경우 전체 94명중 1명(1.1%)에서 7일 이내에 조기분만이 발생하였다. 또한 자궁경부 길이 25 mm를 기준으로 입원 후 분만까지 걸린 시간을 생존 곡선으로 분석하였을 때 자궁경부 길이가 25 mm 이하인 경우 입원 후 분만까지 시간이 의미 있게 짧게 걸리는 것으로 나타났다. 다변량회귀 분석에서는 자궁경부 길이(≤25 mm) (OR: 24.64, 95% Cl: 2.97~204.20, P=0.003)만이 조기진통 산모에서 7일 이내의 분만을 예측하는데 통계학적으로 유의한 의미를 나타내었다. 결론: 조기진통이 있는 임신부에서 질식 초음파를 이용한 자궁경부 길이의 측정이 7일 이내의 조기분만을 예측하는데 있어 유용하다. Purpose: To investigate the usefulness of transvaginal ultrasonographic measurement of cervical length in patients with preterm labor for prediction of preterm delivery within 7 days. Methods: Cervical length was measured by transvaginal ultrasound in 140 women with singleton pregnancies presenting with preterm labor and intact membranes from 24(+0) to 33(+6) weeks of gestation. Other potential predictive factors, such as Bishop score, previous history of preterm delivery, and parity were assessed. Results: The mean gestational age at presentation was 30.5±14.7 (range, 24.0 to 33.6) weeks and the mean cervical length was 29.0±0.9 (range, 31.0 to 52.1) mm. Delivery within 7 days occurred in 7.9% (11/140). Receiver-operating characteristics (ROC) curves established a cervical length of 25 mm as the most relevant cut off level for prediction of delivery within 7 days. Interval between admission and delivery was significantly short when ultrasonographic cervical length was less than or equal to 25 mm. Logistic regression analysis demonstrated that the significant independent risk factors were cervical length ≤25 mm (OR: 24.64, 95% C1: 2.97~204.20, P=0.003). Conclusion: Ultrasonographic cervical length measurement is a useful tool for prediction of progression to preterm delivery within 7 days with patients with preterm labor.

응급과 긴급 자궁경부 원형결찰술을 시행한 임신부에서 조기분만 예측 인자로서 수술 후 측정한 자궁경부 길이의 유용성

박수예 ( Soo Ye Park ),최수란 ( Soo Ran Choi ),이혜란 ( Hea Ran Lee ),양성천 ( Sung Cheon Yang ),이용우 ( Yong Woo Lee ),송지은 ( Ji Eun Song ),문종수 ( Jong Soo Moon ),김성주 ( Seong Joo Kim ),이근영 ( Keun Young Lee ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.9

Objective: The aim of this study is to evaluate the value of the ultrasonographic cervical length after emergent and urgent cervical cerclage to prediction of preterm delivery in patients with incompetence of cervix. Methods: Fifty-one women who underwent emergent cervical cerclage and forty women who underwent urgent cervical cerclage were studied respectively. Receiver-operating characteristic (ROC) curve analysis, Pearson`s partial correlation coefficient, and multiple logistic regression analysis were used for statistical analysis. Results: The mean gestational age at admission was 21.2 ± 2.3 weeks in emergent cerclage group and 21.8 ± 3.2 weeks in urgent cerclage group. Postoperative mean cervical length was 17.6 ± 8.6 mm in emergent group and 21.8 ± 8.7 mm in urgent group. The diagnostic indices of postoperative cervical length (cut-off value 16.5 mm in emergent cerclage, 23.2 mm in urgency cerclage) by ROC curve were sensitivity of 65%, specifi city of 45%, positive predictive value of 17%, and negative predictive value of 8% in emergent cerclage group and in urgent cerclage group, sensitivity of 85%, specifi city of 50%, positive predictive value of 17%, and negative predictive value of 16%. Multiple logistic regression analysis indicated that postoperative cervical length was not an independent predictor of preterm delivery after adjustment of confounding factors in emergent group (P=0.65) in urgent groups (P=0.77). Conclusion: In the both groups, the postoperative cervical length was longer than preoperative. However the postoperative cervical length is not a useful predictor of preterm delivery in patients with emergent and urgent cervical cerclage.

