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만삭산모에서 음향자극검사를 이용한 태아심음반응과 태아안녕의 평가
김종덕 ( JD Kim ),장은실 ( ES Chang ),조성남 ( SN Cho ),강경석 ( GS Kang ),정유석 ( YS Jeong ),엄철 ( C Um ) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.12
Objective clinical evaluation of fetal health is primary goal of obstetrics care. Fetal acoustic stimulation test(AST) has recently received much attention in the literature. To improve the predictive value and to decrease the length of nonstress testing, there has been a wide spread introduction of different acoustic stimulation tests combined with nonstress testing in the assessment of fetal health. This study was undertaken to assess the clinical efficacy of AST on 70 nonmal term pregnant women who are anatomically singleton fetus with vertex presentation and normal amnionic fluid volume from Sep. 1, 1990 to Dec 31, 1990 at the Department of Obstetrics and Gynecology, Chonbuk National University, Medical School. The results were as follows: 1. Fifty one (72.9%) fetuses had reactive fetal heart rate patterns during the control feriod but sixty three(90.0%) fetuses demonstrated reactive fetal heart patterns after vibratory acoustic stimulation. 2. Mean baseline fetal heart rate, mean frequency of accelerations > 15-beats/min, duration of 15-beat accelerations, precentage of acceleration time and mean frequency of fetal movement were significantly increased after vibratory acoustic stimulation(P<0.01). 3. Comparison of Perinatal outcome for reactive versus nonreactive acoustic stimulation showed significanly increases in the incidence of meconium staining of the amnionic flud, cesarean section for fetal indication, Apgar score<7 at 1, 5 minutes, umbilical artery pH<7.20(p<0.01) and newborn intense care unit admission(P<0.001) in the nonreactive group. 4. Predictive value of acoustic stimulation test in antepartum surveillance showed low prevalence rate (below 10%), high sensitivity and negative predictive value(above 90%) respectively. So acoustic stimulation test were considered as an excellent test than nonstress test for the evaluation of fetal well-being.
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불임환자에 대한 자궁난관조영술과 복강경술 및 개복수술 소견의 비교 관찰
김종덕,두재균,이희섭,유철희,강경석 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.7
1984년 1월부터 1989년 8월까지 만 4년 8개월간 전북대학교병원 산부인과에서 불임크리닉에 내원하여 자궁난관조영술과 진단목적의 복강경술을 시행받은 94명과 이들중 기계적 인자에 의한 불임이 확인되고 개인적 여건이 허락되고 수술적 불임치료술을 받기위하여 개복한 48명의 환자를 대상으로 각 진단방법에 따른 개복수술소견을 비교관찰한 결과 다음과 같은 결론을 얻었다. 1. 원발성불임 환자는 51예(54.3%), 속발성불임 환자는 43예(45.7%)이었고 평균연령은 각각 28.9±2.5세, 30.3±3.5세 이었다. 2. 불임에서 자궁난관조영술까지의 평균기간은 원발성이 29.1개월, 속발성이 56.8개월로 속발성이 더 늦게 검사를 시작하는 경향을 보였다. 3. 난관인자를 제외한 불임인자 진단에 있어서 자궁난관조영술은 자궁내질환 진단에 도움이 되는 반면, 복강경검사는 유착, 자궁내막증 등과 같은 골반내 질환의 진단에 보다 유용하였다. 4. 자궁난관조영술에 의한 난관소견은 정상 41예(43.6%), 난관폐쇄 47예(50.0%), 난관주변유착 6예(6.4%)이었다. 5. 복강경술에 의한 난관소견은 정상 32예(34.0%), 난관폐쇄 39예(41.5%), 난관주변유착 23예(24.5%)이었다. 6. 자궁난관조영술과 복강경검사에 의한 난관소견의 일치율은 63예(67.0%)이었다. 7. 복강경검사와 개복수술에 의한 일치율은 자궁소견이 40예(83.3%), 난관소견이 44예(91.7%)이었다. Evaluation of uterine and tubal factor is an important step in the unvestigation of infertility. A comparative study of hysterosalpingography, laparoscopy and laparotomy was done for the evaluation and surgical treatment of infertility. By comparing the findings approved by each diagnostic methods for those 94 patients who underwent hysterosalpingography and diagnostic laparoscopy at infertility clinic of Department of Obstetrics and Gynecology, Chonbuk National University Hospital, from Jan. 1984 to Aug, 1989(for 4years and 8 months), and for 48 patients among them who underwent laparotomy for surgical treatment of infertility, we came to the conclusions as follows: 1. The number of the patients were 51 cases(54.3%)in primary infertility, 43 cases(45.7%)in secondary infertility. The mean age of the patients were 28.9±2.5 years in primary infertility, 30.3±3.5 years in secondary infertility. 2. The interval between infertility and hysterosalpingography was 29.1 months in primary infertility, 56.8 months in secondary infertility. 3. Hysterosalpingogram gave a diagnostic aid for intrauterine diseases as well as for tubal factors. On the other hand, laparoscopy was more available in the diagnosis of pelvic lesions such as adhesion or endometriosis. 4. Thbal findings approved by hysterosalpingography were normal in 41 cases(43.6%), tubal occlusion in 47 cases(50.0%), and peritubal adhesion in 6 cases(6.4%). 5. Tubal findings approved by laparoscopy were normal in 32 cases(34.0%), tubal occlusion in 39 cases(41.5%),and peritubal adhesion in 23cases(24.5%). 6. The accordance of hysterosalpingography and laparoscopy for tubal findings was in 63 cases(67.0%). 7. The accordance of laparoscopy and laparotomy was in 40 cases(83.3%)for uterine findings, in 44 cases(91.7%)for tubal findings.
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