임신 및 분만결과에 따른 경구당부하검사의 분석

김정혜(JH Kim),송혜섭(HS Song),오말례(ML Oh),양석기(SK Yang),민보은(BE Min) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.1

결론 1. 서구인과 비교해 본 저자들의 경구당부하검사는 많은 차이점들 나타내었다. 즉 저자들이 시행한 검사치를 미국인의 것과 비교했을 때 평균치에 있어서 약30~4omg%,2S.D.에서 25~40mg%가 각각 높았다. 그러므로 식생활이 다른 한국인의 임신성 당뇨병 진단에 미국인의 기준치를 적용하는 것은 많은 오류를 범할 수 있다고 생각되므로 좀 더 많은 수의 검사로 한국인의 표준을 정하는 것이 필요하다고 본다. 2. 비정상 임신시 정상 임신에 취하여 비정상 당부하검사를 나타내는 예가 월등히 많았다. 과체중아 분만시에 고혈당치 뿐 아니라 저혈당치의 빈도도 높이 나타났으며 처체중아 분만시에도 고혈당치를 나타내는 빈도가 높았다. 또한 산과력이 나빴던 예에서도 저혈당치를 나타낸 예와 현성당뇨병을 나타낸 예가 많았으며 임신중독증 시에도 고혈당치 뿐 아니라 저혈당치도 높은 빈도를 나타내었다. 3. screening test로써의 single test는 3시간이 의의가 있는 것으로 생각되나 일부의 비정상적인 사람들을 포함하지 못할 수도 있다. 모든 임신부에게 3시간의 single test를 행하는 것이 바람직하나 비정상적인 임신이 기대될 때는 표준당부하검사를 시행하는 것이 좋을 것이다. lt has been wedely recognized that many complications in obstetrics & gynecology are asscoiated with abnormal carbohydrate metabolism. Oral glucose toIerance test is the one of the better tests in diagnsing diabetes mellitus but its value changes depending upon the basic diet, especially amount of carbonhydrate intake. Therefore we thought there may be a difference in glucose tolerance between Western and Korean peoples. Oral glucose tolerance tests were done in 159 control group people, nonpregnant 34, pregnant 59, and postpartum (baby, A.G.A.I.)66, and a group of 389 with abnormali- ties of pregnancy, L.G.A.I.215, S.G.A.I.76, stillbirth unknown cause 22, bad ㅇbstetric history 20, hypertensⅳe disorders in pregnancy 53, and fetal abnormality 3. The results are as follows; 1. There was a marked difference between Korean and American mean oral glucose tolerance test results. This study showed 30~40mg% higher value than American pre- gnancy standard, and 25~40mg% higher in comparing 2 S.D. This study would mean that it would be dangerous if the American standards are used in diagnosis and treat- ment of Gestational Diabetes in Kotea. 2. Abnormal pregnancy showed a more frequent association with abnormai G.T.T. compared to normal pregnancy. Hyperglycemia was associated with L.G.A.I. in 7.9% cases but also hypoglycemia was associated with hyperglycemia. Patients with a bad obstetric history showed 20% hypoglycemia and 15% overt diabetes, but none in the hyperglycemia, not diabetic level. Dypertensⅳe disorders in pregnancy were associated with hyperglycemia as well as hypoglycemia. 3. For singIe Ioading test a 3hr test is probably the best but it would still miss some of the patients with abnormal curves. As a screening test of all pregnant patients the 3hr single loading test could be used but when there is an abnormality of pregnancy it would be adⅵsable to do a full G.T.T.

임신성 융모성종양에서 병기분류와 예후점수제의 신뢰도의 비교

박승희(SH Park),하현미(HM Ha),김양희(YH Kim),김정혜(JH Kim),민보은(BE Min) 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.6

