산전 태아건강상태 평가에서 음진동자극검사의 유용성에 대한 연구

김희범 ( Hee Beom Kim ),이정재 ( Jeong Jae Lee ),김민관 ( Min Kwan Kim ),남계현 ( Kae Hyun Nam ),이순곤 ( Soon Gon Lee ),이권해 ( Kwon Hae Lee ),조태호 ( Tai Ho Cho ) 대한주산의학회 1993 大韓周産醫學會雜誌 Vol.4 No.4

무통분만을 위한 경막외 마취가 제왕절개술에 미치는 영향에 관한 연구

김희범(Hee Beom Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.12

목적: 무통분만을 위해 시행한 경막외 마취가 제왕절개술의 빈도에 미치는 영향을 관찰해 보고자 하였다. 연구 방법: 1996년 1월 1일부터 1996년 12월 31일까지 분만 진통이 있어 질식분만을 위해 본원 산부인과에 입원한 산모 3051명을 대상으로 무통분만을 시행한 군 375명과 무통분만을 하지 않은 군 2676명을 대조군으로 하여 제왕절개술에 미치는 영향에 대하여 의무기록 검토를 통해 후향적으로 조사하였다. 결과: 1. 제왕절개술의 빈도는 경막외 마취를 시행한 군과 대조군 사이에 유의한 차이를 보이지 않았으나 초산모에서 기계적 분만의 빈도는 경막외 마취를 시행한 집단에서 유의하게 증가하였다(대조군:0.08%, 경막외 마취군: 6.61%). 2. 제왕절개술의 적응증중 순수하게 진행장애로 인해 제왕절개술을 시행한 빈도가 초산모에서 경막외 마취군이 대조군에 비해 유의한 증가를 보였다(63.71%: 대조군, 84.78%: 경막외 마취군). 3. 태아곤란증으로 인한 제왕절개술의 빈도는 두 집단 사이에 유의한 차이를 보이지 않았다. 4. 분만한 신생아의 Apgar 점수도 두 집단 사이에 유의한 차이를 보이지 않았다. 5. 경막외 마취 시행후 진통의 완화 정도는 초산모에서 진통을 전혀 느끼지 못했던 경우가 22.91%, 약간의 진통을 느꼈으나 산모가 주관적으로 큰 불편을 느끼지 못했던 경우가 66.96% 였고, 경산모에서는 전혀 느끼지 못했던 경우가 30.41%, 약간의 진통을 느꼈으나 산모가 주관적으로 큰 불편을 느끼지 못했던 경우가 61.48% 였다. 6. 경막외 마취를 한 집단에서 합병증으로는 요통을 호소한 경우가 30예(8.0%)로 가장 많았으며 배뇨 곤란, 떨림, 두통, 저혈압과 오심, 구토, 경막 천자 등이었다. 결론: 무통분만을 위한 경막외 마취를 시행한 초산모에서 기계적 분만 및 순수한 진행장애로 인한 제왕절개술의 빈도가 대조군에 비해 유의하게 증가하였다. 분만 통증을 당연한 것으로 받아드리던 때도 있었으나 이러한 불필요한 통증은 산과마취의 발달로 무통분만이 널리 시행되면 많이 완화되었지만 아직도 무통분만의 안전성 등에 대한 논란이 많다. 따라서 이에 대한 연구가 계속되어야 하겠지만 산과의사로서 산모가 무통분만을 원하는 경우 무통분만의 좋은 점과 기계적 분만 및 제왕절개술의 가능성, 마취 후 생길 수 있는 합병증 등에 대해 충분한 설명 및 상의를 거친 뒤에 시행하여야 할 것으로 사료된다. Objective: This study was to evaluate whether epidural analgesia of labor is associated with an increased risk of cesarean delivery. Method: The study was undertaken for the clinical evaluation on the patients with singleton infants in vertex presentations who had been admitted and delivered at Soonchunhyang Kumi Hospital from January, 1996 to December, 1996. Result: The results were as follows : 1. There was no significant difference in incidence of cesarean delivery between nulliparous women receiving epidural analgesia(20.26%) and those who did not receive epidural analgesia(19.36%). But nulliparous women who received epidural analgesia were significant increase in operative vaginal delivery than those who did not receive epidural analgesia (0.08% of the no-epidural and 6.61% of the epidural group). 2. Among the indication for cesarean section, nulliparous women who received epidural analgesia were significant increase in incidence of failure to progress only than those who did not receive epidural analgesia (63.71% of the non-epidural and 84.78% of the epidural group). 3. There was no statistic significance in incidence of fetal distress only between women receiving epidural analgesia and those who did not receive epidural analgesia. 4. There showed no significant difference in new born Apgar score between women receiving epidural analgesia and those who did not receive epidural analgesia. 5. The subjective and objective successful epidural effects were noted excellent 22.91%, good 66.96% in nulliparous women and excellent 30.41%, good 61.48% in multiparous women. 6. Concerning complications of epidural anesthesia, backache was most frequent(8.00%), voiding difficulty, shivering, nausea/vomiting, hypotension, headache, dura puncture in orders. Conclusion: Our retrospective study shows that epidural analgesia may increase substantially the risk of operative vaginal delivery and the incidence of cesarean delivery for which failure to progress only was listed as an indication in nulliparous women. Although the causal nature of this association remains open to debate, prenatal care providers should routinely discuss the risks and benefits of epidural analgesia with women during their pregnancies so that can make informed decisions about the use of pain relief during labor.

