임신중기(姙娠中期)에 나타난 양수과소증(oligohydramnios)에 가미당귀산(加味當歸散)을 투여하여 효과를 보인 증례보고

김효정,김은섭,진대환,황덕상,이진무,이창훈,장준복 대한한방부인과학회 2019 大韓韓方婦人科學會誌 Vol.32 No.1

Treatment of Mid-trimester Oligohydramnios Using Gami-danggui-san Objectives: The aim of this study was to demonstrate the benefit of Traditional Korean Medicine as an adjuvant therapy in management of mid-trimester oligohydramnios. Methods: It is a case report of a 31 year-old woman hospitalized for oligohydramnios at 24+4/7weeks of gestation. This patient diagnosed with special oligohydramnios had no abnormal findings such as fetal urinary abnormalities or other anomalies. Also, symptom of PPROM (preterm premature rupture of membrane) was not confirmed. The decoction, Gami-danggui-san (DG) was prescribed for the purpose of reducing unnecessary contraction of uterine muscle during pregnancy and promoting blood circulation and metabolism, thereby improving placental function and contributing to the increase of the fluid. DG decoction was administered twice a day until 19th of June, which was 10 days in total. During the treatment, level of amniotic fluid had been monitored by measuring AFI (amnioti fluid index). Results: After these conventional therapies, the amount of amniotic fluid increased steadily, and eventually reached the optimal level. AFI was found to be 3.2 on the 24+4/7 weeks, 8 on the 26+1/7 weeks, 11.5 on the 27+0/7 weeks of gestation. In the same periods, EFW (expected fetal weight) was also found to be increasing gradually: 545 g, 630, and 760 g. Conclusions: Our report implies the potential of herbal medicine as a effective therapy for oligohydramnios tratment. Further studies are needed to assess the efficacy of TKM herbal medicine and reveal the mechanisms of the decoction. Objectives: The aim of this study was to demonstrate the benefit of Traditional Korean Medicine as an adjuvant therapy in management of mid-trimester oligohydramnios. Methods: It is a case report of a 31 year-old woman hospitalized for oligohydramnios at 24+4/7weeks of gestation. This patient diagnosed with special oligohydramnios had no abnormal findings such as fetal urinary abnormalities or other anomalies. Also, symptom of PPROM (preterm premature rupture of membrane) was not confirmed. The decoction, Gami-danggui-san (DG) was prescribed for the purpose of reducing unnecessary contraction of uterine muscle during pregnancy and promoting blood circulation and metabolism, thereby improving placental function and contributing to the increase of the fluid. DG decoction was administered twice a day until 19th of June, which was 10 days in total. During the treatment, level of amniotic fluid had been monitored by measuring AFI (amnioti fluid index). Results: After these conventional therapies, the amount of amniotic fluid increased steadily, and eventually reached the optimal level. AFI was found to be 3.2 on the 24+4/7 weeks, 8 on the 26+1/7 weeks, 11.5 on the 27+0/7 weeks of gestation. In the same periods, EFW (expected fetal weight) was also found to be increasing gradually: 545 g, 630, and 760 g. Conclusions: Our report implies the potential of herbal medicine as a effective therapy for oligohydramnios tratment. Further studies are needed to assess the efficacy of TKM herbal medicine and reveal the mechanisms of the decoction.

정상 임신의 임신 주수에 따른 양수지표 변화에 대한 연구

김복린,유태환,최훈,이홍균 인제대학교 1996 仁濟醫學 Vol.17 No.3

임신중 정상적인 양의 양수를 유지하는 것은 성공적인 임신성과를 얻는데 중요한 요소이다. 따라서 임신 전 기간 동안 반복해서 양수지수를 측정함으로써 양수 과소증 및 양수 과다증을 찾아내어 고위험 임신에 대한 적절한 처치를 하기 위하여 428명의 정상 임신부에서 양수지수를 측정하여 임상적으로 유용하게 이용하기 위한 연구를 하였다. Amniotic fluid index(AFI), the four-quadrant sum of amniotic fluid pockets was studied prospectively in 428 normal pregnancies. Until 27weeks, the AFI increases progressively and after 28weeks, the AFI declines at a progressively increasing rate. The mean of AFI was 13.1mm in term pregnancies and in postdates pregnancies, AFI were decreased rapidly. We concluded that ultrasonographic measurement of AFI is relatively accurate in identifying normal amniotic fluid