A restrospective study of 129 patients with GTT admitted to Il sin Christian hospital between January 1983 and December. 1992 was done to assess and compare the reliability of both the 1983 WHO prognostic score (Prog. score) and 1992 FIGO staging in determining the severity of the disease and therefore the outcome and method of treatment needed. The overall remission rate was 93.8%. The addition of 2 risk factors, HCG titer 10^5 and above and interval of 6 months or more to separate each stage into a, b, c subgroups(none, one or both risk factors) greatly improved the correlation with the prognostic score(r=0.595) compared to the previously purely anatomically staging (r=0.460). 60/66(91%) of stage Ia and 17/21(81%) of stage IIIa pts were low risk but 11/21(52%) of stage Ib and 5/6 (83%) of stage IIIb were high risk, all 4 pts in c subgroup were high risk. When cases were considered form the prognostic score aspect, 60/82(73%) of low risk were stage Ia but 17/82(21%) were stage IIIa, 11/29 pts of high risk pts were stage III or IV and 12 pts were stage I. Treatment was determined according to the prognostic score and apart form a few pts, low risk pts were given single therapy and med/high risk, 42 % of med, risk pts and 24% of Ia and 43% of IIIa pts had to be changed to multiple therapy. The outcome of the treatment given was then evaluated, as if the guide lines of single therpy for low risk, and multiple therpy for med/high risk cases had been strictly followed for the initial treatment on comparing the two modified score, there would had been moderate increase 81.9% appropriate treatment compared 76.4%. In conclusion risk factors seem to be more important than the antomical stage in determining severity of disease. In addition an HCG titer of 10^4 or more may be a better indicator to separate the stage than the titer of 10^5.

만삭 둔위시 아두 신전과도 5예

이청애(CA Lee),한승희(SH Han),민보은(BE Min) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.2

Among the abnormal fetal attitude in utero, hyperextension of the head in full term breech presentation is uncommon. From January 1970 to July 1976, 5 cases of hyperextended head in breech presentation occurred at Il Sin Womens Hospital. Diagnosis was made on the abdominal X-ray scout film and the degree of hyperextension was determined by measuring the angle between the main axes of cervical and thoracic vertebrae. In all cases a trial of labour with external cephalic version in 3 cases was allowed and 4 patients had a successful vaginal delivery except one which case caesarean section was done because of poor propress in spite of good contraction. None of the babies delivered vaginally had permament neural damage, but two cases had transient respiratory depression after delivery. Follow up checkes for the babies ranging from 2 wks. to 4 1/4 years old have shown all the children were being well. Because of the possiblity of the cervical cord injuries, many obstetricians adviced elective Caesarean Section in cases of hyperextension of the fetal head(esp. if more than 90 degree) in breech presentation but the above 4 cases of successful and safe vaginal deliveries confirm the view of other obstetricians that it is justifiable to at least allow a trial of labor for vaginal delivery.

산모의 체중과 출생아의 체중 및 산과적 합병증 고찰

장혜정(HJ Chang),방재희(JH Bang),민보은(BE Min) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.1

1983년 1월부터 1984년 12월까지 일신기독병원에서 분만한 산모 1,207명의 임신상반기의 체중 및 임신중 증가된 체중과 출생아의 체중과의 관계 및 산과적 합병증과의 관계 고찰을 통하여 다음과 같은 결론을 얻었다. 1. 산모의 임신상반기의 체중은 출생아의 체중과 P<0.01로 의의 있는 비례적인 연관관계가 있었다. 2. 임신중 증가된 체중과 출생아의 체중은 P< 0.01로 의의있게 비례적인 연관관계를 보였다. 3. 산모의 체중과 산과적 합병증과의 관계고찰을 통하여 고위험군 산모를 설정하였다. 1) 산모의 첫상반기 체중(kg)이 적을수록 빈혈의 비율은 P<0.05로 의의있게 높았다. 2) 산모의 체중이 65kg이상일 때 임신중 고혈압, 전자간증의 비율은 P<0.01로 의의있게 증가하였다. 3) 임신첫상반기의 신장 대 체중이 표준체중의 10%이하의 산모군에서 저체중아, 전자간증의 비율이 P<0.05로 의의있게 증가하였다. 4) 임신첫상반기의 신장 대 체중이 표준체중의 20%이상의 산모군에서 전자간증의 비율이 높았다. 5) 임신중 증가된 체중이 2.5kg미만의 산모군에서 저체중아, 임신중 고혈압, 조기진통의 빈도가 P<0.01로 의의있게 증가하였다. 6) 임신중 증가된 체중이 2.5kg∼5.9kg+의 산모군에서 저체중아 및 조기진통의 빈도가 P<0.05로 통계적인 의의를 보였다. 7) 임신중 증가된 체중이 16kg이상의 산모군에서 임신중 고혈압, 전자간증의 비율이 P<0.01로 통계적으로 의의있게 증가하였다. 4. 산모의 임신상반기의 체중 및 임신중 증가된 체중과 분만양식간의 상관관계는 없었다. The relationship between maternal weight and obstetric outcome was studied in 1,207 patients delivered at Il Sin Christian Hospital between 1983. 1. 1 and 84. 12. 31. The maternal weight was assessed in three parameters; weight in kgms and weight for height compared to mean desirable value, at booking in the first trimester and total weight gain during pregnancy. The outcome of the pregnancy was assessed by infant birth weight and condition at delivery, pregnancy complications, and method of delivery. 1. There was statistically significant relationship between all maternal weight parameters and infant birth weight -p<0.01. In particular when the booking weight was less than 45Kgm, or 10% below standard weight for height there was and increased incidence of infants weighing less than 3.0Kgm and 2.5Kgm respectively. During pregnancy if the weight gain was less than 6.0Kgm there as an increased incidence of infants with birth weight of 2.5Kgm or less. 2. The incidence of pregnancy complications was compared to maternal weight parameters and weight gain showed a significant relationship to the largest number of complications. Booking weight in Kgm had a statistically significant relationship to anemia, P.I.H. and pre-eclampsia, all p<0.05. In particular when the booking weight was 65.0Kgm or over there was an increased incidence of P.I.H. and pre-eclampsia. The maternal booking weight related to standard weight for height, was statistically related to L.B.W. and preclampsia(p<0.05). When the booking weight was 10% below standard there was an increased incidence of L.B.W., and the incidence of pre-eclampsia was increased when the weight was both 10% below and 20% above standard weight for height. Maternal weight gain was significantly related to L.B.W.I., P.I.H., pre-eclampsia and premature labour, p<0.01, and also to antepartum hemorrhage and low Apgar score, p<0.05.

