제왕절개자궁적줄술, 10년 고찰 50례

변명현(MH Byun),이영희(YH Lee),박채원(CW Park),강신명(SM Kang) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.1

1. 제왕절개자궁적출술을 받은 환자 총수 50명중 대부분(96%)이 응급을 요한 수술이었다. 그들의 적응증은 자궁파열이 15명(30%)으로서 약 과반수를 점하였고 그외 지혈 불가능한 쿠베레어자궁을 동반한 태반조기박리가 10명(2%), 지혈 곤란한 전치태반이 9명(18%), 유착태반이 9명(18%), 기타 이완성자궁출혈이 3명(6%) 등이었다. 2. 심한 출혈이나 shock 상태로 입원한 환자 즉 자궁파열 2명, 쿠베레어자궁 3명, 전치태반 3명, 유착태반 2명 등은 5 pint에서 24 pint 평균 8 pint의 다량 수혈을 요할 정도의 위독한 환자였으므로 이들은 모두 질상부자궁적출술(subtotal hysterectomy)이 적용되었다. Shock 상태가 아니거나 경한 출혈환자로서 비교적 위독하지 않았던 환자들 9명 즉 자궁파열 6례, 유착태반 1례, 자궁 출혈 1례, 자궁근종 1례에 대하여는 거의 다 자궁전적출술을(total hysterectomy) 시행하였다. 3. 수술후 합병증은 대부분(78%)이 아무런 합병증이 없었으나 방광손상이 2례(4%) 있었는데 즉시 봉합으로 잘 치유되었으며 복부 창상감염이 14% 있었고 그외 골반농양 및 뇨로감염도 소수(각각 4%) 있었다. 4. 산모사망은 1례(2%)가 있었는데 제왕절개반흔파열을 위한 제왕절개자궁적출술 후 골반농양 및 패혈증으로 사망하였다. 이 환자는 전형적인 제왕절개술을 받은데 기인되었다는 점이 주목되므로 하절절개술 방법이 전형적 제왕절개술보다 더욱 강조되며 과거 전형적 제왕절개술을 받은 환자는 진통전에 반복 제왕절개술을 받도록 미리 교육되어 있었어야 할 것이다. Cesarean hysterectomy was originally devised to prevent post cesarean infection and hemorrhage and to lower the maternal morbidity and mortality after the operation. Reputedly, it was first performed by Porro in 1876, and is still a first choice procedure in various life threatening obstetrical complications. In this study the outcome of the 50 cases of cesarean hysterectomies performed at Ewha Womans University Hospital Seoul, Korea during 10 year period from Jan. 1965 to Dec. 1975 is discussed and evaluated. Results are obtained as following. In total subject of 50 cases in this series, the majority(96%) of them needed immediate emergency operations. The subject were 15 cases(30%) of uterine rupture, 10 cases(20%) of couvelaire uterus with uncontrollable bleeding, 9 cases(18%) of placenta previa with uncontrollable bleeding, 4 cases of placenta accreta, 4 cases of placenta increta, 1 case of placenta percreta and 3 cases of uterine atony. Patients with severe bleeding and state of shock such as placenta previa(3 cases), Couvelaire uterus(3 cases), Uterine rupture(2 cases), adherent placenta(2 cases) were transfused with 5 to 24 pints(average 8 pints) of whold blood during the procedure and most of these patients were treated well by means of subtotal hysterectomies. Patients with minimal bleeding without any sign of shock(9 cases) received less than 1000cc of blood underwent total hysterectomies. The best operative procedure is to be individualized based on the extent of injuries and degree of hemorrhagic shock. The most important principle is shorten the duration of operation and anesthesia as possible so that to avoid the unnecessary adding the surgical as well as anesthetic shock to the danger of life threatened. In two thirds of total patal patients(76%) there were no complications post operatively. There were 24% of wound infections pnstoperatively, 2% of pelvic abscess and urinary tract infection respectively and 2 cases of bladder injury during procedures. However, bladder injuries were repaired by sim