임상 ; 조기분만진통이 있는 임신부에서 조산의 예측인자로 자궁경부 히스토그램 측정값의 유용성

이효진 ( Hyo Jin Lee ),김진욱 ( Jin Wook Kim ),김종운 ( Jong Woon Kim ),김윤하 ( Yoon Ha Kim ),문종호 ( Jong Ho Moon ),송태복 ( Tae Bok Song ) 대한주산의학회 2013 Perinatology Vol.24 No.2

목적: 조기진통으로 입원한 환자들을 대상으로 자궁경부의 히스토그램을 측정하여 조산의 가능성을 예측하는데 유용성을 평가해보고자 하였다. 연구방법: 전남대학교병원 산부인과에 내원한 임신 20주에서 35주 사이 조기분만진통을 주소로 입원한 임부 97명을 대상으로 전향적 연구를 시행하였다. 환자 입원시 질식 초음파를 이용하여 자궁경부 길이와 히스토그램 값을 측정하였다. 히스토그램은 자궁경부의 전방부 및 후방부에서 측정하고 두 값의 차이를 구하였다. 이 값들과 37주 미만의 분만인 조산과의 연관성을 분석하였다. 결과: 37주 미만에 분만한 경우는 53.6%, 37주 이후의 분만은 46.4% 이었다. 로지스틱 회기분석에서 자궁경부 길이(P=0.003; odds ratio [OR], 0.189; 95% confidence interval [CI], 0.064-0.560) 뿐만 아니라 자궁경부 전방부의 히스토그램(P=0.028; OR, 0.319; 95% CI, 0.115-0.884)이 37주 미만의 조산과 연관이 있었다. 또한 전방부 히스토그램 값의 차이의 cutoff 값을 ROC curve를 이용하여 분석하였고, 자궁경부 전방부 히스토그램 값 85.9에서 민감도 78.8%, 특이도 46.7%, 곡선 아래 면적이 0.634로 조기분만을 예측하는데 있어 유용한 것으로 나타났다. 결론: 자궁경부의 히스토그램 측정값은 조기분만 진통이 있는 임신부에서 유용한 조산의 예측 인자이다. Purpose: The aim of this study was to determine the value of a gray-level histogram of the cervix as a predictor of preterm birth in women who admitted for preterm labor. Methods: Ninety-seven women who admitted Chonnam national university for preterm labor were enrolled in this prospective study. A transvaginal ultrasonography for measurement of cervical length (CL), gray-scale histogram and cervical volume was performed when patients were admitted. Anterior and posterior cervical walls and AP (anterior and posterior) difference in MGL (mean gray level between anterior and posterior) were checked. And we analyzed the relationship between the value and preterm birth. Results: The overall rate of preterm birth before 37 weeks was 53.6% and after 37 weeks was 46.4%, respectively. Logistic regression analysis demonstrated that not only cervix length (P=0.003; odds ratio [OR], 0.189; 95% confidence interval [CI], 0.064-0.560) but also anterior histogram (P=0.028; OR, 0.319; 95% CI, 0.115-0.884) was independent predictor of preterm birth before 37 weeks. The receiver operator characteristics (ROC) curves were analyzed for the anterior histogram, a value of 85.9 was the best cut-off value to determine the preterm birth. The areas under the ROC curve indicate that the variable provides a prognostic value for the prediction for preterm birth. To predict a preterm birth, anterior histogram had 78.8% sensitivity and 46.7% specificity. Conclusion: Gray-level histogram of the uterine cervix may predict the preterm birth in pregnant women with preterm labor.

