산과입원환자의 통게적 관찰 ( 제2보 )

송상환(SW Song) 대한산부인과학회 1963 Obstetrics & Gynecology Science Vol.6 No.5

An in other meidcal fields great progress has been made in obstetrics for past 30 years due to not only the increased availability and use of blood transfusion, chemotherapeutics but statistical study of the obstetrical cases each each year. However, in Korea modern obstetrics has been introduced rather recently and consquently few baseline studies in obstetrical statistics are available. In order to establish a starting point from which to measure progress, various clinical inveestigations are being carried out in our institution, a part of which is from Feb. 21, 1959 to Aug. 31, 1962, obtaining the following data. 1) Statistical investigations were made on 1623 delivered, 89 undelivered cases and 1659 new born babies. 2) The percentage seeking antepartal care ahs shown gradual increase from 48.3% in 1959 to 61% in 1962 with slight increase of hospital delivery in number. 3) Incidence of anemia in pregnancy and positive serology by V.D.R.L. or Kahn and Kolmer tests were found to be 21.3% (anemia) and 1.1% (positive serology) respectively. However, incidence of anemia in pregnancy was 16% in those having antepartal care and 28.2% in those without antepartal care. 4) In age distribution, 46.3% of deliveries was in age group between 26 and 30. The youngest mother was 19 years old and the eldest mother was 46 years old. Primipara was 36.1% and multipara was 63.9% in our series. 5) Incidence of various presentations were as follows: Vertex 91.5%, breech 6% transeverse lie 2%, face 0.3% and brow 0.19%. 6) 56.6% of cases were delivered with forceps: low forceps 52.6% low mid forceps 52.6% low mid forceps 8%, mid forceps 2.2%. Cesarean section rate was 8.3% and in this group 77% was primary section and 23% was repeat section. 7) Obstetrical analgesia was used in 66.7% and narve block anesthesia was used in 65.2% and general anesthesia was used in only 7% of the obstetrical cases. 8) episiotomy was made in 94.9% of primipara and 36.1% of multipara. 9) Delivery during night was 51.0%, day delivery with onset of labor during night was 25.8% and day delivery with labor during night was 2.8%. Labor and delivery related with night was 76.6% 10) Birth weight in 37 weeks and more gestation was 3270 Gm. in average 11) The most important obstetrical complication among the patients was toxemia in pregnancy showing an incidence of 13.4%.

응혈장애

송상환(SW Song) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.7

응혈장애는 여러 응혈인자의 결핍으로 될 수 있으나 산과학에서 일어나는 거의 모두는 혈장 섬유소원(plasma fibrinogen)의 농도가 저하되어 응혈에 장애를 일으키는 저섬유소원증(hypofibrinogenemia) 또는 무섬유소원증(afibrinogenenmia)이다. 혈장섬유소원의 혈장농도는 임신중에 생리적으로 임신전의 약 50%나 상승하며 다른 혈액응고인자도 약간 상승하여 분만때에 생길 출혈을 지혈할 목적으로 이에 대비하는 상태로 되어 있다. 혈장 섬유소원이 200mg% 이하로 되면 저섬유소원증으로 처리되어야 하며 임상적으로 심각한 출혈이 나 타나는 농도는 100mg% 이하이다. 저섬유소원증이 속발할 수 있는 질병과 상태는 1. 태반조기박리 2. 태아사망의 장류기계 3. 산과적 출혈합병증(전치태반, 태반잔류, 산후출혈) 4. 양수혈전증 5. 패혈증 6. 부적합한 혈액의 수혈 7. 수액의 부작용 8. 유산목적으로 양수내 고장액주입등이다. 저섬유소원증은 선행질환도 위중하지만 약 10%의 모성사망율이 있고 약 2%는 생존하더라도 불구자가 된 다.