만삭전 조기양막파열에서 분만 잠복기의 예측지표로서 입원시 측정한 양수지수의 유용성

양순하(Soon Ha Yang),박선혜(Seon Hye Park),오성희(Sung Hee Oh),황종대(Jong Dae Whang),노정래(Cheong Rae Roh) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.12

Objectives: The purpose of this study was to determine the clinical significance of residual amniotic fluid volume, as measured by the amniotic fluid index(AFI), on the prediction of latency period and perinatal outcomes in patients with preterm premature rupture of the membranes(PPROM). Methods: Study population consisted of 103 singleton pregnancies with PPROM between 24 and 34 weeks' gestation. Amniotic fluid index was determined using transabdominal ultrasound at admission. Latency period was defined as time interval in hours between admission and delivery. All medical records of mothers and neonates were reviewed. Spearman's rho rank correlation, receiver-operator characteristic(ROC) curve analysis, survival analysis and Cox's proportional hazard model were used for statistical analysis. Results: There was a statistically significant correlation between latency period and AFI at admission. ROC curve analysis showed that AFI at admission had a significant predictive value in the prediction of latency period < 48 hours. Survival analysis demonstrated that AFI < 5.0 was strongly associated with the likelihood of shorter latency period, Cox's proportional hazard model indicated that AFI < 5.0 was a significant independent predictor for the occurrence of latency period < 48 hours even after adjustment of other independent variables. The patients with AFI < 5.0 had a higher rate of cesarean section due to fetal distress than those with AFI > 5.0 but the incidence of chorioamnionitis was not significantly different between two groups. Comparing the perinatal mortality and neonatal morbidity including infectious morbidity between the neonates born to mothers with AFI < 5.0 and those with AFI > 5.0, there was no significance after adjustment of gestational age at birth. Conclusion: AFI at admission has a significant correlation with latency period and predictive value in prediction of latency period in the patients with PPROM. AFI < 5.0 is a independent predictor for the shorter latency period.

지연임신에서 양수지수에 따른 주산기 예후

이경복 ( Kyung Bok Lee ),김현찬 ( Hyun Chan Kim ) 대한주산의학회 1997 大韓周産醫學會雜誌 Vol.8 No.2

자연임신에서의 양수지수와 주산기 예후와의 관계에 대한 연구

서희승 ( H. S. Seo ),선우재근 ( J. K. Sunwoo ),장경택 ( K. T. Jang ),서수형 ( S. H. Seo ),배동한 ( D. H. Bae ) 대한주산의학회 1995 大韓周産醫學會雜誌 Vol.6 No.3

고위험 임신에서 수정된 생물리학적 계수검사법을 이용한 태아안녕평가의 유용성에 관한 연구

김동옥(DO Kim),한정열(JY Han),김은성(ES Kim),채난희(NH Chae),정영철(YC Jung),강창성(CS Kang),양재혁(JH Yang),김문영(MY Kim),류현미(HM Ryu),한호원(HW Han) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.7

Objective: Our purpose was to evaluate the effectiveness of the modified biophysical profile[MBPP] for antepartum fetal wellbeing assessment in high risk pregnancies. Materials and Methods: From Jan.1,1996, through Dec.31,1996, 2,275 tests in 1,270 patients with singletone high risk pregnancies were performed for antepartum fetal wellbeing assessment using a MBPP consisting of nonstress test[NST] with acoustic stimulation and ultrasound evaluation of amniotic fluid index[AFI] weekly or twice a week. Nonreactive NST, significant fetal heart rate deceleration, and AFI <5 were regarded as positive results. Results: Those patients were 28.0±6.4 years old in mean age and the MBPPs were performed in mean 38.1±2.7 weeks` gestation. 1,182 patients had negative MBPPs on the last test before delivery. 88 patients had positive MBPPs such as 20 nonreactive NST[22.7%], 19 significant fetal heart rate deceleration[21.6%], 5 nonreactive NST plus oligohydramnios[5.7%], and 44 oligohydramnios alone[50.0%]. Population characteristics were not significantly different between negative and positive MBPPs. Perinatal outcome parameters included 5-minute Apgar score less than 7, thick meconium stained amniotic fluid, prematurity, cesarean section for fetal distress, small for gestational age, and perinatal death. They were significantly different between negative and positive MBPPs except perinatal death. There were two perinatal death. One perinatal death resulted from cord prolapse on the 5th day after negative MBPP of the last screen test. The false negative rate was 0.4/1000. The other occurred in positive MBPP. Conclusion: The MBPP appears to be a effective primary mean of fetal surveillance in high risk pregnancies.

