단안증에 다발성선천성기형을 동반한 기형아의 1 예

오혜숙(HS Oh),나주환(JH Na),황병철(BC Whang),박지홍(JH Park) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.9

단안증에 다발성선천성기형을 동반한 기형아의 1 예 Cyclopia is a rare congenital fetal ocular anomaly in which the eyes are fused together and located in a single orbit It is commonly associated with other congenital anomalies such as omphalocele anencephalus polydactyly and etc and these serious malformations make it inadequate to survive We presented a case of cyclopia associated with multiple congenital anomalies with a brief review of the literature.

비수축검사 ( Nonstress test ) 및 수축검사 ( Contracion stress test ) 에 의한 태아장애 예측

오혜숙(HS Oh),유정옥(JO Yoo),조현실(HS Cho),김종일(JI Kim),우복희(BH Woo),강신명(SM Kang) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.12

1981년 5월부터 8월까지 이화대학병원 산부인과에 입원한 고위험도 임신부 157명을 대상으로 임신 33주에서 45주 사이 153회의 비수축검사 (nonstress test)와 수축검사 (contraction stress test)를 단독 또는 병행 실시하여 다음과 같은 결론을 얻었다. 1.비수축검사에서 반응성(Reactive)으로 나타날 경우엔 그의 97%가 수축검사에서 음성(Negative)을 나타냄으로써 양자간에 잘 부합되었다. 그러나 비수축검사에서 무반응성(Nonreactive)으로 나타날 경우엔 오직 그의 19%만이 수축검사에서 양성(Positive)을 나타냄으로써 위무반응성(False nonreactive)이 많고 잘 부합되지 않으므로 정확한 예후판정을 위해선 이들 검사를 반복해야 할 것이다. 2.비수축검사에서 무반응성인 경우엔 63%의 태아가 이환된 것으로 나타났으나 반응성인 경우엔 24%만이 태아이환을 보였다. 3.수축검사에서 양성무반응성(Positive nonreactive)으로 나타났을 때는 100%의 태아이환율을 보였으나, 음성무반응성(Negative nonreactive)에서는 약 반수만이 이환되었고 음성반응성(Negative reactive)에선 23%로 낮았다.이들 주산기이환(Perinatal morbidity)중에는 신생아사망이 2예(양성무반응성에서 1예, 음성반응성에서 1예)있었으며, 이들은 부검결과 모두 치사적인 선천성 기형아였다. 4.비수축검사에서 무반응성으로 나오면 6점이하의 낮은 아프가점수 빈도가 54%로써 제대혈액상의 산독중(Acidosis)과 산독전증(Preacidosis) 빈도와 비슷하게 나타났다. 수축검사에 있어서 양성무반응성으로 나타날 경우엔 그의 전부가 아프가점수 6이하의 태아장애를 보였고 이들은 태아 두피혈 pH상의 산독증 및 전산독증의 빈도와 부합되었으며 음성무반응성으로 나타났을때는 그의 약 반수가 아프가점수 6이하의 태아장애를 보였고 태아 두피혈 및 제대혈 pH상의 소견도이에 부합되었다. 그러나 음성반응성으로 나타났을 때에는 아프가점수상의 태아장애의 출현은 17%로 적었으나 두피혈 pH상의 소견으론 약 59%가 산독증이나 산독전증을 보였다. 5.42주이상의 연장임신중 비수축성검사에서 무반응성으로 나타났을때는 그의 58%가 과숙아였음을 예측할 수 있었으나 반응성이면 91%가 비과숙아임을 예측할 수 있었다. 수축검사에서도 양성 및 음성무반응성으로 나타날 때에는 그의 40%가 과숙아였음을 예측할 수 있었으나 음성반응성이면 94%가 비과숙아임을 예측할 수 있었다. 즉 연장임신주에서 비수축검사에서 반응성을 나타내거나 수축검사에서 음성반응성을 나타낼 때는 비과숙아일 확률이 높다. 6.수축검사에서 정현(Sinusoidal) 태아심박형을 보인 1예는 아프가점수가 낮은 저산소증(Hypoxia)인 태아였다. The antepartum assessment of fetal well being has become an integral part of the management of any risk pregnancy. For practical purposes, fetal monitoring,especially nonstress test and contraction stress test, has been found to be efficacious clinically. And the goal of these tests is to identify fetuses at risk for intrauterine demise so that intervention can be undertaken before irreversible fetal compromise ensues. From May to August 1980, 153 nonstress tests and 165 contraction stress tests university hospital, and it`s result were efficacious in early prediction of fetal compromise and in reducing the perinatal morbidity and mortality. The results of this study were as follows. 1.Reactive nonstress test was excellently correlated with negative contraction test, in the rate of 97%, but nonreactive nonstress test was correlated with positive contraction stress test only in 19%. 2.In nonstress test, the reactive tests had 24% of perinatal morbidity but nonreactive test had 63%. 3.In contraction stress test(CST), the patients with positive nonreactive test consequently showed 100% perinatal morbidity, and in negative nonreactive test, it was 51.4% but in negative reactive test, it was 23%. And there were 2 cases of neonatal death in CST, one was in positive nonreactive and the other was in negative reactive test and both had congenital fetal anomalies which was proved by autopsy. 4.In nonreactive nonstress test, the incidences of low apgar score and fetal acidosis and/or preacidosis were 54% and 67% respectively. In both positive and negative nonreactive contraction stress tests, the incidences of low apgar score were fairly high, 100% and 62.5% respectively, and the incidences of fetal acidosis and/or preacidosis were also high ( 80% and 63%). 5.In postdatism, both reactive nonstress test and negative reactive contraction stress test showed high specificity in prediction of non postmaturity with the rate of 91% and 94% respectively. 6.There was one case of sinusoidal fetal heart rate pattern among 42 weeks in contraction stress test, and it revealed poor fetal outcome with low apgar score of 5 in 1 minutes and 6 in 5 minutes.

