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제왕절개술 시행한 산모에 합병된 폐전색과 심부정맥혈전증 2 예
홍서유,방영태,정환부,김대영,한경철,최재웅 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.6
저자 등은 본원에서 척추마취하에 제왕절개술을 시행하고 수술 2일째 갑작스런 호흡곤란과 일시적인 의식소실을 보인 산모에 대해 심초음파와 폐관류스캔을 시행하였고, 또한 동통 및 부종이 있는 산모에 대해 정맥조영술 및 폐관류 스캔을 시행하여 폐전색을 확진하고 헤파린 요법으로 치료하였다. 이에 폐전색의 위험요인이 없는 산모에 있어서도 폐전색의 발생 가능성을 생각하고 조기진단 및 적극적인 치료의 필요성을 인식할 필요가 있기에 간단한 문헌 고찰과 함께 보고하는 바이다. Pulmonary embolism is a critical complication of pelvic surgery. This diagnosis should be suspected if pulmonary symptoms occur abruptly. Pulmonary embolism is a complication of pelvic or lower extremity thrombophlebitis; Indeed, in some patients no evidence of thromboembolism can be found and occurs on about the several to tenth postoperative days, although it may occur at any time. Also, pulmonary thromboembolism, first identified as the leading cause of maternal death in 1970s, continues to account for an increasing proportion of maternal deaths. The main or major causes of maternal deaths were pulmonary thromboembolism, hemorrhage, ectopic pregnancy, pregnancy induced hypertension complication and infection. Recently, deaths by pulmonary thromboembolism may be becoming more important as a cause of maternal death. Pulmonary thromboembolism was originated almost commonly from the venous thrombus, especially deep vein thrombus in the leg, which migrated to and occluded the pulmonary vasculatures. Also, the deep vein thrombosis was most commonly located in the lower extremities. Of the deep vein thrombosis patients, 40% showed high probability pulmonary embolism on the lung perfusion scans. We reported 2 cases of pulmonary thromboembolism and deep vein thrombosis developed after cesarean section with the review of literature.
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강재열,유달영,방영태,선윤수,정환부,김대영 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.7
Cervical pregnancy is one of most rare form of ectopic pregancy in which the blastocyst implants within the cervical canal below the internal os of uterine cervix. Most cervical pregnancy result in early spontaneous abortion, complicated by severe hemorrhage frm the eroded blood vessels within the cervix. Because of fear of rofuse hemorrhage, abdominal hysterectomy has been historically considered the standard therapy. However, a number of new therapies have been aimed at uterine preservation, conservative treatment is highly desirable for young women who want to be pregnancy in the future. Methotrexate has been utilized recently for the successful management of tubal, interstitial, and cervical ectopic gestations. We report a case of a cervical preganncy that was successfully managed with methotrexate and leucovorine.
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김대영(D . Y . Kim),정수미(S . M . Chung),송지훈(C . H . Song),정환부(H . B . Chung),신정환(J . H . Shin),홍서유(S . Y . Hong),손동우(D . W . Son) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.12
N/A Prostaglandin E2 is capable of ripening the unfavourable cervix and thus improving the outcome of induced labor by altering the state of the cervix and myometrial fibers of the lower uterine segment. This study was performed to compare the clinical efficiency of PGE and oxytocin for the elective induction in term pregancies. A retrospective randomized study was undertaken comparing the efficacy of a 3mg prostaglandin E2 vaginal suppository (group 1, n 80), intravenous oxytocin (group 2, n=72), and prostaglandin E plus intravenous oxytocin (group 3, n 74) for the elective induction of labor. The results of above three groups were also compared with normal spontaneous labor group (control group, n 75) as a control. Gestational age of every subject was between 38 and 42 weeks with Bishops score from 1 to 6. The duration of 1st stage, cesarean section rate, Apgar score, incidence of neonatal complication, and side effect of every group were evaluated. The results were as follows; 1. In nulliparous women with Bishops score of 4 or less, the duration of the first stage of labor was significantly shortened in the group 1, 2, and 3 compared with that of control group. (P<0.0001, respectively) The duration was significantly shortened in the group 3 compared with group 1 or 2 (P<0.0001, respectively) while the difference was not found between group 1 and 2. (P>0.05) 2. In parous women with Bishops score of 4 or less, the duration of the first stage of labor was significantly shortened in the group 1, 2, and 3 compared with that of control group. (P<0.0001, respectively) No difference was found among group 1, 2, and 3. (P>0.05, respectively) 3. In nulliparous women with Bishops score of 5 or more, the duration of the first stage of labor was significantly shortened in the group I, 2, and 3 compared with that of control group. (P<0.0001, respectively) The duration was significantly shortened in the group 3 compared with group 1 or 2 (P<0.0001, respectively) while the difference was not found between group 1 and 2. (P>0.05).4. In parous women with Bishops score of 5 or more, the duration of the first stage of labor was significantly shortened in the group 2 and 3 compared with that of control. (P<0.0001, respectively) No difference was found between group 1 and control group (P>0.05) and no difference were found among group 1, 2 and 3 (P>0.05, respectively). 5. The Cesarean section rate were 16%, 8.7%, 12.5%, and 6.8% for control, group 1, group 2, and group 3, respectively. 6. There were no significant differences in 1, 5-min Apgar score, and the incidence of neonatal complication in each group. 7. The side effects (nausea, vomiting, headache, hypertonus, and fever) developed in 9 case (3.0%) of group 1, 2, and 3. There were no significant differences in side effect in each group.
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