거대아에 대한 임상적 고찰

홍경화(KW Hong),김현주(HJ Kim),오주엽(JY Oh),전정희(JH Jeun),민보은(BE Min) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.7

1981년 1월1일부터 1985년 12월 31일까지 5년간 일신기독병원에서 출생한 36692예의 신생아 중 출생시 체중 4000gm이상이 신생아 및 그들 산모를 대상으로 임상기록을 중심으로 통계 학적으로 조사분석하여 다음과 같은 결론은 얻었다. 1. 거댕빈도는 4000gm이상 4.1% 그중 4.5kg미만 3.7% 4.5kg이상 0.4%였다. 2. 출산경력에 따른 빈도는 초산부 42.1%, 경산부 57.9%였다. 3. 산모연령분포는 25-29세군 54.3% 30-34세군이 17.1%, 35세이상군이 4.2%여다. 4. 산모의 임신초기 체중과 신장과의 관계에서 과체중 26.9%, 비만 21.9%였다 5. 산모의 임신중 체중증가에서 16kg이상 증가군은 23.3%였다. 6. 재태기간은 42주이상이 19.7%였다. 7. 거대아를 낳은 과거력을 4.5kg이상 군에서 50.7%가 가지고 잇었다. 8. 분만방법은 제왕절개수술이 29.7%였고, 적응증으로는 아두골반불균형이 높은 빈도를 보 였다. 9. 모성 합병증은 분만 2기지연이 10.3% 견갑난산 0.8%, 산후출혈이 13.6%, 경구당부하시험 이상이 12.5%였다. 10. 거대아의 성비는 192.0:100으로 남아의 비가 높앗다. 11. 신생아 합병증으로 태아 저산소증이 17.6%였다. 12. 태아 기형율은 1.0%였다. 13. 주산기 사망은 1,000명당 12로 자궁내 태아사망 5예, 분만중 사망 3예, 신생아 사망 4예 가 있었다. A study was done on 1491 cases of macrosomia infants weighting 4000gm or more, delivered Il sin Christian hospital January .1st 1981 and December. 31st 1985. The results were as follows; 1. The Total number of delivery during the study period was 36692 and the incindence of infants weighting 4000gm or more was 4.1% and that of infants weighting 4500mg or more was 0.4%. 2. The incindence of multiparity was 57.9% compared to 41.9% overall hospital distribution. 3. Compared to the overall hospital distribution there was a lower incindence of mothers aged less than 25 and an increased incindence of mothers age over 30 4. These was increased incindence of post maturity 19.7% being 42 weeks and over compared to hospital incindence 6.5%. 5. Male to female ratio was 192.0:100.0 compared to overall hospital ratio of 106.0:100.0 6. Cesarean section delivery rate was 29.7% compared to 16.8% hospital rate and main indication for section were cephalo-pelvic disproportion previous cesarean and abnormal presentation. 7. Postpatum glucose tolerance test was done in 497 cases and of the 12.5% had an abnormal G.T.T 8. Maternal complications were hypertenstion in pregnancy(11.7%) delayed second stage of labor (10.3%) shoulder dystocia(0.8%) and postpartum hemorrhage (13.6%). 9. Neonatal complications were birth hypoxia (17.6%) cephalhematoma(9cases), clavicle fracture (2cases) and Erb`s palsy(1case). 10. There were only 15 infants (1.0%) with congenital anomalies compared to 2.2% overall hospital incindence . 11. There were 5 cases of fetal death in utero, 3 cases of intrapartum death giving a perinatal mortality rate of only 8.1 compared to overall hospital perinatal morthality rate of 30.7