산모에서 발생한 쭈쭈가무시병 1례

원성윤 ( Seong Youn Won ),김판영 ( Pan Young Kim ),김희범 ( Hee Beom Kim ) 대한주산의학회 1996 Perinatology Vol.7 No.2

뇌하수체 프로락틴분비선종을 동반한 임신 4예

천일미 ( Il Mi Chun ),임경빈 ( Kyung Been Yim ),김희범 ( Hee Beom Kim ),이정재 ( Jeong Jae Lee ),이임순 ( Im Soon Lee ),이권해 ( Kwon Hae Lee ) 대한주산의학회 1996 Perinatology Vol.7 No.2

조기 복강임신 1례

전준기 ( Jun Gi Jeon ),이지연 ( Ji Yeon Lee ),정집광 ( Jib Kwang Chung ),심일구 ( Ill Goo Shim ),김희범 ( Hee Beom Kim ),고은석 ( Eun Suk Koh ) 대한주산의학회 1999 Perinatology Vol.10 No.3

자궁내 태아 사망에 대한 임상적 고찰 (1990-1997)

김희범,서기원 순천향의학연구소;Soonchunhyang Medical Research Institute 2000 Journal of Soonchunhyang Medical Science Vol.6 No.1

Objective : Our purpose of this study was to evaluated the incidence, cause of intrauterine fetal death, termination method and the maternal complications of fetal death clinically. Patients : From January 1990 to December 1997, a retrospective study was made of the hospital records of 188 cases of the intrauterine fetal death among 42,576 deliveries after 20 weeks gestation by gestational age in Soonchunhyang Kumi Hospital. Results : The incidence of the fetal death in utero was 0.44%. The most common gestational week when intrauterine fetal death was detected was 35-40 gestational weeks(35.6%). The parity of mother in the fetal demise in utero was not different between nulliparous and multiparous women. The sex ratio of fetus in intrauterine death was not different between male and female. The cases of the fetal death in utero weighting less than 2500gm were 134 cases(71.2%). The causes of the intrauterine fetal death showed unknown causes(51.6%), maternal diabetes(11.2%), abruptio placenta(8.5%), congenital anomaly(8.0%), pregnancy induced hypertension(5.9%), intrauterine infection(5.3%), cord complication(4.3%), multiple causes(2.7%), vasa previa rupture(1.6%) and oligohydramnios(1.1%). The mode of the pregnancy termination for intrauterine fetal death showed prostaglandin E2(42.0%), oxytocin(34.5%), hysterotomy(11.2%), spontaneous delivery (9.6%), and misoprostol(2.7%). The maternal complication were hemorrhage(4.3%), infection(1.6%), cervical laceration(1.1%), and uterine rupture(0.5%). Conclusion : The cause in about 50% of the intrauterine fetal death could not be determined, so further studies must be made on mother, stillborn infants, placenta and umbilical card in cases where the causes in unknown for the purpose of good outcome and prevention of intrauterine fetal death in next pregnancy. And the studies investigating the safe and effective method for pregnancy termination are needed in order to reduced maternal complication and shortened termination time.

분만방법으로서 제왕절개술의 빈도 및 적응증에 대한 연구(1982년 - 1996년)

