조산의 예측에 있어 산모의 질 분비물내 Nitrate 와 Nitrite 측정의 유용성

김영한 ( Young Han Kim ),이창희 ( Chang Hee Lee ),박용원 ( Yong Won Park ),조재성 ( Jae Sung Cho ) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.7

Objective :This study is directed to determine whether the concentrations of nitrate and nitrite, metabolites of nitric oxide, in vaginal secretions could be used to predict a premature delivery. Method: A total of 60 pregnant women from March, 2000 to February, 2001 received continuous prenatal care and underwent delivery in our hospital was enrolled in the study. Gestational age was ranged between 20 and 37 weeks. Those patients were divided into four groups according to clinical parameters such as preterm labor, premature rupture of membranes and premature delivery. Specimens were obtained by though washing of vagina with 5 mL sterile physiologic sodium chloride solution for determination of nitric oxide metabolites. The total nitrate and nitrite concentration was determined by treatment with nitrate reductase followed by the Griess reaction. Results : Subjects were divide into four groups (group I, no preterm labor and term delivery [n=19]; group II, preterm labor and term delivery [n=12]; group III, preterm labor and consequent premature delivery [n=6]; Group IV, preterm labor with premature rupture of membranes and consequent premature delivery [n=23] ). Total nitrate and nitrite concentrations in group II-IV (62.2±50.3 μpmol/L in group II, 113.3±77.0μpmol/L in group III, 101.94±72.4μpmol/L in group IV) were significantly higher than the concentration in Group I (9.44±11.9μpmol/L). From the receiver operating characteristic curve in the prediction of premature delivery, we set 27.6 p μmol/L as a cut-off value in this study. Sensitivity, specificity, positive predictive value, and negative predictive value were 71.9%, 78.6%, 79.3%, and 71.0%, respectively. Conclusion :Patients with premature delivery do have increased nitric oxide metabolites in vaginal secretions. These results suggest that nitric oxide may be involved in the initiation of cervical ripening and used as a predictor of premature delivery.

국제물품매매협약상 매도인의 물품인도의무

허해관(Hai-Kwan HEO) 한국무역상무학회 2018 貿易商務硏究 Vol.77 No.-

Under CISG the places of delivery by the seller of the goods are: If the seller is not bound to deliver the goods at any other particular place and the contract of sale involves carriage of the goods, the seller has to hand the goods over to the first carrier for transmission to the buyer. However, if the contract does not involve carriage of the goods, he has to place them at the buyer s disposal at the place where, at the time of the conclusion of the contract, both the seller and the buyer knew that the goods were at, or were to be manufactured or produced. This rule applies when the contract relates to specific goods, or unidentified goods to be drawn froma specific stock or to be manufactured or produced. Finally, in ant other cases the seller has to place the goods at the buyer s disposal at the place where the seller had his place of business at the time of the conclusion of the contract. As to time of delivery, if a date is fixed by or determinable fromthe contract, the seller has to deliver the goods on that date. If a period for delivery is fixed by or determinable fromthe contract, he has to deliver the goods on any date within that period. In this way the seller chooses the specific date of delivery within that period, while circumstances indicate otherwise that the choice is to be made by the buyer. There no such date or period, the seller has to deliver the goods within a reasonable time after the conclusion of the contract. If the seller delivers the goods before such the date or period, the buyer is entitled to take delivery or refuse to take delivery. Under these backgrounds of provisions of CISG, this study first suggests the concepts of the handing over of the goods by the seller to the carrier and the placing themat the buyer’s disposal. Then it goes further to looks into exactly where and when the delivery has to occur. In these context, this study more examines what happens if there is a breach of contract by the seller in connection with the delivery. That is, if the seller delivers non-conforming goods or at wrong place; what if there is a partial delivery or a premature delivery.