자궁경관임신 16례의 임상적 관찰

강경화(KH Kang),박숙현(SH Park),홍수명(SM Hong),양석기(SK Yang),민보은(BE Min) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.10

Cervical pregnancy is a rare from of ectopic pregnancy in which the fertilized ovum implants within the cervix. There is no distinctive presenting symptom as the chief complaint is painless vag inal bleeding which can also occur in other diseases. Cervical pregnancy carries a high mortality rate due to this heavy bleeding. During 10 year period from January 1, 1972 to December 31, 1981, 16 patients with cervical pregnancy were treated and a clinical review of these cases is presented. The results were as follows; 1) The incidence of cervical pregnancy was 1 in 3656 deliveries and 1 in 78 ectopic pregnancies. 2) Women over 30 years of age comprised 81.25% of the group compared to 20.28% for the same age group in the normal obstetric population. 3) Cervical pregnancy never occnrred in the first pregnancy and 75% of the women had had one or more induced abortions. 4) Gestation at termination of pregnancy ranged from 4 to 24 weeks with a mean 9.75 weeks. 5) The major presenting symptom was heavy vaginal bleeding in 11 cases, persistent spotting in 4 cases and epigastric pain, with vomiting, weight loss in 1 case. 6) The diagnosis at admission was cervical pregnancy (31.25%), incomplete abortion (31.25%), choricarcinoma(18.75%), inevitable abortion (12.5%) cervical myoma (6.25%). 7) Blood trsnsfusion was necessary in all patients ranging from 400cc to 3200cc with an average of 1600cc. 8) The majority of patients were treated by immediate hysterectomy in 6 cases but in 7 cases hysterectomy was only done after failure of conservative management. In 3 cases conservative management of dilatation and curettage and gauze packing was successful.

임신성 융모성 종양에서 Methotrexate 단일 항암화학요법시 약제 내성의 발생에 대한 분석

안현숙(HS Ahn),김경서(KS Kim),박치희(CH Park),김정혜(JH Kim),민보은(BE Min) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.4

MTX with Leucovorin rescue as a single drug treatment for G.T.T. causes complications, is usually adequate but drug resistance occasionally occurs. This is a report of a study done in 80 consecutive patients (pts) treated with MTX between 1983 and 1991 at Il Sin Christian Hospital, Pusan to see if predictive factors for the development of the drug resistance could be identified. According to the 1983 WHO prognostic score 72 pts were low risk, 7 medium and high risk. Durg resistance developed in 22/72 pts (30.6%) low risk pts and in all of the medium and high risk pts. Factors analysed as possible predictive factors for developing drug resistance were total prognostic score, the seperate factors of the prognostic score, factors related to the preceeding mole, size of uterus at start of chemotherapy and factors relatd to previous fertility. The most significant factors associated with a higher risk of resistance were WHO prognostic score 5 and over, 8/8 pts(100%), HCG titer>10^4 mIU/ml, 12/15 pts(85.7%), tumor size 3 cm and over, 8/8 pts(100%), and less commonly a preceeding non molar pregnancy 2/3 pts. Among the 8 medium & high risk pts the preceeding preg. was non molar in 2 pts and of the remaining 6 pts all had at least 1 of the 2 predictive risk factors and 5/6 had both of these factors. These results emphasise the reliability of the WHO prognostic score in selecting pts who need multiple therapy and also that MTX alone is usually inadequate in these pts. Among the low risk pts if either or both of these factors were present, 80% of pts (8/10) developed drug resistance compared to 22.6% (14/62) if neither factor was present.

