조기분만 시 조직학적 융모양막염 유무에 따른 혈청 C-반응성 단백질, 태반 내 interleukin-6, 지 질과산화도 및 단백산화도

윤대석 ( Dae Seok Yoon ),김윤하 ( Yoon Ha Kim ),김철홍 ( Chul Hong Kim ),조문경 ( Moon Kyoung Cho ),김종운 ( Jong Woon Kim ),조혜연 ( Hye Yon Cho ),김석모 ( Seok Mo Kim ),강우대 ( Woo Dae Kang ),이기호 ( Ki Ho Lee ),송태복 ( Tae B 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.1

Objective: To evaluate predictive value of maternal serum white blood cells (WBCs), C-reactive protein (CRP) levels, placental interleukin-6 (IL-6), lipid peroxide, and protein carbonyl levels in preterm birth according to histologic chorioamnionitis (HCA). Methods: This cohort study included 45 cases of preterm delivery with preterm labor and intact membranes (preterm labor [PTL] group; n=16) and preterm premature rupture of membranes (preterm premature rupture of membranes [PPROM] group; n=29). Blood samples at admission and placental sample at postpartum were collected. HCA was diagnosed in the presence of neutrophils infiltration into the subamnionic space. Results: The incidence of HCA was significantly higher in PPROM group than PTL group. Maternal serum WBC and CRP levels at admission, and placental IL-6, lipid peroxide, and protein carbonyl levels in HCA group were significantly higher than group without HCA. Maternal serum CRP levels at admission, and placental IL-6, lipid peroxide, and protein carbonyl levels of PPROM group with HCA were significantly higher than PPROM group without HCA. Maternal serum CRP levels at admission of 7 days and more latency period (n=14) were significantly lowered than those of less than 7 days latency period (n=15). The cut-off points of CRP determined with the receiver operating characteristic curves was 0.875 mg/dL. Perinatal morbidity such as respiratory distress syndrome, intraventricular hemorrhage, pneumonia in HCA group was significantly higher than group without HCA. Conclusion: Maternal serum CRP on admission may be possible a predictor for duration of the latency period in PPROM.

조기분만 시 양막파열 유무에 따른 제대정맥혈장내 interleukin-6와 tumor necrosis factor-α 및 항산화능의 변화

정광필 ( Kwang Pil Jeong ),김윤하 ( Yoon Ha Kim ),김철홍 ( Cheol Hong Kim ),조문경 ( Moon Kyoung Cho ),김기민 ( Ki Min Kim ),김종운 ( Jong Woon Kim ),안봉환 ( Bong Whan Ahn ),양성렬 ( Sung Yeul Yang ),주은현 ( Eun Hyun Joo ),송태 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.2

Objective: To compare interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α), oxygen-radical absorbance capacity (ORAC), and antioxidant vitamin levels in the umbilical venous plasma of preterm labor with intact membranes (PTL) and preterm premature rupture of membrane (PPROM) with that of full term normal pregnancy (NP) and to evaluate their roles of pathophysiology in preterm labor and PPROM. Methods: Umbilical venous blood samples were collected from women with PTL (n=30), PPROM (n=30) and NP (n=30). IL-6 and TNF-α were measured by enzyme-linked immunosorbent assay. Lipid peroxide levels were measured by thiobarbituric acid reaction. The ORAC was mesured by Cao`s method. Antioxidant vitamin levels were measured by high performance liquid chromatography. Results: IL-6 and TNF-αlevels in the umbilical venous plasma of PPROM were significantly higher than that of PTL and NP (3.28±0.31 vs. 2.84±0.19 vs. 2.79±0.22 pg/ml, p<0.05), (2.30±0.27 vs. 1.64±0.23 vs. 1.40±0.25 pg/ml, p<0.01). Lipid peroxide levels in the umbilical venous plasma of PPROM were significantly higher than that of NP and PTL (2.78±0.27 vs. 2.54±0.32 vs. 2.24±0.24 nmol/mg protein, p<0.01). ORAC levels in the umbilical venous plasma of PTL and PPROM were significantly lower than that of NP (967425.4±98.99 vs. 965165.8±91.20 vs. 1011328.5±85.96 U/ml, p<0.05). Ascorbic acid levels in the umbilical venous plasma of PPROM were significantly lower than that of NP and PTL (125.6±2.33 vs. 158.3±3.08 vs. 221.7±2.82 nmol/ml, p<0.01). Conclusion: Increase in inflammatory cytokines (IL-6, TNF-α) and imbalance of increased lipid peroxidation and decreased antioxidant activity in umbilical venous blood may be involved in the pathophysiology of PPROM.