임신부 B군 연쇄구균의 조기파막 및 조기분만과의 연관성

김명철(MC Kim),이준원(JW Lee),어영(Y Uh) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1

Our purpose was to determine whether maternal colonization of group B strpetococci is associated with premature rupture of membrane and preterm delivery. Vaginal, anorectal and urethral swab specimens from 459 pregnant women attending the Wonju Christian Hospital during the period of May 1995 to January 1996 were cultured with new Granada medium and selective Todd-Hewitt broth. Ten pregnant women with underlying factors of preterm delivery such as twin pregnancies, hydramnios, uterine myoma, and other medico-surgical problems were excluded. Statistical comparisons were performed by use of unpaired two-tailed t tests and 2 analysis. Of 449 women, 56 and 22 were premature rupture of membrane and preterm delivery, respectively. Twenty five women among 449 pregnant women had cultured positive for group B streptococci. Women with premature rupture of membranes were higher colonization rate of group B streptococci than women without premature rupture of membranes, a statistically significant difference (14.3% vs 4.3%, p < 0.01; odds ratio, 3.7; 95% confidence limits, 1.5 to 9.0). However, there was no difference of positive culture rate of group B streptococci between preterm delivery and normal delivery. In conclusion, these data suggest a causal relationship between group B streptococci colonization and events leading to premature rupture of membranes.

Questionnaire survey on the management of pregnant women with preterm premature rupture of membranes

( Seo Yeon Kim ),( Han Sung Kwon ),( Jayeon Lee ),( Ah Ram Sul ),( Hyun Sun Ko ),( Jeong In Yang ) 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.3

Objective The aim of this survey was to study the status of the actual practice in the management of preterm premature rupture of membranes (PPROM) between 34.0 and 36.6 weeks of gestation. Methods This survey was designed for obstetricians who work in secondary or tertiary medical institutions and attended the Korean Society of Maternal Fetal Medicine conference held on July 1, 2017, in Korea, using a structured questionnaire consisting of 5 questions. Results The most commonly used antibiotic was cephalosporin monotherapy (34.5%). Antenatal corticosteroids were applied up to 34.0 weeks of gestation in half of the respondents. The frequency of expectant management was higher than that of immediate delivery in women with PPROM between 34.0 and 36.6 weeks of gestation (57.4%). The most important factor in determining immediate delivery was the symptoms of chorioamnionitis. Conclusion The present survey showed a considerable variation in the actual management of PPROM in women, especially the optimal timing of delivery. More evidenced-based studies with statistical power are required to decrease the heterogeneity of clinical practice.

Determination of maternal risk factors of preterm delivery: adjusted for sparse data bias; results from a population-based case-control study in Iran

( Mehrdad Valipour ),( Erfan Ayubi ),( Narges Shiravand ),( Yousef Moradi ),( Abolfazl Abbaszadeh ),( Firooz Amrai ),( Shahin Mokhtari ),( Kaveh Bahmanpour ),( Kamyar Mansori ) 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.2

Objective To determine the maternal risk factors associated with preterm delivery in Iran. Methods A population-based case-control study was conducted including 48 women having preterm delivery (case group) and 100 women having term delivery (control group) between March 2007 and March 2012 in the maternity hospitals of the Selseleh County, Lorestan province, Iran. Information regarding maternal risk factors was collected by structured interview and reviewing the medical records. The maternal risk factors associated with preterm delivery were identified using univariate and multivariable logistic regression analysis after adjusting the sparse data bias. The area under the receiver operating characteristic (ROC) curves was estimated to evaluate the discrimination power of the statistical models. Results Multivariable analysis demonstrated that multiparty (odds ratio [OR], 14.23; 95% confidence interval [CI], 1.60-127.05), history of gestational diabetes (OR, 0.10; 95% CI, 0.01-0.99), thyroid dysfunction (OR, 97.32; 95% CI, 5.78-1,637.80), urinary tract infection (OR, 16.60; 95% CI, 3.20-85.92), and taking care during pregnancy (OR, 0.12; 95% CI, 0.03-0.50) had significant impact on preterm delivery after adjusting the potential confounders. The area under the ROC curve for the aforementioned maternal risk factors was 0.86 (95% CI, 0.80-0.92). Conclusion Our study provides evidence for the associations between multiparty, history of gestational diabetes, thyroid dysfunction, urinary tract infection, as well as taking care during pregnancy, and preterm delivery.

