선천성기형 10년 6개월 연구 ( 1967.1 - 1977.7 )

최진주(JJ Choi),전영실(YS Chun),김종일(JI Kim),우복희(BH Woo),강신명(SM Kang),조석재(SJ Cho) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.12

1967년 1월 1일부터 1977년 7월 31일까지 본 이화여대 부속벼원 산부인과에서 임신 20주 이후에 분만한 총 19054예의 출산아를 대상으로 선천성기형에 대하여 조심스럽게 관찰한 결과 다음과 같 은 결론을 얻었다. 1. 총 출산아 중 선천성 기형아 의 발생빈도는 103예로 0.54%였고 남아와 여아는 비슷한 발생빈도를 나타냈다. 2. 사산아에서 기형발생빈도는 3.7%로서 신생아에 비해 9 배로 월등히 높았다. 3. 저체중아(2500gm 미만)에서 기형발생빈도는 성숙아에 비해 1.9%로서 4 배나 높았다. 4. 분만 회수가 4회 이상일 때는 기형발생빈도가 초산부터 3회까지의 경사누에 비 하여 1.23%로 월등히 많이 발생했다. 5. 기형아의 선진부위는 둔위가 16.5%로 정상보다 월등히 많았고 무뇌아 및 이분척추에서는 7배나 더 많았다. 6. 기형을 가진 일부의 과거력에 있어서 유 산을 경험한 경험이 약 12%로서 정상임부군에 비하여 3배로 높앗고 사산 및 신생아 사망을 경험 한 율도 약 5%로서 정상군에 비하여 약 3배로 높았다. 과거 기형아를 가진 경험은 약 1.9%로서 정상군에 비하여 6배로 현저히 높았다. 7. 선천성 기형아를 분만한 임부는 임신초기(1-12주)에 그의 약 28%가 평균 1.38 종류의 각종 약물을 복용했으며 특히 보약 등 한약을 섭취한 빈도는 12.6%로서 정상대조군(9.1%)에 비하여 1.4배로 높았다. 8. 무뇌아 및 이분척주 기형군에서는 그 임신초기에 약물 복용한 기왕력이 62.5%로서 정상대조군 27.5%에 비하여 2.3배나 높았고 특히 한양 복용 기왕력은 29.2%로서 정상대조군(9.1%)에 비해 3배나 월등히 높았다. 9. 기형아 군에서 는 정상대조군에 비하여 임신초기에 다음과 같은 약물을 더 많이 섭취하였음을 확실히 알게 되었 다. 즉 한약(12.6% : 9.1%), 감기약(3.8% : 0.5%), 신경안정제 및 수면제(3.0% : 1.1%), 진통제 (3.8%:0.8%), 구충제(2% : 0.5%), 경구피임약(12%:9%), Corticosteroids(1%:0%), 항 결핵제 (1%:0.3%) 등이었다. 이와 반대로 정상대조군에서 더 많이 섭취한 약물들은(기형아에 비하여) 소화제(7.7%:3.0%), 유산방지제(주사) 및 음료수(1.5% : 0%)등으로 국한되었다. 10. 임신 3개월에 일산화탄소(연탄가스) 중독된 한 임부에서 임신 43주에 자연분만한 결과 무뇌아의 기형이 발견되었다. The data to be presented are based on the 103 cases of congenital anomalies among 19054 newborns delivered after 20 weeks gestation during a 10 and half year period lasting from January 1, 1967 to july 31, 1977 at Ewha Womans University Hospital. This paper will be mainly discussed the types of congenital anomaly,the possible etiologic factors and the ingestion of drugs during firing first trimester pregnancy. The main types of congenital anomalies were found to be 24 cases of anencephalus, 13 congenital heart disease, 7 cleft palate, 7 polyps of ear region, 6 Imperforated Anus, 6 Downs Syndrome, 5 Polydactylism, 3 Omphalocele and 32 others. The over all incidences of congenital anomaly were 103 cases(0l54%) among 19054 new borns of total deliveries. The sex ratios between anomaly and normal gravida showed no any differences. The incidence of congential anomaly in stillbirth was 3.7% which was 9 folds higher than that of live births. The incidence of congentital anomaly in the low birth weight less than 2500gm was 1.9% which was 4 times that in the matured babies. The congenital anoma has occured more often in the women with 4 or more parities(1.23%) in comparision with nullipara or gravidas with one to three parities. The incidence of breech presentation in congenital anomaly was very high compared to those innormal newborns. particularly, it was 7 folds the control group in the anomalies associate with anenccephaly and spina bifida. In reviewing the all mothers 12% of all the mothers had the history of spontaneous abortion and 5% had stillbirths and /or neonatal deaths in the past which were considered very high, three times the normal group. 1.9% of all the mothers who currently delivered anomalous infants had also been experieced previously of congenital anomalies. Approximately one third(28%) of the mothers who delivered congenital anomaly have been taken various medicines including herb drugs(1.38 kinds of drug per gravida) during the first trimester of pregnancy. The ingestion of herbproved that some drugs listed below were one of the most frequently taken in the anomalous group compared to normal control group. mothers with anomaly mothers in control group drugs taken 12.6% 9.1% herb drugs 3.8% 0.5% medicine for cold 3.0% 1.1% sadative & narcotics 3.8% 0.8% Analgesics 2% 0.5% Anti-helminthics 2% 0% Oral Contraceptives 1% 0% Corticosteroids 1% 0.3% Antituberculous agents On the contrary, drugs listed below were more frequently taken in normal control group of mothers than in anomalous group inthe rate of control anomaly drugtaken 7.7% 3.0% digestints 2.8% 1% drugs used for preventing abortion 1.5% 0% beverage A pregnant woman who had been suffered from acute CO gas intoxiccation during her first trimester pregnancy unfortunatly resulted in 43 weeks prolonged pregnancy and consequently delivered an anencephalic infant.