자궁내 태아사망의 임상적 고찰

이명희(MH Lee),오혜숙(HS Oh),김영선(YS Kim),김두호(DH Kim) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.2

Intrauterine fetal death is the death of a fetus after 20 weeks gestation or attainment of 500gm body weight prior to the complete expulsion from its mother. This is a clinical study of 159 cases of fetal death in uterus among 7650 deliveries at Incheon Gil Hospital during 4 years from January, 1980 to December, 1983. The results of this study are as follows: 1. The incidence of intrauterine fetal death was 2.07%. 2. Age distribution of mothers with intrauterine fetal death was between 18 to 41 years and was highest in the 26 to 30 years range(40.9%). 3. The parity of mother in intrauterine fetal death was most highest in nulliparous groups(54.7%) and next group is para-1. 4. There were 4 cases(2.5%) with previous history of intrauterine fetal death and 29 cases(18.2%) with previous history of spontaneous abortion. 5. The most common gestational weeks when intrauterine fetal death was detected was 37 to 40 weeks gestational period(21.4%) and the common presentation was cephlic(80.5%). The sex ratio of male vs female fetus was 1.01:1 and 69.2% of intrauterine fetal death weighing less than 2500gm. 6. The mode of delivery for intrauterine fetal death, spontaneous delivery was most common(40.8%), induction of labor was 33.5% and laparotomy was performed in 25.7% of intrauterine fetal death. 7. The etiologic factors of intrauterine fetal death, the unexplained cases were 37.8%, pre-eclampsia 19.5%, abruptio placenta 15.1%, congenital anomaly 6.3%, placenta previa 6.3%, syphilis 4.4%, chorioamnionitis 3.8%, cord prolapse 2.4%, maternal illness 1.8%, transverse lie 1.3%, trauma 1.3%. 8. There were 84 cases(53.8%) of maternal complication. The most common was hemorrhage(63.1%), and the others were intrapartum and postpartum fever (19%), cystitis(8.3%), wound infection(6%), uterine rupture(2.4%), sepsis(1.2%). 9. 77.9% of the cases had not received any prenatal care, 10.6% of cases had received care only 1 or 2 times and 3.3% had received 3 or 4 times, 8.2% had received more than 5 times.

복강임신 1례

강신명(SM Kang),오혜숙(HS Oh),우복희(BH Woo),조현실(HS Cho),정경숙(KS Chung) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.12

Abdominal pregnancy is a kind of the ectopic pregnancy and it is extremely rare but aserious obstetric complication. The diagnosis of the abdominal pregnancy is very difficult and frequently confirmed at the time of operation. This abdominal pregnancy presented here accounted for l in 37968 deliverie for the past 20 years. (1962~1981)

진통시 태아심박동 변이지수의 임상 적용

유정옥(JO Yoo),정건숙(GS Jung),오혜숙(HS Oh),김종일(JI Kim),강신명(SM Kang) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.7