임신 38주 초음파검사에 의한 일주일 이내의 분만가능성 예측

노현경 ( Hyun Kyung Rho ),이선경 ( Sun Kyung Lee ),차지영 ( Ji Young Cha ),조태일 ( Tae Il Cho ),김광준 ( Gwang Jun Kim ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.12

Objective: The aim of this study is to predict spontaneous labor onset delivery within 7 days in low risk pregnant women at 38 weeks` of gestation by ultrasonographic examination of cervical changes. Material & Methods: This prospective study included 110 singleton low risk pregnancies between 37+0 and 37+6 weeks of gestation. Fifteen cases were lost during follow-up and finally 95 pregnant women (58 nulliparous, 37 multiparous) were analysed. The study period was from Oct/2005 to May/2007. Four cervical changes (length, gland thickness, funneling and canal formation) were evaluated. Main outcome was remaining day to delivery after the examination. Remaining days to actual delivery with spontaneous labor onset were recorded and the pregnancies were divided into two groups according to remaining days (within 7 days, over 7 days) to compare predicting power of delivery within 7 days. ROC curves were drawn to find out cut-off values of cervical length and gland thickness. Sensitivity, specificity, positive predictive value and negative predictive value were extracted from four cervical changes. Resullts: Mean cervical length of pregnant women at 38 weeks` of gestation was 25.8 (±10.0) mm and mean cervical gland thickness was 4.3 (±1.2) mm. Funnelings of uterine cervix were detected in 13 cases (13.7%), canal formations in 6 cases (6.3%). All four cervical changes were statistically valuable to predict delivery within 7 days and the cervical length showed highest sensitivity. When the cervical length was measured under 20 mm, the possibility of delivery within 7 days was 78.6% (p<0.001). The cervical gland thickness less than 4 mm could predict the delivery within 7 days with sensitivity of 57.1% (p<0.01). Sensitivities of funneling and canal formation for delivery within 7 days were 54.5%, 36.4% each. Conclusion: Ultrasonographic examination of the cervical changes in low risk singleton pregnancy at 38 weeks` of gestation are valuable for predicting spontaneous labor onset delivery within 7 days. Among four cervical changes, cervical length is most sensitive ultrasonographic marker.

만삭 임신에서 자궁경부각 및 자궁경부길이 측정을 이용한 7일 내의 분만 예측

김광준 ( Gwang Jun Kim ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.8

Objective: The study was to assess the value of the cervical angle (CA) and cervical length (CL) measurement by transvaginal ultrasonography (USG) in predicting delivery within 7 days after USG in low risk singleton term pregnancies. Methods: This prospective study included 85 singleton low risk term pregnancies. The CA and the CL were measured at 36 weeks` gestation and each week thereafter. Seven cases were lost to follow-up and finally a total of 78 cases were analyzed. The number of days to delivery was recorded. The odds ratios of the CA and CL for predicting delivery within 7 days after USG at different weeks` gestation were calculated using the Cox proportional hazard model. Receiver-operation characteristic curves were drawn to determine the cutoff values of the CA and CL. Results: CA measurement did not predict delivery within 7 days after USG. However, there was a significant relationship between the CL and the days to delivery at 37 weeks` gestation. The optimal cutoff value in predicting the delivery within 7 days was 10 mm at 37 weeks` gestation. We could not obtain proper cutoff points at other weeks` gestation. Conclusion: CA measurement by transvaginal USG may not have a significant clinical impact on predicting delivery within 7 days after USG. However, CL measurement USG at 37 weeks` gestation can help predict the delivery within 7 days after USG.