자연조기파막 482예

박채원(CW Park),이영희(YH Lee),변명현(MH Byun),안정자(JJ Ahn),강신명(SM Kang) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.6

1972년 1월 1일부터 1975년 12월 31일까지 만 4년간 이화대학병원 산부인과에서 분만한 총수 6290예중 자연조기파막 482예를 임상적으로 분석 관찰하여 다음과 같은 결론을 얻었다. 1) 자연조기파막의 발생빈도는 7.7%였다. 2) 조산의 빈도는 17.6%로서 경산부에서 많았으며(26.5%) 초산부(12.3%)보다 약 2배로 높았다. 3) 모체측에 합병된 질환은 23.6%로서 이중 임신중독증이 13%로 약 반수를 차지했다. 4) 파막후 24시간 이상을 초과한 환자는 산모측의 산후발열이 시간에 정비례하여 높았다. 동시에 신생아의 이환율도 높았으므로 가급적 조기파막된 임부는 24시간내에 분만시키는 것이 좋다. 5) 신생아의 이환율 및 주산기 사망율(교정사율(corrected death rate)은 4.6%)은 분만전 항생제치료로서는 개선시킬 수 없었다. 6) 그러나 파막직후 또는 입원즉시에 투여하기 시작한 예방적 항생제치료는 산모의 이환율 및 재원치료소요기간을 현저히 감소시켰다. The management of spontaneous premature rupture of membranes is still remain controversial as far as the use of prophylactic antibiotics or timing of delivery is concern. The data presented here are based on the 482 cases of premature rupture of membranes among 6290 deliveries at the Department of Obstetrics and Gynecology, Ewha Womans University Hospital from January 1, 1972 to December 31, 1975. The policy of delivery, maternal and newborn morbidity and the effect of prophylactic antibiotics treatment were discussed. The results obtained as follows; 1) The incidence of premature rupture of membranes was 7.7% or 482 cases of 6290 deliveries. 2) The incidence of prematurity was 17.6% and it was figured that twice in the multiparas(26.5%) than in the primiparas(12.3%). 3) The associated maternal disease was 23.6% of the cases in the premature rupture of membranes and the main maternal disease was toxemia of pregnancy(13%). 4) Postpartum maternal fever and newborn morbidity were increased in proportion to the duration of the premature rupture of membranes, particularly when it exceeded over 24 hours. It is our experienced that the optimal delivery should be accomplished within 24 hours after premature rupture of membranes as possible. 5) Even with regular antepartum antibiotic treatments in the cases of premature rupture of membranes, any changes or reduction of the newborn morbidity or perinatal mortality could not be expected. 6) When prophylactic antibiotics treatment was used, the maternal morbidity and duration of antibiotics treatment needed in postparum were reduced markedly.

임신 및 산욕기의 신우신염

이영희(YH Lee),박채원(CW Park),변명현(MH Byun),우복희(BH Woo),강신명(SM Kang) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.6