출혈로 인한 모성사망

송상환(SW Song) 대한산부인과학회 1971 Obstetrics & Gynecology Science Vol.14 No.12

출혈로 인한 모성사망의 예방은 사회, 경제, 의학등 여러분야의 공동발전과 협력에서 이루어지는 것으로 다음과 같이 요약할 수 있다. 1) 국민의 생활수준의 향상으로 국민건강이 향상되어 출혈성 합병증에 대한 개체의 저강이 높아 지고 2) 국민계몽으로 임신분만, 산욕기의 출혈합병증을 조기에 치료를 받게 하고 3) 임신의 산전관리를 철저히 하여 시설분만 또는 합병증례만이라도 시설분만을 할 수 있게하는 의료제도를 설정하고 4) 위험도가 높은 부인은 임신전부터 지도를 필요한 임신만을 하게하여 특별히 관호하고 5) 모성사망의 원인분석을 할 수 있게 부검율을 높이고 예방여부를 토의할 수 있는 학술적 기구 를 설립한다. 그리고 6) 진단의학의 수준을 향상하고 진단한계를 분명히 한다.

자간뇌척수액의 단백질 분획에 관한 연구

노대식(DS Ro),송상환(SW Song) 대한산부인과학회 1974 Obstetrics & Gynecology Science Vol.17 No.8

Cellulose acetate electrophoresis를 이용하여 정상임산부 10예 및 자간임산부 12례의 뇌척수 액 단백분획을 측정, 분석한 결과는 다음과 같다. 1) 자간뇌척수액의 단백질 중 beta와 gamma globulin이 증가되었다. 2) beta globulin보다 gamma globulin이 더욱 선택적으로 증가되었다. 3) 뇌척수액 중 증가한 beta와 gamma globulin은 혈청중의 beta와 gamma globulin 농도와 는 상관관계가 없다. 이상의 결과로서 자간에서 뇌척수액 중 beta, gamma globulin의 증가는 자간에 다르는 뇌 병변으로 나타나며 gamma globulin은 자간에서 선택적으로 증가하는 것으로 다른 경련성 질 환과 감별하는 데 도움이 된다고 생각한다. Eclampsia is one of the most serious complications and has been studied for a long time in order to clarify its etiology, pathophysiology or treatment. However, as of yet the cause of eclampsia is not clear, and a few studies on changes of cerebrospinal fluid have been carried out. Recently, Morrion et al. and Choi ot al. have found that protein content of cerebrospinal fluid is higher in eclampsia than in normal pregnancy. This study was carried out to know which protein fractions in cerebrospinal fluid are specificially elevated in eclampsia. Cellulose acetate electrophoresis was undertaken to evaluate the protein fractions in cerebrospinal fluid in 10 normal pregnant women, and 12 eclamptic cases. The results were as follows. 1) Beta and gamma globulins tended to be elevated in eclampsia. 2) Gamma globulin showed significant elevation more than beta globulin. 3) Elevation of both beta and gamma globulins cerebrospinal fluid was not related to those of serum. In summary, this results suggested that gamma globulin elevation of cerebrospinal fluid was a specific change due to eclamptic brain pathology and could be helpful to diagnose eclampsia from other convulsive disorders.