김희범 순천향의학연구소 1999 Journal of Soonchunhyang Medical Science Vol.5 No.2

Objective : Our purpose of this study was to determine the incidence and indication of cesarean section in order to evaluate how rapidly increased cesarean section rate influenced in the trend of delivery. Method : The study was undertaken for the clinical evaluation on the patients who had been admitted and delivered at Soonchunhyang Kumi Hospital from January, 1982 to December, 1996. Result : The result were as follows : 1. Of the total deliveries, overall incidence of cesarean section was 18.0%, of which the incidence of primary cesarean section was 67.7% and that of repeat cesarean section was 32.3%. The cesarean section rate was 9.1% in 1982, 11.1% in 1887, 21.1% in 1993 and 30.1% in 1996, which shows a tendency to gradual increment. 2. Among the indication for cesarean section, the repeat cesarean section alone was the most common. 3. The repeat cesarean section rate was 27.0% in 1982 and 41.8% in 1996, which shows a tendency to marked increment. 4. The indication for primary cesarean section were cephalopelvic disproportion(53.7%), breech(21.6%), fetal distress(10.3%), placenta previa(4.2%), pregnancy induced hypertension(5.0%) and miscellaneous(5.3%). Conclusion : This results suggest that repeat cesarean section and those performed for labor dystocia together account for approximately half of all such operation. Unless the primary cesarean rate is reduce, an important reduction in overall cesarean rate is unlikely. Therefore efforts to encourage vaginal birth after a previous cesarean and restricting cesareans for labor dystocia to women who meet strictly defined criteria appear to be the most productive approach to lowering the cesarean rate.

쌍태임신중 일측태아 사망 5 예에 대한 임상적 고찰

신정옥,심일구,이항재,김희범 순천향의학연구소 1999 Journal of Soonchunhyang Medical Science Vol.5 No.1

Objective : Our purpose of this study was to evaluated the incidence of twin pregnancy with one fetal demise, predisposing factors and the maternal complications and perinatal outcomes. Patients : From January 1993 to December 1997, 5 twin pregnancy with single fetal demise after 28 weeks gestation by gestational age were observed in Soonchunhyang Kumi Hospital. Results : 1. The incidence of one fetal demise was 3.01% in twin pregnancy. 2. Maternal disseminated intravascular coagulation has not been demonstrated. 3. The predisposing factors of twin pregnancy with single fetal demise are umbilical cord torsion (40%), congenital anomaly(20%) and unknown(40%). 4. According to chorionicity, it seems that the perinatal mortality rate of monochorionic group was higher than dichorionic. Conclusion : This study suggests that monochorionic placentation is associated with increased risks of twin pregnancy with single fetal demise. But it may be partially explained due to small numbers of cases in this study.

비면역성 태아수종에 대한 임상적 고찰

이권해,남계현,주명찬,김희범,조태호 순천향대학교 1992 논문집 Vol.15 No.4

The retrospective study was performed including 13 cases of nonimmunologic hydrops fetalis who were delivered at the Department of Obstetrics and Gynecology, Soonchunhyang University, College of Medicine from Jan. 1990 to June 1992 during the period of 3years. The results were as follows 1. The incidence of NIH was 0.24%. 2. Average maternal age was 28years. Average gravida and parity were 2.2 and 0.7. Average gestational weeks was 26.8weeks. 3. The sex ratio of male to female was 1:1.25/ 4. Frequency of maternal condition associated with NIH were hypoalbuminemia (37.5%), anemia(30.8%), poly or oligohydramnios(30.8%), maternal disease(15.4%), syphilis(7.7%) and drug medication in early pregnancy(7.7%). 5. Associated fetal anomaly were gastroschisis(7.7%), omphalocele(7.7%), hydrocephalus(7.7%), cord anomaly(7.7%) and anatrophic dwarfism(7.7%). 6. The result of chromosomal study in the 3 cases of NIH were normal; 2 cases (46, XX), 1 case (46,XY). 7. Complications in 13 involved pregnancies were poly or oligohydramnios(30.8%), preterm labor(7.7%), placenta previa(7.7%), breech presentation(23.1%), transverse lie(7.7%). 8. Maternal serum α-fetoprotein was checked in ten of total cases. Maternal serum α-fetoprotein were increased in 5 cases (50.0%). 9. Amniotic fluid α-fetoprotein was checked in 4 of total cases. Amniotic fluid α-fetoprotein were increased in 2 cases (50.0%) 10. Gestational age at ultrasonographic diagnosis of NIH was 20-25weeks (53.8%), 26-30weeks(23.1%), 31-35 weeks (15.4%) and 36-40weeks(7.7%). 11. Ultrasonographic findings of NIH were fetal ascites (100%), edema on scalp or abdomen(76.9%), fetal hydrothorax(61.5%), poly or oligohydramnios (30.8%), intrauterine growth retardation (23.1%), large placenta(15.4%). 12. Management associated gestational weeks were bougination (76.9%), normal spontaneous vaginal delivery (15.4%), cesarean section(7.7%). 13. Autopsy finding were generalized edema (100%), marked extramedullary hematopoiesis in liver, spleen(75.0%), fetal ascites (100%), hydrothorax(75.0%), severe anasarca(50.0%), lung hypoplasia (85%), congestion of liver and spleen (50.0%), infarction of adrenal gland (12.5%). 14. Neonatal death rate was 100%.