Predicting factors for success of vaginal delivery in preterm induction with prostaglandin E2

김유민,박주영,성지희,최석주,오수영,노정래,김종화 대한산부인과학회 2017 Obstetrics & Gynecology Science Vol.60 No.2

ObjectiveTo evaluate the efficacy and safety of prostaglandin (PG) E2 for preterm labor induction and to investigate the predictive factors for the success of vaginal delivery. MethodsA retrospective cohort study was performed in women (n=155) at 24+0 to 36+6 weeks of gestation who underwent induction of labor using a PGE2 vaginal pessary (10 mg, Propess) from January 2009 to December 2015. Success rates of vaginal delivery according to gestational age at induction and incidence of intrapartum complications such as tachysystole and nonreassuring fetal heart rate were investigated. Multivariable logistic regression analysis was performed to evaluate the predictive factors for success of labor induction. ResultsThe vaginal delivery rate was 57% (n=89) and the rate of cesarean delivery after induction was 43% (n=66). According to gestational age, labor induction was successful in 16.7%, 50.0%, and 62.8% of patients at 24 to 31, 32 to 33, and 34 to 36 weeks, showing a stepwise increase (P=0.006). There were 18 cases (11%) of fetal distress, 9 cases (5.8%) of tachysystole, and 6 cases (3.8%) of massive postpartum bleeding (>1,000 mL). After adjusting for confounding factors, multiparity (odds ratio [OR], 8.47; 95% confidence interval [CI], 3.10 to 23.14), younger maternal age (OR, 0.84; 95% CI, 0.75 to 0.94), advanced gestational age at induction (OR, 1.06; 95% CI, 1.02 to 1.09), rupture of membranes (OR, 11.83; 95% CI, 3.55 to 39.40), and the Bishop score change after removal of PGE2 (OR, 2.19; 95% CI, 1.0 to 4.8) were significant predictors of successful preterm vaginal delivery. ConclusionAn understanding of the principal predictive factors of successful preterm labor induction, as well as the safety of PGE2, will provide useful information when clinicians consult with preterm pregnant women requiring premature delivery.

재태주령 34주 이전에 출생한 미숙아에서 병원도착시점에서 분만까지 소요된 시간과 뇌성마비 발생과의 관련성

황재웅,허아름,구수현,이해정,이준화,이주석,조경래 대한소아청소년과학회 2009 Clinical and Experimental Pediatrics (CEP) Vol.52 No.11

목 적:34주 이하로 출생한 미숙아에서 병원도착시점에서 분만까지 소요된 시간이 짧은 경우 향후 뇌성마비 발생과 관련이 있는지 알아보고자 하였다. 방 법:34주 이하의 미숙아 142례를 대상으로 하였다. 산모의 내원시점에서 분만까지 소요된 시간(소요시간)을 측정하였고 한국형 영유아 발달 검사 및 신경학적 검사를 통해 뇌성마비를 진단하여 분만에 소요된 시간과 뇌성마비 발생과의 상관관계 여부를 알아보았다. 결 과:병원 도착시점에서 분만에 이르는 시간이 짧으면 짧을수록 조대운동 발달지수가 낮아지고 뇌성마비의 발현빈도가 높아지는 경향을 보인 기본적인 결과 외에 1분 및 5분 Apgar 점수가 모두 작아지는 경향을 보였고 분만까지 소요된 시간이 짧을수록, 특히 분만에 소요된 시간이 6시간 이내인 경우 RDS의 발생가능성이 높은 것으로 나왔으며 제태기간이 짧을 가능성이 높은 것으로 나왔다. 그러나 다인자 분석에서 소요시간은 뇌성마비 발생에 영향을 주지 못하는 것으로 나왔다. 결 론:34주 이하로 출생한 미숙아에서 병원도착시점에서 분만까지 소요된 시간은 뇌성마비의 발생에 영향을 주지 못하는 것으로 나왔다. 그러나 본 연구에서는 급박하게 이루어진 분만이 뇌성마비 발생에 영향을 줄 수 있는 가능성에 접근하는 결과를 보여 향후 추가적인 연구가 있어야 할 것으로 사료된다. Purpose:This study aimed to evaluate whether a shorter time from the arrival at a hospital to delivery is related to the occurrence of cerebral palsy in premature infants of less than 34 weeks of gestational age. Methods:We studied 142 newborns of less than 34 weeks of gestational age. The time from the arrival at the hospital to delivery was measured. The correlation between the time required for delivery and the occurrence of cerebral palsy was elucidated by diagnosing cerebral palsy in neonates using the Korean Infant Development Screening Test and neurological examination. Results:Preliminary result suggested that a shorter time from hospital arrival to delivery was related to a lower development score for gross motor activity and to a higher frequency of cerebral palsy occurrence. Moreover, it was responsible for a tendency of obtaining lower Apgar scores at 1 and 5 minutes. The shorter delivery time was associated with a higher probability of respiratory distress syndrome (RDS) occurrence when the length of delivery time was less than 6 hours and there was a higher probability of a shorter gestation period. However, the multifactor analysis revealed that there was little impact of delivery time on the occurrence of cerebral palsy. Conclusions:The length of hospital arrival time to delivery did not significantly influence the occurrence of cerebral palsy in premature infants of less than 34 weeks of gestational age.