마취중 모체 과환기가 태아에 미치는 영향

김정(C Kim),송상환(SW Song) 대한산부인과학회 1976 Obstetrics & Gynecology Science Vol.19 No.5

선택적 cesarean section 16예에서 전신마취후 25분간 정상환기와 과환기를 시행하였던 결과 는 다음과 같다. 1. 과환기군에서 모체동맥의 산소분압이 평균 197.3mmHg, 제대정맥 및 동맥혈의 산소분압 은 평균 43.9mmHg 및 34.4mmHg로 대조군에 비하여 높았다. 그러나 산소포화도는 각각 64.7% 및 52.3%로서 제대동맥혈에서만 높앗다. 2. 과환기군에서 제대정맥 및 동맥혈의 이산화탄소 분압은 37.0mmHg 및 41.9mmHg로 대조 군에서 보다 낮았으나 전례에서 정상범위내에 있었다. 3. 과환기군에서 모체 및 태아의 pH는 대조군에 비하여 비슷하였고 정상치였다. 4. 과환기군에서 모체 및 신생아의 건강상태는 하등의 차이가 없었다. 이상의 결과로 보아 전신마취하에 cesarean section을 시행할 때 과환기를 하면 모체 및 제 대혈의 산소분압의 상승, 이산화탄소의 저하에 도움이 되었으나 산소포화도는 제대동맥에서 만 높았다. 그러나 정상환기를 하였을때보다 모아에 뚜렷한 좋은 성적이 없었으므로 정상환기로 마취하 여도 모아에 이상이 없음을 알앗다. 1. Oxygen partial pressures of maternal artery, umbilical vein and umbilical artery bood were higher in the hypervetilated group than those in the control groups, and exygen saturations of maternal artery and umbilical vein blood in the former group were almost the same as those in the latter, but oxygen saturation of umbilical artery blood in the former higher than that in the latter which seemed to promote fetal conditions. 2. Carbon dioxide partial pressure of maternal artery and umbilical blood were fairly low but were within normal limits in the hyperventilated group ; this meant that about 20 min moderate degree of manual hyperventilation made no serious hypocapnea. 3. There was no particular difference of pH of maternal artery from that of umbilical blood between the two groups. 4. The conditions of the newborn infants in both groups were manual maternal hyperventilation during Cesarean section under general anesthesia does not have any advantages for the mother or the baby except for better oxygenation than in normal status, so normal ventilation during cesarean section can keep the mother and the baby in good health.

임신고혈압증의 뇌척수액에 관한 연구

최유덕(YD Choi),노대식(DS Ro),송상환(SW Song) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.9

1) 뇌척수액의 단백은 자간에서 현저히 증가되어 있었고 다른 임신고혈압에서는 증가되어 있지 않았다. 2) 뇌척수압은 자간에서 상승하는 경향이 있었고 전례가 200mmH2O 이상으로 높았다. 3) 자간에서 뇌척수액의 소견은 적혈구가 특징적으로 출현하였고 이 적혈구의 수는 대체적으로 자간성경련의 회수에 비례하였다. 4) 뇌척수액의 뇨산은 혈중뇨산의 증가에 비례하였으며, 대조군 만성고혈압에 합병된 전자간, 중 증전자간, 그리고 자간의 순위로 증가되었다. 그리고 당의 변화는 없었다. 이상의 결과로 임신자간에 있어서 뇌척수액의 적혈구의 출현, 단백의 증가 및 뇌압의 상승은 뇨 의 배설량, 혈압, 심폐의 기능상태와 더불어 자간의 경중의 판단 및 예후판정과 치료의 보조적 지 표가 될 수 있다고 생각한다. A study was carried out to investigate cerebrospinal fluid in hypertensive pregnancies comparing with normal nonpregnant status. Protein, sugar and uric acid level, and red blood cell count of cerebrospinal fluid were measured in hypertensive pregnancy and normal nonpregnant status. The results were as follows; 1. Protein level in cerebrospinal fluid elevated in eclampsia while there were no changes in other hypertensive pregnancies and in normal nonpregnant women. 2. Pressure of cerebrospinal fluid was over 200 mmH2O in eclampsia wich was not related to bolood pressure. 3. Red blood cell appeared in cerebrospinal fluid of eclampsia and its number was corelated to number of eclamptic convulsion. 4. Elevated uric acid level in cerebrospinal fluid in severe cases of hypertensive pregnancies was probably due to increased blood uric acid, and there was no change in concentration of sugar in cerebrospinal fluid in hypertensive pregnanies. In summary, elevation of pressure and protein level, and apperance of red blood cell in cerebrospinal fluid were characteristic features in eclampsis, and there results could be used to make correct diagnosis and predict patient`s prognosis in hypertensive pregnancy.

