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박학열(Hak Youle Park),서준영(Jun Young Seo),송준백(June Baek Song),김태상(Tae Sang Kim),김익수(Ik Soo Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10
Acardiac twinning affects 1 in 100 monozygotic twin pregnancies and 1 in 35,000 pregnancies overall. This condition is characterized by the absence or rudimentary development of fetal heart, and associated with various anomaly. The presence of an acardiac twin requires the normal (or pump) twin to provide circulation for itself, as well as the acardiac sibling. The acardiac malformations are uniformly fatal in the affected twin, and mortality in the co-twin is as high as 55%. The principal perinatal problems associated with acardiac twinning are pump-twin congestive heart failure, maternal hydramnios, and preterm delivery. We recently experienced a case of acardius anceps associated with a normal male infant, so present with a brief review of the literature.
왕중서(Joong Seo Wang),박후철(Hoo Chul Park),김극원(Geug Won Kim),송준백(June Baek Song),이계현(Kei Hyun Lee),강상대(Sang Dae Kang) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.8
목적: 선행 제왕절개 임부에서 시도분만의 결과 및 안전성을 알기 위하여 본 연구를 시행 하였다. 연구방법: 1997년 5월부터 1998년 4월까지 마산 파티마병원 산부인과에서 분만한 선행 제왕절개 임부 303명을 대상으로 시도분만에 동의한 62명에게 질식분만을 시행하여 그 빈도, 성공률, 모성 이환률, 주산기 이환률과 사망률등을 비교 분석하였다. 결과: 선행 제왕절개 임부 303예 중 62예(20.5%)에서 시도분만을 시행하여 질식분만한 경우는 54예(87.1%)이었고, 8예(12.9%)는 제왕절개 분만을 하였다. 계획 제왕절개를 하였던 241예의 수술 적응증은 시도분만을 원하지 않은 경우(51.9%), 난관결찰술을 원해서(17.4%), 2회 이상 선행 제왕절개를 했던 경우(7.5%)등이다. 선행 제왕절개의 적응증이 난산인 경우에 성공적으로 질식분만한 경우는 85.0%(17/20)이며 난산이 아닌 경우는 88.1%(37/42)이다. 선행 제왕절개의 적응증에 따른 시도분만의 성공률에 유의한 차이는 없었다(P>0.05). 시도분만군에서 모성사망이나 자궁파열은 1예도 없었다. 계획 제왕절개군과 시도분만군간의 모성 이환률, 주산기 이환률 및 사망률에 대한 비교에서 유의한 차이는 없었다(P>0.05). 결론: 엄격한 적응증하에서의 선행 제왕절개 임부에 대한 질식분만의 시도는 비교적 안전하며, 계속 증가하고 있는 제왕절개의 빈도를 줄일 수 있을 것으로 사료된다. Objective: The purpose of this study was to evaluate the outcome and safety of vaginal delivery after previous cesarean birth. Methods: This study was based on 303 cases of delivery with previous cesarean birth at Masan, Fatima Hospital from May, 1997 to April, 1998. Among them, 62 cases had performed trial of labor. We had made a comparison between elective repeat section group and trial of labor group by analizing the frequency, successful rate, maternal morbidity, perinatal morbidity and mortality. Results: Among 303 cases with previous cesarean birth, trial of labor was done in 62 cases(20.5%). Among trial of labor group, vaginal delivery was done in 54 cases (87.1%) and repeat section was done in 8 cases(12.9%). Indications for elective repea section before the onset of labor were refuse trial of labor(51.9%), request for tubal ligation(17.4%), and previous section ≥2(7.5%), etc. The successful rate of vaginal delivery according to indication for previous cesarean birth was 85.0%(17/20) in the cases of dystocia and 88.1%(37/42) in the cases except dystocia. The successful rate was not influenced by the indication for previous cesarean birth(P>0.05). There were no maternal death or uterine rupture in the cases of trial of labor. There were no significant difference between elective repeat section group and trial of labor group in maternal morbidity, perinatal morbidity and mortality(P>0.05). Conclusion: Under strict indications, vaginal delivery subsequent to cesarean birth may be safe, and can reduce the rate of cesarean section that was increased constantly.