모성사망 20년간 연구 ( 1961~1980 )

이남희(NH Lee),이재옥(JO Lee),조의경(EK Cho),우복희(BH Woo),강신명(SM Kang) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.12

Maternal deaths encountered in Ewha Woman`s University Hospital for the period of 20 years from 1961 to 1980 were 111 cases including 60 cases of hospital deaths and 51 cases of deaths on arrival among 36682 live births. In this paper the overall leading causes of maternal death, the possible preventibility and the end result of comparative observation on the maternal deaths between early 1960`s and late 1970`s will be discussed. 1.The average hospital maternal mortality over the recent 4 years (1977~`80,9 deaths) were 108 per 100,000 live births. It was decreased tremendously to about one-half in comparison to 185 of the early 1960s` (1961~`66,19 deaths). 2.Direct causes of hospital maternal deaths over the recent 4 years ( 6 cases): Over the recent 4 years (1977~`80), major cause of maternal deaths or risk factors was hemorrhage (22.0%, all of 2 cases were due to abruptio placentae), and the hemorrhagic deaths were in increasing tendency when it is compared with the early 1960s` ( 10.5%, 1961~`66). The rest of death were due to preeclampsia (11.1%, 1 death), sepsis following pregnancy termination (1/9 deaths) and anesthesia (1/9 deaths). Over the past 20 years it was important to noted that the hospital maternal deaths rate due to sepsis following pregnancy termination, hemorrhagic abruptio placentae and infectious hepatitis apperaed to be increased although the deaths due to toxemia or uterine atonic bleeding have been relatively decreased. 3.Indirect causes of hospital maternal deaths or risk factors ( 3 cases over the recent 4 years): The incidence of infectious hepatitis-deaths was markedly increased up to 22.2% or 2 cases of total deaths over the recent years. It was compared with 5.3% of late 1960s`(1967~`71) and 15.4% of early 1970s` (1972~`76). The other was ruptured cerebral aneurysm. 4.Deaths on arrival (D.O.A.): Over the recent 4 years (1977~`80). there were 12 cases of deaths on arrival. The major causes of D.O.A. were also hemorrhage (33%, 4 cases), eclampsia (17%, 2 cases), septic abortion (17%, 2 cases), amnionic fluid embolism (17%, 2 cases), and anesthesia (17%, 2 cases). Two cases of hemorrhagic deaths were due to retained placenta resulted from home deliveries without medical attendant. And the other 2 cases of hemorrhagic deaths transferred from general practitioners were a case of uterine rupture probably due to oxytocin abused and a case of abruptio placentae. 5.Preventability of maternal deaths. (1)The hospital deaths. The possible preventable maternal deaths over the recent 4 years (1977~`80) accounted for 55% or getting less to about one-half of the early 1960s` (905) because not only the incidence of delayed admission or lacking the prenatal cares by patient-herself against the serious risk factors of toxemia or abruptio placentae have been markedly decreased, but the medical management of toxemia or post-abortive sepsis seemed to be improved. However the inevitable deaths including infectious hepatitis, choriocarcinoma or ruptured aneurysm were significantly increased over the recent years or late 1970s`(1977~`80). (2)The deaths on arrival: Over the recent years (1977~`80) the incidence of preventable deaths on arrival among the home deliveries on delayed admission transferred from the family side were fortunately decreased to 25% of the total D.O.A. or one-half of the early 1960s`(53.3%). However one of the unsolved problems was that the incidence of preventable D.O.A. referred from general practitioners were 50% of the D.O.A. or increasing steadily over the recent years. All such causes of the D.O.A. or risk factors were considered to be and result of the unskilled managements including bougination for termination of midtrimester pregnancy, toxemia or obstetric anesthesia.

제왕절개술의 변천과 모아 양측의 예후

이제옥(JO Lee),안영옥(YO Ahn),이남희(NH Lee),우복희(BH Woo),강신명(SM Kang) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.10