자궁내번증의 1례

최진주(JJ Choi),홍창수(CS Hong),이재현(JH Lee) 대한산부인과학회 1970 Obstetrics & Gynecology Science Vol.13 No.2

Inversvon of uterus is a rare obstetrical complication. We present a case of cute puerperal inversion of the uterus with fatal outcome and add a brief review of the literature.

흔적 자궁각을 수반한 단경단막 자궁 1 예

안덕보(DB Ahn),최진주(JJ Choi),문재민(JM Moon),송승규(SK Song) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.1

특별한 증상 및 합병증 없이 4회의 정상임신 및 분만과 3회의 인공유산을 경한한 흔적각을 동반한 단경단각자궁 1예를 보고함과 동시에 문헌적 고찰을 하였다. Congenital anomalies of the uterus are so infrequently encountered. A case of uterus unicornis unicollis with a rudimentary uterine horn has been presented with a brief review of literature about anomaly of the female genital tract.

만삭정상 및 발육지체아의 태반계측상의 비교

이숙인(SI Lee),최진주(JJ Choi),최응환(EW Choe),현춘(C Hyun) 대한산부인과학회 1970 Obstetrics & Gynecology Science Vol.13 No.7

The authors observed the placental dimensions in 162 cases of term deliveries during the period from April 1969 to June 1969 at the department of Obst. & Gynec. St. Mary`s Hospital. Based on the intrauterine weight chart of Lubchenco, it was found that 146 infants(90%) were normal term infants(N.T.I.) and 16(10%) were intrauterine growth-retarded infants(I.U.G.R.I.) The purpose of this investigation was to compare N.T.I. with I.U.G.R.I. in various placental measeurements(placental weight, volume, decidual area, thinkness and density, umbilical cord length and diametar, umbilical vein diametal), placental coefficients, feto-placental weight rations, and the relations of some of these data ti infant weight. And in addition was made histopathological examination of the placenta in 69 cases out of the 162. The results and conclusion were as follow: 1. Fetal body weight and length: 1) The mean birth weight of N.T.I. was 3,326gm and it was significantly larger than 2,475gm in I.U.G.R.I.(P<0.001). 2) The mean body length of N.T.I was 50.1㎝ and was significantly larger than 47.1㎝ in I.U.G.R.I.(P<0.001) 2. Placenta and cord: 1) Placental weight, volume, decidual area, thinkness, and density: (1) The mean weight of placenta in N.T.I. was 464gm and it was heaveier than 386gm in I.U.G.R.I.(P<0.001). (2) The mean placental volume of the I.U.G.R.I., 386㎤, was significantly smaller than 462㎤ in N.T.I.(P<0.001). (3) The mean decidule area of the placenta of I.U.G.R.I., 268㎠, was significantly smaller than 305㎠ in N.T.I.(P<0.025). (4) The mean placental thickness in N.T.I., was 1.49㎝. The difference in the mean placental thinkness between N.T.I. and I.U.G.R.I., was not statistically significant. (5) in both the groups of the infants, the placental volume in cubic centimeter was numerically similar to the weight in gram. Density was therefore unity. 2) Cord length and diameter, umbilical vein diameter: (1) The mean length of umbilical cord of N.T.I., 54㎝, was significantly larger than 50㎝ in I.U.G.R.I.(P<0.025). (2) The mean cord diameter of the umbilical vein in N.T.I., and I.U.G.R.I. were each 12.3㎝, and 11.7㎝. There was no significant difference between the two groups. (3) The diameter of the umbilical vein in N.T.I., and in I.U.G.R.I., were 7.74mm and 7.21 mm respectively. The former was significantly larger than the letter.(P<0.05). 3. Fetal weight placental weight: 1) The mean value of the placental coefficient in N.T.I. was 0.140, which was significantly smaller than in the I.U.G.R.I., 0.156(P<0.001). 2) The mean ratio of the birth weight to the placental weight in N.T.I. was 7.09, being significantly higher than in the I.U.G.R.I., 6.43.(P<0.001). 4. Correlation between the fetus and the placenta: 1) In N.T.I. the birth weight was directly related to placental weight, volume, decidual area, cord diameter and umbilical vein diameter, And no relation between birth weight and placental thinkness could be found. 2) In I.U.G.R.I., the birth weight was directly related to placental volume, decidual area, and weight. It was not related to cord diameter, umbilical vein diameter. 3) Several cases of I.U.G.R.I. associated with severe toxemia of pregnancy had extremely small birth weight in spite of the placenta of absolutely normal dimensions. The histopathological examination of these placentas revealed numerous pathological changes(Fig1~6). It suggests that the placental dysfunction due to toxemia of pregnancy may be one of influencing factors of fetal growth.

난소임신 1예

원연희(YH Won),최진주(JJ Choi),김석희(SH Kim),유한기(HK Yoo) 대한산부인과학회 1980 Obstetrics & Gynecology Science Vol.23 No.11

본 보고의 난소임신 1예는 원발성 난포내 난소임신으로 확인되었고 아울러 난소임신에 관한 문헌적 고찰을 하였다. Ovarian pregnancy is comparatively rare in ectopic pregnancy. A case of ovarian pregnancy which we have experienced is reported and literature are briefly reviewed.

자궁탈을 동반한 과립 난포막 세포종 1예

김창이(CY Kim),황세영(SY Hwang),최진주(JJ Choi),김윤호(YH Kim) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.1

자궁탈을 동반한 과립 난포막 세포종 1예 A case of granulosa theca cell tumor combiend with uterine prolapse in a 57 year old postmenopausal woman was presented and a brief review of literature on granulosa theca cell tumor was made.