병원 분만한 임산부의 혈색소치에 관하여

이우영(WY Lee),강경화(KH Kang),박둘임(Dl Park),민보은(BE Min),신경숙(KS Shin) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.1

저자들은 1979년 12월 1일부터 1980년 2월 10일까지 일신부인병원 산과에 내원 분만한 임산부 1002명을 대상으로 임신말기의 혈색소량을 측정하고 얻은 결론은 다음과 같다. 1. 임산부의 임신말기 평균혈색소치는 11.5gm/dl인데 반하여 정상 비임부의 평균혈색소치는 12.8 gm/dl이었다. 2. 임산부의 임신말기 평균혈색소치 11.0 gm/dl이하는 41.8%이었고 이 중 8.0 gm/dl이하는 1.6%이었다. 3. 임산부에 있어서 빈혈의 발생빈도는 합병성질환 특히 자간증 및 전자간증 폐경핵등의 만성소모성 질환을 가진자, 다산 그리고 고령산모에서 높아다. 4. 임신중 주기적인 산전 진찰을 혈색소량의 증가를 가져오고 빈혈의 발생빈도를 저하시킬 수 있었다. Anemia of pregnancy is a common complication in patients from poor socio-economic conditions and is important because it is associated with increased maternal and perinatal morbidity and mortality. A study on Hb levels in pregnancy was done on 1002 patients whose pregnancies were over 26 weeks gestation delivered at Il Sin Womens Hospital between 1st.Dec. 1979 and 10th Feb. 1980. In 694 women pregnancies were uncomplicated but 308 pregnancies were complicated by eclampsia, preeclampsia and other toxemias, syphilis, renal disease, pulmonary Tbc, diabetes and heart disease. Few large studies of Hb levels of pregnant women in Korea are available. The study results are as follow; 1. The mean hemoglobin level in the third trimester of pregnancy were 11.5 gm/dl compaired to a mean level of 12.8gm/dl in a comparable group of non pregnant women. 2. The Hb was below 11.0 gm/dl in 41.8% of the study group, including 1.6% whose Hb was below 8.0gm/dl. 3. A high incidence of anemia in the third trimester of pregnancy was present in patients with preeclamsia and eclampsia high pariety, pulm. Tbc. and with increasing age in complicated pregnancies. 4. The effect of antenatal care, on low hemoglobin level in complicated pregnancy and no regular antenatal care. The benefit of antenatal care in shown in the high incidence of low Hb and complications of pregnancy in those with only 1 or 2 antenatal visits before delivery compaired to those with regular antenatal care.

Rh 음성 산모의 문제점

송혜섭(HS Song),장애숙(AS Chang),김정혜(JH Kim),양석기(SK Yang),민보은(BE Min) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.7

1976년 1월 1일부터 1980년 7월 31일까지 일신부인병원 산부인과에서 분만한 Rh 음성 산모 43명과 53회의 임신으로 출생된 55명의 신생아를 대상으로 Rh 음성이 산모와 태아에 미치는 영향을 비교 관찰한 결과 다음과 같은 결과를 얻었다. 1.28,249명의 산모중 Rh 음성은 43명이었고 53회의 임신으로 그 빈도는 0.19%였다. 2.Rh 면역된 임신 5예에서 그 원인이 수혈에 의한 것으로 생각되는 것이 3예로 가장 많았고 이전의 인공유산에 의한 것으로 생각되는 것이 2예였다. 3.산후 Rhogam을 투여했던 9예에서는 모두 Rh면역이 일어나지 않았다. 4.Rh 음성 산모의 산전관리에서 Rh 항체역가치에만 의존하지 말고 양수천자에 의한 빌리루빈치의 측정이 필요한 것으로 생각되었다. 5.Rh 음성이 산모에 미치는 영향으로써 산후출혈 후 혈액공급이 어려운 것이었고, 분만전에 가족의 광범위한 혈액형 검사로 Rh 음성 혈액의 준비가 필요한 것으로 사료되었다. 6.Rh 면역된 신생아에서 주산기 사망은 없었으나 빠른 빌리루빈치의 증가가 나타남으로 제대혈액으로 혈액형, 혈색소치, 빌리루빈치, 직접쿰수치의 측정이 필요하고 출생 후 면밀한 관찰과 적극적인 처치가 요구된다. 53 pregnancies in 45 Rh neg. women who were delivered between Jan. 1st 1976 and July 30th 1980 in Il Sin Women`s Hospital were reviewed and following results were obtained. 1.The incidence of Rh neg. women among a total 28,249 patients was 0.19%. 2.5 patients were immunized. In 3 patients the immunization was probably due to previous transfusion of Rh positive blood and in 2 cases the immunization followed previously induced abortions. 3.The use of Rhogam after delivery, abortion, ectopic or possible placental trauma in the non-immunized patient prevents immunization and reduces the neonatal problem.In this series 9 patients who had been given Rhogam after previous delivery Rh immunization was not present. 4.In the management of pregnancy in a Rh negative women not only the Rh antibody titer but also amniocentesis with bilirubin absorption curve is required. 5.Danger to the mother was difficulty in obtaining Rh negative blood for transfusion after severe P.P.H. It is important to check blood grouping of many of the relatives as possible in order to have rapid collection of Rh negative blood when necessary. 6.There were no stillbirths or neonatal deaths, but 4 babies required exchange transfusion due to rapid increase of serum bilirubin. To lower the perinatal morbidity the cord blood needs to be examined in detail followed by close observation with active treatment if jaundice develops to a certain level.