태아안녕검사에 있어서 Rapid Biophysical Profile 의 유용성

김학준(Hag Joon Kim),고민석(Min Seok Koh),임병도(Byeong Do Lim),여정언(Jung Eun Yeo),정의식(Eul Sik Jung) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.6

Object : The nonstress test(NST) and complete biophysical profile(BPP) were compared with the rapid biophysical profile(BPP) in order to evaluate the efficacy of the rapid BPP, namely, the combination of amniotic fluid index(AFI) and sound-provoked fetal movement(SPFM) detected by ultrasound, in predicting intrapartum fetal distress in high-risk pregnancies. Study design : From JAN 9th 2000, through JAN 5th 2001, the prospective study of diagnostic tests was conducted on a total of 91 high-risk singleton pregnancies, undergoing antepartum assessment both the standard NST and the new rapid BPP(including other indices of complete BPP). The diagnostic indices of the NST, rapid BPP and complete BPP were calculated in term of predicting intrapartum fetal distress. Result : The sensitivity, specificity, negative predictive value, and positive predictive value of NST were 50.00, 94.81, 96.05, and 42.86% respectively, and those of rapid BPP were 75.00, 98.53, 98.53, and 75.00%, and those of complete BPP were 83.33, 98.72, 98.72, and 83.33%, as well. In addition, the efficiency of NST, rapid BPP, and complete BPP were 91.57%, 97.22% and 97.62% respectively. Conclusions : The rapid BPP is an effective and reliable predictor of intrapartum fetal distress with high-risk pregnancies. Moreover, it may be inexpensive and less time-consuming method.

저위험 산모군에서 주산기 예후의 예측인자로서 양수과소증의 의의

민주영 ( Joo Young Min ),오민정 ( Min Jeung Oh ),조금준 ( Geun Joon Cho ),이재관 ( Jae Kwan Lee ),이경주 ( Kyung Ju Lee ),김해중 ( Hai Joong Kim ),허준용 ( Jun Young Hur ),서호석 ( Ho Suk Saw ),박용균 ( Yong Kyun Park ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.9

Objective : The aim of our study was to assess whether isolated oligohydramnios is associated with adverse perinatal outcomes in low-risk term pregnancy. Methods : Women delivered between March 2001 and July 2003, who underwent ultrasonography from 37 to

자궁적출술의 수술적 접근방법으로 복식에서 질식경로로의 변화에 관한 연구 : 1990년부터 1997년까지 질식자궁적출술 3408예의 임상 경험적 연구

강정배(Jung Bae Kang),정태범(Tae Bum Jung),김홍배(Hong Bae Kim),이근영(Geun Young Lee),강성원(Sung Won Kang) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.1