본 이화대학 산부인과 교실에서는 1972년 1월 1일 부터 1976년 5월까지 4년 5개월간 입원한 산과 환자 7,122명중 신우신염을 병발한 환자 90명에 대한 임상적 연구 관찰결과 다음과 같은 결론을 얻었다. 1.신우신염의 발생빈도는 총 환자중 1.26%를 정하였고 그중 임신부에선 0.8%, 산후엔 0.46%였다. 2. 원인적 소인 : 연령적으로 26세에서 30세 사이에 제일 많았으며(54.0%), 분만 횟수별로는 초산부에서 많았고(51%), 임신기간별로는 중기 및 말기에 갈수록 많았으며(54%) 기왕력에서 과거 도뇨를 받은자에게서 많았음이 주목되었다(35.6%). 3. 주요 원인균은 E. coli 및 Coliform organism이었고(47%) 다음으로는 Staphylococcus aureus(25%)가 많았다. 4. 임상증세는 대부분(70%) 고열, 오심, 구토, 신장부위압통 및 세균뇨를 정하였고 부 위적으로는 우측이 많았으며 일일중 고열 발생시간은 오후 8시경에 평균 38.5℃이상의 최고열을 나타냈다. 5. 조산율은 7.4%로써 대조군에 비하여(10.5%) 오히려 낮았다. 6. 치료는 E. colil 및 Coliform organism인 경우 Ampicillin, 다량의 penicillin G 또는 Sulfa제로써 평균 7∼8일 내에 호전되었으며 Staphylococcus aureus 및 기타균에 의한 감염도 비슷한 약제로 평균 6∼7일 내에 호전되었으며, 대조군은 Chloromycetitin Streptomycin 등의 사용군에 비하여 오히려 치료기간이 단축되는 경향이 있었다. 7. 합병증 : 자연유산 3명은 임신 각각 10, 12, 16주에 신우신염 병발로 초래됐고 조산 그예는 임신 34∼37주때 병발됐으며 태아사망은 1예로써 임신 34주때 태반조기 박리를 동반한 사산이었으며 산모사망은 없었다. 8. 재발은 90명중 3명으로써 3.3%였는데 이들은 불완전한 항생제 투여로 인한 재발이 었다. 9. 요컨데 완전 치유를 위해서는 일단 임상 증상이 호전되고 평열이 된 후에도 상당 기간동안 계속 사후 관찰을 하면서 적어도 2∼3주 이상의 잔유기 치료로써 기대할 수 있었다. Acute pyelonephritis is one of the most common medical complications of pregnancy. Not only is this disease an important cause of maternal morbidity, but the acute disease may also play a significant role in the natural history of chronic pyelonephritis. The purpose of this paper is to evaluate the clinical importance of pyelonephritis during pregnancy, the frequency of pyelonephritis, and its relationship to prematurity. Major causes of neonatal mortality are preexisting factors such as previous catheterization, urinary tract disease, preeclampsia, and anemia during pregnancy, culture, sensitivity test, and treatment. Clinical observations were accomplished on 90 cases of acute pyelonephritis admitted to Ewha Womans University Hospital during the 53 months period from Jan. 1, 1972 to May 31, 1976. The following results were obtained; 1. The incidence of pyelonephritis during pregnancy and puerperium was 1.26%. 2. The frequency of pyelonephritis decreased with increasing age and was highest at the age of 26-30 (54.4%). It was most common in primipara (51%) and was more common in the second and third trimester (54%). The major preexisting factors were instrumentation (35.6%), urinary tract disease, and preeclampsia in that order. 3. The most significant organisms found in the pyelonephritis were colifoum organisms (47%), and of these, E. coli was the most predominant. 4. the most common clinical symptoms were high fever, chills, flank pain and tenderness, nausea, vomiting, and bacteriuria. The disease, when unilateral, was more frequently right-sided and initial high fever (above 38.5℃) was usually seen in the late afternoon and evening(8PM) 5. There did not seem to be an increased tendency of prematurity in the offspring of pyelonephritis patients (incidence of 7.4%). 6. In treating active pyelonephritis particularly during pregnancy, parenterally administered ampicillin (2gm/day, I.V or I.M.) was probably the most effective treatment. Most of the clinical symptoms disappeared within seven to eight days. 7. Complications; There were 3 cases of spontaneous abortion in the first trimester of pregnancy and 1 stillborn case which accompanied abruptio placenta totalis at the 34 week point of pregnancy. 8. Recurrence; There were three cases of recurrence (3.3%) and those had had inadequate antibiotic treatment previously. They were cured after 3-4 weeks of further antibiotic treatment. 9. For complete cure, at least 2 to 3 weeks of further antibiotic treatment and follow up were needed after clinical improvement.