임신중독증의 모성사망에 대한 고찰

조양현(YH Cho),이수자(SJ Lee),한승희(SH Han),민보은(BE Min),신영우(YW Shin) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.9

1969년 1월부터 1977년 12월까지 9년간 일신 부인병원에서 사망한 산모 149명 중 임신중독증으로 인하여 사망한 71예를 대상으로 임상적으로 분석하여 다음과 같은 결과를 얻었다. 1. 산과입원수에 대한 임신중독증의 발생빈도는 35.3%였다. 2. 모성사망율은 1,000생아 출생당 3.6이었고, 그중 임신중독증으로 인한 사망은 1.7%이었다. 3. 모성사망 149예중 75.2%가 직접적 사인, 20.8%는 간접적 사인, 4.0%는 비관련성 사인으로 사망하였다. 4. 모성사망 149예중 71예는 임신중독증으로 인한 사망이었고 이중 임신중독증이 직접 선행 사인이었던 예가 61예, 중요한 기여인자였던 예가 10예였다. 5. 임신중독증의 가장 빈번한 사인은 심부전증과 뇌혈관질환이었고, 이 두 질환이 약 72%를 차지하였다. 6. 연령은 25∼29세군에서 51.7%로 가장 많았으나 사망률은 고위험을 임신군인 35세 이상군에서는 높았다. 7. 초산산모에서 39.4%로 가장 많았으며 5회 이상 경산에서 사망률이 가장 높았다. 8. 산전진찰을 1회로 받지 않았던 예가 95.8%로 대부분을 차지하였다. 9. 병원도착후 24시간내에 사망한 예가 57.7%였다. 10. 자간증과 전자간증에서는 정기적 산전진찰을 받은 예에서는 그 발생빈도가 현저히 감소하나 비분류 고혈압에서는 큰 변화가 없었다. The 149 maternal deaths which occurred at Ⅱ Sin Women`s Hospital between Jan. 1969 and Dec. 1977 are reviewed. 76 of these deaths were associated with toxemia of pregnancy, and in all but 5 cases toxemia was related to the cause of death. The detailed results of the review are as follows 1) The incidence of toxemia in all obstetric admissions was 35.3%. 2) Overall maternal mortality rate was 3.6/1000 live births and of these 1.7/1000 live births were due to toxemia. Over the period of review there was a consistent decrease in the maternal mortality rate except for a peak in 1972. 3) Of 149 maternal deaths 75.2% were due to direct obstetric causes, 20.8% were due to indirect obstetric cuses, 4.0% were not related to obstetrics. The major direct obstetric causes were toxemia, 47.7% hemorrhage 14.8% and infection 8.7%. 4) In 71 of the 149 maternal deaths toxemia was related to the cause of death, either as a direct antecedent cause, 61 cases, or as a significant contributing factor 10 cases. 5) In the toxemic deaths the most common causes of death were cardiac failure and C.V.A. which comprised 72.1% of cases. 6) Various factors were studied in toxemic related death. a) Age distribution : 31.0% were in the 25-29 age group but this group also comprises the largest percentage percentage of obstetric admissions. Compared to the overall distribu of obstetric admissions the highest mortality was in the over 35 age group. b) Partiy : 39.4% were primipara but compared the distribution of parity in the obstetric admissions the highest mortality was in para 5 and over. c) Antenatal care : 95.8% of patients had not received any antenatal care at this hospital. d) Time of death : 57.7% died within 24 hrs of arrival at the hospital. 7) The incidence of toxemia in all obstetric admissions was reviewed it was noted that the incidence of eclampsia and preeclampsia decreased with regular antental care, but the incidence of unspecified hypertension was not related to the degree of antenatal care.