자궁적출술에 관한 임상적고찰

이진호(JH Lee),이재억(JA Lee),송상환(SW Song) 대한산부인과학회 1974 Obstetrics & Gynecology Science Vol.17 No.2

한양대학교 의과대학 산부인과학교실에서 1972년 5월부터 1973년 8월까지 시술하였던 90예 의 자궁적출술을 받은 환자에 대하여 임상적 관찰을 하였다. 90예 중 복식전자궁적출술예는 67, 질상부자궁적출술예는 4, 그리고 질식전자궁적출술의 예가 19였다. 수술 후 감염율의 정의는 산욕열의 정의를 인용하였고 본 연구에서 비교연구의 목적으로 수 술 후 첫 24시간을 제외한 감염율과 수술 후 첫 72시간을 제외한 감염율을 조사하였다. 1) 수술 후 감염율은 첫 24시간을 제외하였을 때 47%(43예)였으며 첫 72시간을 제외하였을 때는 21%(19예)였다. 수술시에 이미 감염이 되었거나 수술 전 감염의 기회가 많았던 16예를 제외하였을 때 첫 24시간 이후의 감염율은 41%(31예)이고 첫 72시간 이후의 감염율은 16.2%(12예)였다. 2) 원인을 찾을 수 없었던 예에서 첫 24시간을 제외한 감염은 10명이었으나 첫 72시간을 제 외하면 1명뿐이었다. 3) 복식자궁적출수술과 질식자궁적출술의 경우 첫 24시간을 제외한 감염율은 각각 43%, 36%였으며 첫 72시간을 제외한 감염율은 각각 20% 및 5.2%였다. 4) 수술 후 감염율의 가장 많은 원인은 뇨로기관의 감염이었고 첫 24시간을 제외한 감염은 13예이었고 첫 72시간을 제외하였을 때는 9명이었다. 5) 수술 후 첫 72시간을 제외한 감염율 중에서 가장 많은 원인은 뇨로감염으로 12명 중 9명 이었다. 6) 본 연구의 결과로 수술 후 첫 24시간을 제외한 감염율의 경우 알려진 원인이 없었으며 특별한 치료가 없이도 정상으로 회복하는 예들로 보아 수술 후 감염율 조사를 위하여서는 수술 후 첫 72시간을 제외하는 것이 좋다고 사료되었다. 본 논문의 요지는 1973년 10월 5일 제31차 대한 산부인과학술대회에서 발표하였음. A study was carried out to evaluate postoperative morbidity in 90 hysterectomies from May 1972 to August 1973 at the Dept. of Obstetrics and Gynecology, Hanyang University School of Medicine. Ninety cases include 67 abdominal hysterectomies, 4 subtotal abdominal hysterectomies, and 19 vaginal hysterectomies. Definition of postoperative morbidity was quoted from the definition of puerperal morbidity except for a condition that authors arbitrarily divided morbidity into group A(excluding first 24 hours postoperatively) and group B(excluding first 72 hours postoperatively). Results obtained were as follows : 1) Postoperative morbidity was 47%(43 cases) in group A 21%(19 cases) in group B. When 16 cases who were already infented or who had chances of infiction at time of operation were excluded, the morbidity in both groups was 41.8%(31 cases) and 16.2%(12 cases) respectively. 2) Postoperative morbidity fue to unknown cause was 10 cases in group A whereas group B had only one case. 3) Postoperative morbidity in abdominal hysterectomy and vaginal hysterectomy was 43% and 36% in group A, and 20% and 5.2% in group B respectively. 4) Urinary tract infection was the most common cause of morbidity and showed 13 cases in group A and 9 case in group B. 5) Postoperative morbidity in group B was mainly due to urinary tract infection, 9 out of 12 cases. Authors felt that for the evaluation of postoperative morbidity, excluding postoperative first 72 hours tends to give better insight.

X선골반계측에 관한 산과학적 고찰

황동훈(DH Hwang),이용배(YB Lee),김용우(YW Kim),송상환(SW Song) 대한산부인과학회 1969 Obstetrics & Gynecology Science Vol.12 No.5