초음파상 자궁경부가 짧은 무증상 임신부에서 조산예방을 위한 자궁경부 원형결찰의 효용성

김민형 ( Min Hyoung Kim ),정진훈 ( Jin Hoon Chung ),최준식 ( June Seek Choi ),안현경 ( Hyun Kyung Ahn ),한정열 ( Jeong Yeol Han ),류현미 ( Hyun Mee Ryu ),김문영 ( Moon Young Kim ),양재혁 ( Jae Hyug Yang ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.11

Objective: To investigate the clinical efficiency of the cervical cerclage for preventing preterm birth in asymptomatic women who showed a shortened cervix at the second trimester ultrasound Methods: From January 1996 to December 2005, we retrospectively reviewed the medical records of pregnant women who received routine second trimester ultrasound (16~24 gestational weeks) without abdominal pain or bleeding at Cheil general hospital. Women with a short cervical length ≤25 mm were classified into cerclage and expectant group. Women who received cervical cerclage within 1 week after detection of cervical shortening without any change of cervical length and shape were included in cerclage group. Primary outcome was the frequency of delivery before 34 weeks` gestation. Secondary outcome was the most important risk factor for preterm delivery in pregnant women with short cervix. Chi-square test, t-test, and multiple logistic regression analysis were used for statistical analysis. P<0.05 was considered statistically significant. Results: The mean gestational age at ultrasound was 21.6 weeks` gestation. A total of 111 women had short cervix, including 26 that were treated by cerclage and 85 managed expectantly. The proportion of preterm delivery before 34 weeks` gestation was higher in the cerclage group [38% (10 of 26)] than that of the expectant group [20% (17 of 85)], but there was no significant difference (P=0.069). In the univariate analysis, funneling (38% vs 16%, P=0.012) and cervical length ≤15 mm (47% vs 15%, P=0.069) were associated with preterm delivery before 34 weeks` gestation. In the multiple logistic regression analysis, a cervical length ≤15 mm had an adjusted odd ratio of 3.7 (95% CI 1.3~10.6) for preterm delivery before 34 weeks`s gestation. Conclusions: These data suggest that cerclage in asymptomatic woman with a short cervix in the second trimester ultrasound does not prevent preterm delivery before 34 weeks of gestation. Woman with extremely shortened cervical length ≤15 mm needs intensive management for prevention of preterm delivery.

쌍태 임신에서 경질초음파를 이용한 임신 주수에 따른 자궁경부 길이의 정상역 설정에 관한 연구

김혜진,홍준석,박교훈,정지예,박혜은,김현준,한상훈,전용탁,지병철,김용범,서창석 대한산부인과학회 2006 대한산부인과학회 학술대회 Vol.92 No.-

쌍태 임신에서 경질초음파를 이용한 임신 주수에 따른 자궁경부 길이의 정상역 설정에 관한 연구

김혜진 ( Hye Jin Kim ),홍준석 ( Joon Seok Hong ),박교훈 ( Kyo Hoon Park ),정지예 ( Ji Ye Jung ),박혜은 ( Hye Eun Park ),김현준 ( Hyun Jun Kim ),한상훈 ( Sang Hoon Han ),전용탁 ( Yong Tark Jeon ),지병철 ( Byung Chul Jee ),김용범 ( 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.2

정상 한국인 임신부에서 임신주수에 따른 자궁경부길이의 변화양상

양순하 ( Soon Ha Yang ),최성진 ( Seong Jin Choi ) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.11

Objective: The aims of this study are to evaluate the longitudinal change in the cervix throughout pregnancy by transvaginal ultrasound and to establish a normogram of the cervical length in Korean pregnant women. Methods: A prospective observational stud

조기진통 임신부에서 조기분만의 예측에 있어 질식초음파를 이용하여 측정한 자궁경부길이의 유용성

최수란 ( Choe Su Lan ),양순하 ( Yang Sun Ha ),이지수 ( Lee Ji Su ),서용수 ( Seo Yong Su ),김종화 ( Kim Jong Hwa ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.11

Objective : The aim of this study is to evaluate the value of vaginal ultrasonographic cervical length in prediction of preterm delivery in patients with preterm labor. Methods : One-hundred twenty-nine women in preterm labor at 24-34 weeks of gestation w