Successful delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a twin pregnancy

( Yu-jin Koo ) 영남대학교 의과대학 2018 Yeungnam University Journal of Medicine Vol.35 No.1

There has been a significant increase in the number of multiple pregnancies that are associated with a high risk of preterm delivery among Korean women. However, to date, delayed-interval delivery in women with multiple pregnancy is rare. We report a case of delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a dichorionic diamniotic twin pregnancy. The patient presented with vaginal leakage of amniotic fluid at 16 weeks of gestation and was diagnosed with a preterm premature rupture of membranes. Three days later, the first twin was delivered, but the neonate died soon after. The second twin remained in utero, and we decided to retain the fetus in utero to reduce the morbidity and mortality associated with a preterm birth. The patient was managed with antibiotics and tocolytics. Cervical cerclage was not performed. The second twin was delivered vaginally at 34 weeks and 5 days of gestation, 128 days after the delivery of the first-born fetus. This neonate was healthy and showed normal development during the 1-year follow-up period. Based on our experience with this case, we propose that delayed-interval delivery may improve perinatal survival and decrease morbidity in the second neonate in highly selected cases.

Successful delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a twin pregnancy

구유진 영남대학교 의과대학 2018 Yeungnam University Journal of Medicine Vol.35 No.1

There has been a significant increase in the number of multiple pregnancies that are associated with a high risk of preterm delivery among Korean women. However, to date, delayed-interval delivery in women with multiple pregnancy is rare. We report a case of delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a dichorionic diamniotic twin pregnancy. The patient presented with vaginal leakage of amniotic fluid at 16 weeks of gestation and was diagnosed with a preterm premature rupture of membranes. Three days later, the first twin was delivered, but the neonate died soon after. The second twin remained in utero, and we decided to retain the fetus in utero to reduce the morbidity and mortality associated with a preterm birth. The patient was managed with antibiotics and tocolytics. Cervical cerclage was not performed. The second twin was delivered vaginally at 34 weeks and 5 days of gestation, 128 days after the delivery of the first-born fetus. This neonate was healthy and showed normal development during the 1-year follow-up period. Based on our experience with this case, we propose that delayed-interval delivery may improve perinatal survival and decrease morbidity in the second neonate in highly selected cases.

Successful delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a twin pregnancy

Koo, Yu-Jin Yeungnam University College of Medicine 2018 Yeungnam University Journal of Medicine Vol.35 No.1

There has been a significant increase in the number of multiple pregnancies that are associated with a high risk of preterm delivery among Korean women. However, to date, delayed-interval delivery in women with multiple pregnancy is rare. We report a case of delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a dichorionic diamniotic twin pregnancy. The patient presented with vaginal leakage of amniotic fluid at 16 weeks of gestation and was diagnosed with a preterm premature rupture of membranes. Three days later, the first twin was delivered, but the neonate died soon after. The second twin remained in utero, and we decided to retain the fetus in utero to reduce the morbidity and mortality associated with a preterm birth. The patient was managed with antibiotics and tocolytics. Cervical cerclage was not performed. The second twin was delivered vaginally at 34 weeks and 5 days of gestation, 128 days after the delivery of the first-born fetus. This neonate was healthy and showed normal development during the 1-year follow-up period. Based on our experience with this case, we propose that delayed-interval delivery may improve perinatal survival and decrease morbidity in the second neonate in highly selected cases.