This is a clinical analysis of 244 obstetrical patients who received X-ray pelvimetry among a total of 3655 patients admitted to the Dept. of Ob & Gyn from january 1, 1965 to August 31,1968. The Colcher-Sussman technique was used to measure the various diameters of the pelvis while the biperietal diameters and weights were obtained post[artum. Since labor and delivery are a dynamic process this study is mainly concerned with relationships between pelvic diameters and fetal weight-size factors. 1. 190 X-ray were taken in patients thought to have dystocia with a vertex presenting. In this 54.2% had a vaginal delivery12.2% had a mid-forceps delivery and the remaining 33.3% received a Cesarean section. 2. In this same group when the AP of the inlet was less than 10.0cm.61.9% had a Cesarean section, when between 10.0 and 10.4cm. the rate was 30.2% and above 10.5 the rate was 22.5%. 3. Even better correlation is found in terms of type of delivery when the A.P of the inlet is related to the biparietal diameter of the infant. When the difference was between 1.0 and 1.4cm. the C-section rate was 51.1%; when the difference was between 1.5 and 1.9 weight above 3500gm. and the difference under 1.4cm. the C-section rate was around 73%. 4. The mid-pelvic transverse diameter was much less accurate in predicting the method of delivery, especially C-section. 5. When used with nulliparous breech presentation the section rate was 12.5%. 6. When the X-ray was used un patients requiring an induction the subsequent section rate was 7.9%.

제왕절게수술에 관한 임상적 고찰

이계용(KY Lee),장세훈(SH Chang),정태묵(TM Chung),송상환(SW Song) 대한산부인과학회 1967 Obstetrics & Gynecology Science Vol.10 No.7

The Study was carried out retrospectively based on the clinical charts of patients who had 241 Cesarean seations performed, and 246 new borns including 5 pairs of twins delivered at Dept. of Obst. & Gyn., Yonesei University Cllege of Medicine, from January 1,1962 to December 31, 1996. The results were as follows: 1.Cesarean section rate was 7.4% for the period. 2. The indications for Cesarean section were that cephalo-pelvic disproportion was the most prevalent and 30.3%, repeat section 29.9%, antepartum hemorrhage (Placenta previa and abruptio placentae) 10.0%, malpresentation 12.8%, cervical cancer was 2.5% and so on. 3. In type of operation, low cervical section was 86.6%, classic 7.9%, and Csearean hysterectomy was 4.5%. 4. The average pelvic diameters by Colcher-sussman X-ray pelvimetry in disproportion cases were 10.39 Cm. and 12.30 Cm. in antrerio-posterior and transverse dimeters of pelvic inlet, 10.59 Cm. and 9.57 Cm. in anterio-posterior and transverse diameters of mid pelvis and 6.98 Cm. and 9.48 Cm. In posterior sagital and transverse diameters of pelvic outlet respectively. 5. The types of anesthesia until the baby was delivered were local, spinal, and general anesthesia respecively 7.0%, 50.2% and 42.8%. 6. In new borns, 14.6% had low birth weight, and 4.47% of total births had Apgar score 0, 12.6% Apgar sore 1-5, and heavier babies had higher scores. 7. Perinatal mortality was 6.69% and the half of those were premature babies. 8. Puerperal infection was 17.77% in cases with membrane ruptured, and 10.80% in cases with mombrane was intact when Cesarean section was decided respectively, and was 12% in average. 9. Maternal deaths accured in two cases corresponding to 0.83% of mortality and were caused by a hypofibrionogenemia and septicemia complications respectively.

임신 중 급성충수염

고봉호(BH Koh),조태호(TH Cho),손형심(HS Sohn),송상환(SW Song) 대한산부인과학회 1970 Obstetrics & Gynecology Science Vol.13 No.5

The diagnosis of acute appendicitis is difficult during pregnancy particulary in order patients or obese women, and its delayed diagnosis may cause fetal and/or maternal deaths. Twenty-nine cases of acute appendicitis during pregnancy which had been admitted to the Everance Hospital during 10 years from 1958 to 1968 are analyzed clinically with reviewing references. The results are as follows: 1. The incidence of acute apendicitis during pregnancy is 0.41 per cent which is higher than those of other authors. 2. More than half of the cases(51.7%)had symptoms or sign of acute appendicitis on a least one occasion in the past and were treated conservatively. 3. Fetal wastage were 4 out of 29 cases or 13.8% mortality. Peritonitis history, and Alder`s test. the surgical treatment is recommendablw as soon as possible to prevent further complication.