조기분만진통 임신부에서 자궁내 감염의 산전 진단과 주산기 예후의 예측에 있어 양수내 백혈구 수 측정과 양수 배양검사의 비교 연구

문정빈(Jeong Bin Moon),이기주(Ki Joo Lee),강석범(Sok Bom Kang),김길자(Gil Ja Kim),김데리샤(Teresa Kim),박중신(Joong Shin Park),전종관(Jong Kwan Jun),윤보현(Bo Hyun Yoon),신희철(Hee Chul Syn) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10

Objectives: To compare the diagnostic and prognostic performance of amniotic fluid white blood cell(AF WBC) count and amniotic fluid culture for the prenatal diagnosis of intrauterine infection and the prediction of neonatal outcomes in patients with preterm labor and intact membranes. Methods: Amniocentesis was performed in 75 patients with preterm labor and intact membranes, who delivered preterm neonates within 72 hours after amniocentesis. AF WBC was determined and amniotic fluid was cultured for aerobic and anaerobic bacteria as well as mycoplasma. The relations among placental histologic findings, perinatal outcome, AF WBC count, and AF culture were examined. Student t test, Mann Whitney U test, χ2 test, Fisher's exact test, modified t test, and logistic regression analysis were used for statistical analysis. Results: Microbial invasion of the amniotic fluid was more frequent in the patients with histologic chorioamnionitis than patients without histologic chorioamnionitis (28.9% vs 5.4%, p<0.05), and patients with histologic chorioamnionitis had significantly higher amniotic fluid white blood cell counts than those patients without such lesion (median 99, range 0-3024 cells/mm3 vs median 1, range 0-180 cells/mm3, p<0.01). Amniotic fluid white blood cell count (≥ 50cell/mm3) had a sensitivity of 55.3%(21/38) and a specificity of 94.6%(35/37) for the diagnosis of histologic chorioamnionitis and a sensitivity of 47.5%(19/40) and specificity of 90.9%(30/33) for the prediction of significant neonatal morbidity (defined as neonatal sepsis, respiratory distress syndrome, pneumonia, intraventricular hemorrhage, bronchopulmonary dysplasia, or necrotizing enterocolitis). These sensitivities were significantly higher than those of amniotic fluid culture (for histologic chorioamnionitis, 55.3% vs 28.9% ; for significant neonatal morbidity, 47.5% vs 25.0%, p<0.01 for each). Conclusion: Amniotic fluid WBC count is a more sensitive test for the prenatal diagnosis of intrauterine infection and for the prediction of significant neonatal morbidity than amniotic fluid culture in the patients with preterm labor and intact membranes.

조기진통 융모막에서 cDNA Microarray를 이용한 유전자 발현 분석

고현선 ( Hyun Sun Ko ),김연희 ( Yeun Hee Kim ),길기철 ( Ki Cheal Kil ),양동은 ( Dong Eun Yang ),박인양 ( In Yang Park ),김사진 ( Sa Jin Kim ),박태철 ( Tai Churl Park ),신종철 ( Jong Chul Shin ) 대한주산의학회 2006 Perinatology Vol.17 No.2

Objective : We used a genome-wide approach to identify differentially expressed genes in patients with preterm delivery caused by preterm labor to improve the understanding of underlying molecular mechanism. Methods : RNA was isolated from the chorions of patients with preterm delivery caused by preterm labor with intact membranes and term vaginal delivery. cDNA microarray experiments were used to identify differentially expressed genes, and reverse transcriptase-polymerase chain reaction was used in follow-up experiment. Results : cDNA microarray experiments identified significantly increased expression of 104 genes and decreased expression of 102 genes in the preterm cases. 18 genes showed more than 1.5-fold increased expressions in the chorions of patients with preterm delivery by preterm labor than those with term vaginal delivery. In preterm delivery, up-regulated genes were associated with cell adhesion, cell cycle regulation, development, transport, morphogenesis, muscle contraction, signal transduction, and transcription. 15 genes showed more than 1.5-fold decreased expressions in chorions of patients delivered preterm by preterm labor than delivered term by labor. In preterm delivery, down-regulated genes were associated with cell differentiation, development, metabolism, morphogenesis, RNA processing, signal transduction, transcription, and transport. Conclusion : This study suggests cDNA micro array technique might provide insights into the molecular basis of preterm delivery caused by preterm labor.

단기간 동안 경험한 조기분만의 임상적 고찰

박영준(Young Joon Park) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.6

Objective : This study was undertaken to evaluate for the clinical characteristics of preterm birth experienced during the short term at Myongii hospital. Methods : This study was done 49 pregnant women and 52 preterm infants who were admitted and delivered under the diagnosis of preterm birth at Myongji hospital from Jan. 1, 2000 to Jun. 30, 2001. The data were collected retrospectively and all charts were reviewed. Results : 1. The incidence of preterm birth was 19.7% (49/249) 2. Age distribution of cases was showed the highest frequency at 36 gestational weeks (24.5%). The mean age was 31.4 years old and peak age was between 31-40 years group. 3. The causes of preterm birth were the preterm labor with premature rupture of membrane (55.1%), the preterm labor without premature rupture of membrane (32.7%), pregnancy-induced hypertension (8.2%), and placental abnormality (4.0%). 4. The incidence of vaginal delivery was 67.3% and the incidence of episiotomy was 49.0%. 5. The incidence of use of steroid before delivery was 26.5%. 6. Respiratory distress syndrome (RDS) was not noted among the all cases. Conclusion : Preterm birth is one of the major causes of perinatal mortality. Several trials including tocolytic agents, steroid, and surfactant are being used for prevention or treatment of preterm birth and RDS. In the future, many cases are needed for the exact evaluation of preterm birth.