Objective : The purpose of our study evaluate to assess the feasibility and safety of performing vaginal hysterectomy on our experience. Methods : Between 1990 year and 1997 year, 3408 women underwent vaginal hysterectomy without laparoscopic assistance at Hallym University Hospital in Korea. All hysterectomies(abdominal & vaginal) were reviewed and these were compared with all hysterectomy cases from most recent year available for complete analysis. Result : 1. In 1990 yrs ∼ 1997 yrs, vaginal hysterectomies compromised 51%(vaginal hysterectomy〔below VH〕: 268 / total abdominal hysterectomy〔below TAH〕: 258 ; 1990), 55%(VH: 254 / TAH: 212 ; 1991), 60%(VH: 346 / TAH: 227 ; 1992), 64%(VH: 341 / TAH: 190 ; 1993), 72%(VH: 434 / TAH: 168 ; 1994), 75%(VH: 489 / TAH: 156 ; 1995), 76.%(VH: 632 / TAH: 196 ; 1996), 78%(VH: 657 / TAH: 190 ; 1997), a high increased rate of vaginal hysterectomy significantly. 2. The average age of patients was 41.9± 8.18(26∼84) years old and 25 nullipara and 274 primiparas and 3109 multiparas. The mean parity was 2.74±0.36. 3. The common surgical indications were uterine myoma(53.9%), prolapse of uteri(23.3%), CIN II-III or microinvasive cervical cancer(6.5%), others(16.3%) 4. The average time of operation(hysterectomy and colporrhaphy) was 78.3± 14.2 min(40∼230). 5. The average weight of uterus was 166.5± 111.4 gm(60∼1130 gm), 34.0% was done morcellation. 6. 5.7% of operated women had previous abdominal operaton (without tubal ligation). 7. The common associated procedures were posterior colporrhaphy(47.4%), anteroposterior colporrhaphy(45.6%), adnexectomy(4.9%), other(2.1%). 8. The mean blood loss was 280± 104.4 ml and 12.4% of operated women were need of transfusion. 9. The minor complication rate was 10.6% e.g. urinary retention(5.3%-179cases), abdominal bleeding (including conversion TAH) (0.3%-9cases), pelvic hematoma(0.3%-11cases), post operation fever(2.8%-94cases), mortality cases none. 10. The mean hospital days were 7 days(4∼20) Conclusion : In our experience the following conclusions have been reached that vaginal hysterectomy is usually well tolerated by most women, a safe operation with few complications and without notable blood loss and without the need of expensive laparoscopic equipment. The incidence of vaginal hysterectomy is characterized by pronounced fluctuations suggested that no valid general guidelines have yet been established for the indication via vagina of surgical treatment. The incidence of vaginal hysterectomy correlates with the experience of individual surgeon strongly. Vaginal hysterectomy remains the method of choice for removal of the uterus in the absence of absolute contraindication.

만기 임신의 저위험 산모군에서 양수과소증이 주산기 예후에 미치는 영향과 임상적 의의

안현영 ( Hyun Young Ahn ),김연희 ( Yeon Hee Kim ),김아리 ( A Ri Kim ),서미원 ( Mi Won Seo ),김옥경 ( Ok Kyung Kim ),이귀세라 ( Guisera Lee ),김사진 ( Sa Jin Kim ),신종철 ( Jong Chul Shin ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.12

Objective: The purpose of this study was to assess the effect of the isolated oligohydramnios on the perinatal outcome in uncomplicated term pregnancies. Methods: We used data from Jan 2002 to Dec 2005 in all uncomplicated pregnancies between 37 and 41weeks and 6 days of gestation with a singleton fetus, underwent monitoring with serial determination of AFI. Oligohydramnios was defined by ultrasonographic determination of AFI ≤5 cm. Exclusion criteria were PROM, maternal medical complications and fetal anomalies detected by prenatal ultrasound. We investigated the mode of delivery, birth weight, birth weight < 10th percentile, 1 and 5 min Apgar score, umbilical cord pH and base excess, and meconium stained amniotic fluid (MSAF). We also assessed the predictive value of obstetric factors associated with adverse perinatal outcome. We used statistics analysis by Chi-square test, independent-samples T test using SPSS 14.0 V. Results: 2,491 patients met our inclusion criteria. Oligohydramnios was diagnosed in 8.63% (215/2,491). There was significantly difference in cesarean section for fetal distress between those with oligohydramnios vs. normal AFI (43.8% vs.4.1%). Patients with oligohydramnios had significantly lower SGA (15.3% vs. 5.7%), lower Apgar score at 1 min<7 (7.9% vs. 3.3%), and higher rate of MSAF (31.2% vs. 18.4%) than those with normal AFI. There were musculoskeletal abnormalities in 10/215 (4.6%) and urogenital abnomralites in 53/215 (24.6%). Conclusion: Isolated oligohydramnios in uncomplicated term pregnancies is associated with an increased adverse perinatal outcome. Nulliparity, advanced maternal age, MSAF, SGA, and lower BPP were significantly associated with the adverse perinatal outcomes.