1980년 12월부터 1981년 2월까지 이화대학병원 산부 인과에 입원한 임산부중 위험도가 높은 임신성고혈압 또는 42 주이상의 연차임신등 52명을 대상으로하여 진통중 대아심박형과 이상지수별로 태아예후를 관찰측정하였다. 1. 진통중에 나타난 태아심박형의 상태 및 빈도는 변이하강(variable deceleration)이 제일 많았고, 그다 음이 심박상승(acceleration), 무주기변화(no periodic change), 만기하강(late deceleration) 순으로 나타내었다. 2. 하강(deceleration) 즉 만기(late), 변이 (variable) 및 연장하강(prolonged deceleration)형으로 나타날 때 에 변이지수(variability index)가 4이하로 낮은 군에 서는 태아장애의 빈도가 대단히 높았고(8o0%), 그와 반대로 변이지수가 5이상으로 증가된 경우에는 30~40%로 낮았으며, 혈액 pH 정도도 경하였다. 3. 륵히 만기하강(1ate deceleration) 심박형으로 나타났을때 만일 볏이상지수가 4이하로 감소하게 되면 모두 태아장애를 나타내었다. 그러나 연장하강(prolonged deceleration)으로 나타났을 때는 변이지수가 5이상으로 높았음에도 불구하고 모두 태아장애가 초래되었다. 4. 심박상승(acceleration)이나 무주기변화(no periodic change)형으로 나타났을 때는 변이지수의 증감에 관계없이 거의 다 양호한 태아상태를 나타내었다. 요컨데 태아심박형외에 변이지수를 보조적으로 참고 하면 태아장애의 조기발견에 도움은 문론 번거로운 태아 두지피 PH검사리 빈도를 줄일 수 있을 것이다. Accurate assessment of fetal condition during labor constitutes one of the major problems of modern obstetrics. The clinical usage of intrapartum fetal monitoring has increased dramatically in the past few years. This study was performed in an attempt to evaluate the significance of fetal heart rate pattern with variability index in intrapartum fetal surveillance. So our purpose is to decrease the frequency of fetal blood sampling for checking pH. The fetal heart rate monitoring during labor was evaluated by the fetal blood pH determination obtained from 52 patient in high risk pregnancy at the Obstetric and Gynecologic department of Ewha Womans University from December, 1980 to February, 1981. The results were as follow; l. In the incidence of fetal heart rate pattern during labor, the most frequent one was variable deceleration and the next was acceleration, no periodic change, late deceleration and prolonged deceleration. 2. When deceleration (late, variable and prolonged deceleration) pattern was appeared in association with low variability index (below 4), the incidence of Apgarscores below 6 in one minute was high (80%). In contrast, if variability index was above 5, the incidence of low Apgar scores below 6 in one minute was low (30~40%) and it was compatible with fetal blood pH findings 3. Especially, when late deceleration pattern was appeared and if variability index was below 4, a1l of the babies were in distress. But when prolonged deceleration was appeared even associated with 5 or more variability index, all of the fetus were also in distress. 4. When acceleration or lacking periodic change were appeared, almost all babies were in good condition regardless of variability index chages.

자연파열된 거대과립막세포종의 1 례

박지홍(JH Park),안성탁(ST Ahn),오혜숙(HS Oh),김두호(DH Kim) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.2

Although ovarian granulosa cell tumor is relatively rare neoplasm, it arises most frequently in the functioning ovarian tumors and occupies 10% of all solid malignant ovarian tumors. We present a case of spontaneously ruptured large granulosa cell tumor in 64- year-old postmenopausal women with a brief review of the literatures.

완전자궁내번증의 1예

구병삼(BS Koo),이상웅(SW Lee),이경희(KH Lee),오혜숙(HS Oh),김응춘(EC Kim) 대한산부인과학회 1967 Obstetrics & Gynecology Science Vol.10 No.9

A 27 year-old gravida 2, para 2, admitted on Feb. 19. 1967. was delivered apontaneously of a living child at home by private doctor. The patient admitted one hour after delivery from vaginal mass, lower abdominal pain, shock and hemorrhage ue to complete inversion of the uterus. And brief review literatures on inversion of uterus is presented.

양수과다증을 동반한 무심장 무뇌아의 1예

박용재(YJ Park),이성균(SK Lee),송주천(JC Song),정윤영(WY Chung),이근용(KY Lee),이상옥(SO Lee),오혜숙(HS Oh) 대한산부인과학회 1967 Obstetrics & Gynecology Science Vol.10 No.4

A case of acardiac anencephalic monster associating with single ovum twin combined with hydr- amnios is presented, and it`s review of literatures was made briefly.