일태아 분만된 쌍태임신에서 자궁경부봉축술 후 지연분만

이현정 ( Hyun Jung Lee ),전종관 ( Jong Kwan Jun ),김미경 ( Mee Kyung Kim ),유원정 ( Won Jeong Yoo ),심순섭 ( Soon Sup Shim ),박중신 ( Joong Shin Park ),윤보현 ( Bo Hyun Yoon ),신희철 ( Hee Chul Syn ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.8

With delayed childbearing and increased use of ovulation-stimulating drugs and assisted reproductive technologies (ART), the incidence of multiple pregnancies has increased dramatically in the past 20 years. One of the most common and serious complications of multiple pregnancies is preterm delivery. The delivery of the initial fetus in a multiple gestation usually is followed by the delivery of the subsequent fetus or fetuses shortly there after. However, a few successful delayed-interval deliveries have been reported since the first case in 1880 by Carson. Since that time, an interest in delayed-interval delivery has been developed and spurred by the increased prevalence of multiple gestations and preterm deliveries associated with these pregnancies. We report a case of a delayed-interval delivery in a twin pregnancy with an interval of 71 days. This case is the longest interval case and the first delayed-interval delivery in monochorionic twin in Korea.

조기파수와 Cytochrome P450 1A1 및 1A2 유전자 다형성과의 연관성

김사진 ( Sa Jin Kim ),박철훈 ( Cheol Hoon Park ),신종철 ( Jong Cheol Shin ),양동은 ( Dong Eun Yang ),박인양 ( In Yang Park ),고현선 ( Hyun Sun Ko ),김연희 ( Yeun Hee Kim ),안현영 ( Hyun Young Ahn ),김수평 ( Soo Pyung Kim ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.12

Objective : Preterm delivery (PTD) is the leading cause of perinatal mortality and morbidity. However, its etiology and pathogenesis remain unknown in most cases. Recently, some research put forth the hypothesis that PTD results, at least in part, from a

조기분만진통 임부와 만삭 전 조기양막파열 임부의 정맥혈장내 산화 스트레스 지표

김윤하 ( Yoon Ha Kim ),노은지 ( Eun Ji Noh ),백주아 ( Ju A Back ),김종운 ( Jong Woon Kim ),송태복 ( Tae Bok Song ) 대한주산의학회 2015 Perinatology Vol.26 No.4

Purpose: This study was performed to investigate the oxidation and antioxidation capacity in the maternalvenous plasma of preterm labor with intact membranes, and premature rupture of membranes (PPROM), andalso to evaluate their roles in the pathophysiology of PPROM. Methods: Seventy five women in the following categories had venous blood retrieved: (1) Group A, normal pregnancy (n=24). (2) Group B, preterm labor with intact membranes (n=25). (3) Group C, preterm premature rupture of membranes (n=26). Malondialdehyde (MDA) levels as a marker of lipid peroxidation by thiobarbituric acid reaction, protein carbonyl content by 2,4-dinitrophenylhydrazine reaction, and total antioxidant capacity by oxygen radical absorbance capacity assay (ORAC) were measured. Mann-Whitney U test, Kruskal-Wallis test were used for statistical analysis. Results: Lipid peroxide levels in the venous plasma of group B and C were significantly higher than those of group A (group B: 4.59±0.30, group C: 5.40±0.22 vs. group A: 3.90±0.26 nmol/mg protein, P<0.05). Lipid peroxide levels in the venous plasma of group C were significantly higher than those of group B (P<0.05). Protein carbonyl levels in the venous plasma of group C were significantly higher than those of group A (group C: 5.68±0.42 vs. group A: 5.43±0.41 nmol/mg protein, P<0.05). There was no significant difference of protein carbonyl levels in the venous plasma between group A and B. ORAC levels in the venous plasma of group B and C were significantly lower than those of group A (group B: 117.90±0.48, group C: 111.68±1.23 vs. group A: 119.14±1.12 mM/mL, P<0.05). ORAC levels in the venous plasma of group C were significantly lower than those of group B (P<0.05). Conclusion: In the blood of the women with preterm premature rupture of membranes, the lipid peroxidation was increased and the antioxidant capacity was decreased compared to women with normal pregnancy and preterm labor with intact membranes. These results suggest that oxidative stress was increased in preterm premature rupture of membranes.

조기분만과 TNF-α 및 IL-1β 유전자의 다형성과의 연관성

박철훈 ( Cheol Hoon Park ),박인양 ( In Yang Park ),고현선 ( Hyun Sun Ko ),안현영 ( Hyun Young Ahn ),김수평 ( Soo Pyung Kim ),신종철 ( Jong Chul Shin ),김연희 ( Youn Hee Kim ),이귀세라 ( Gui Se Ra Lee ),이희중 ( Hee Joong Lee ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.12

Objective : To elucidate whether polymorphisms of tumor necrotic factor-α (TNF-α) and interleukin-1β (IL-1β) are associated with preterm delivery caused by preterm labor and preterm premature rupture of membrane (PPROM) in korean pregnant women. Methods :

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

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.