2년간 제왕절개술(1980~81) 936예를 대상으로 관찰 분석한 결과 다음과 갈은 결론을 얻었다. 1. 전체적인 제왕절개술의 빈도는 최근 80년대 초에 와서 27.3% 그 중 첫제왕절개술의 빈도는 18.5%로서 10년전(1961~63)에 비하여 각각 2배로 증가된 추세에 있었다. 2.. 첫제 왕절개술의 적응증은 난산을 위한 것이 75% 즉 대부분을 점하였고 그 증 특히 둔위를 위한 제왕절개술이 최근 11% 즉 상당히 증가된 추세로 포함되었다. 3. 제왕절개술후 모체측 합병증은 적었으며 보통 볼 수 있는 자궁내막감염(2.9%) 창상감염(2.2%)등 이었다. 4 모성사망은 자간발작환자 제왕절개술후에 1예(0.075%)있었는데 이것은 비교적 적은 빈도이었다. 5. 분만방법 개선과 신생아사망 감소. 1) 첫둔위분만방법을 과거 1961-63년대의 질실분만 위주 즉 소극적인 제왕절개 분만방법(15%)에서 최근 2년간(1980~81) 둔위제왕절개분만 위주(79%, 140예)로 둔위분만방법을 개선한 결과 둔위분만손상에 의한 태아장애빈도가 1/10로 현저히 감소(29%→1.5%)되었고 둔위 신생아 사망도 0으로 모두 예방되었다. 2) 선택적 진통없는 제왕절개술 338예에 대하여 술전 Oxytocin 자극방법 적용으로서 초자막질환 이환에 의한 사망을 전부 예방할 수 있었다(대조군 596예 중 1예 사망). 전체 주산사망은 평균 1000분만당 22.5였다. 특히 신생아 사망은 전체 제왕절개술의 0.9%로서 과거 10년전 2.4%)에 비하여 감소되었다. This study was an analysis of 936 cesarean sections done among 4830 cases of deliveries at Ewha Womans University Hospital, Seoul during 1980 to 1981. In recent years, the indications for cesarean section has been changed. The purpose of this paper is to discuss the change of indications for or increased incidence of cesarean section, the end result for both maternal and perinatal morbidity and mortality. The results obtained were as follows; 1. Overall incidence of cesarean section was 27.3% or 1319 cases of 4830 deliveries, while primary cesarean section rate was 18.5% or 895 cases of cases of 4830 cases. 2. In 614 cases of primary cesarean section, the dystocia was the most frequent indication (75% or 463 cases). Among the dystocia, primary breech cesarean sections were markedly incerased(11% or 69 cases) in recent 2 years. The other frequent indications were antepartum bleedings (6.5% or 40 cases) .including placenta previa (5.4%) and abruptio placente (1.1%), and fetal distress (5.7% or 35 cases) in order. 3. The maternal complications in cesarean sections in this series were relatively low. There was only 2% or 27 cases of 936 cases with endometritis and a few cases of wound infections (2.2% or 21 cases). 4. We have encounterd with 1 case or 0.075%(1:1319) maternal death among 1319 cesarean sections. The cause of death was cerebral homorrhage due to eclamptic convulsion 5. The policy of primary breech cesarean section and perinatal death; (1) Since we have established policy starting from 1980 to 1981 that almost all (79% or 140 cases) primary breech presentation has been delivered by cesarean section, the perinatal death or traumatic delivery was reduced completely or down to 0. It was compared with 10 cases or 6% of higher perinatal deaths (corrected) during the era of early 1960s (1963~68) with conservative delivery method or 85% of primary breech presentation has been delivered vaginally. (2) Neonatal mortality due to hyaline membrane disease 338 cases of elective (without labor) cesarean section has

복식 선택적 유산술에 관한 임상연구

전정희,이남희,문정주,정미은,조지영 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.8

Over the past 30 years , there has been an increase in the incidence of multifetal pregna-ncies , primarily because of the introduction of ovarian stimulants for ovulation induction and assisted reproductive technology ( ART ) in infertile patients. It is well established that multifetal pregnancies are associated with an increased frequency of the maternal complications and gre-ater perinatal morbidity and mortyality. The adverse outcome of multifetal pregnancies is dire-ctly proportional to the number of fetuses , primarily as an consequence of prterm delivery. Re-duction in the number of fetuses in multifetal pregnancies has been proposed as a way to impr-ove the perinatal outcome in this situation. Therefore , selective fetal reduction ( SFR ) is sugges-ted as a therapeutic option for continuation of pregnancy with fetuses mature enough to survi-ve. In this paper , we report our infertility clinic experiences with 6 patients who carried mult- ifetal pregnancies including 1 quintuplet , 1 quadruplet, and 4 triplets. from January, 1991 to May, 1996, transabdominal SFR was accomplished by fetal intrathoracic KCl injection at 9∼10 weeks of gestation. After the prcedure , 4 patients remained as twin pregnancies, and 2 patients as single pregnancy. There have been 3 sets of twin deliveries and the 2 sets of single delivery. One case was aborted. Two patients were delivered after 37 weeks of gestation , 2 patients were at 35 weeks , and 1 patient at 24 weeks. All babies have been healthy after birth in patients after 35 weeks gestation. There was no fetal anomaly related to the procedure in the 6 cases. We concluded that transabdominal SFR is a rather safe and useful procedure that may improve the outcome of multifetal pregnancies.

만삭임신부의 유도분만에서 Misoprostol과 Dinoprostone 질정의 비교

김성희,이남희,안현숙,전미경,신지원 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.9

Our purpose was to compare the safety and efficacy of intravaginal misoprostol versus dinoprostone vaginal tablet for induction of labor at term pregnancies. Two hundred three patients with indications for induction of labor at term were randomly assigned to receive either intravaginal misoprostol or dinoprostone vaginal tablet. Fifty micrograms of misoprostol was placed in the posterior vaginal fornix every six hours, with a potential maximum of four doses. 3 milligrams of dinoprostone vaginal tablet was placed in the posterior vaginal fornix every eight hours, with a potential maximum of three doses. Further medication was withheld with the occurrence of spontaneous rupture of membrane, entry into adequate contraction pattern(twenty second sustained with two or more frequent uterine contraction in 10 minutes), nonreassuring FHR tracing, or delivery. Artificial membrane rupture with both study protocol was done at the discretion of the attending physician. After membrane rupture, in the cases of failure of active labor or arrest of dilation, oxytocin was administerated. Among those evaluated, 100 received misoprostol and 102 received dinoprostone. The average interval from start of induction to vaginal delivery was shorter in the misoprostol group(784.7±389.3 min) than in the dinoprostone group(988.3±369.5 min)(p$lt;0.01). There was no significant difference in change of Bishop score between the two groups. No statistically significant differences were noted between two groups in case of need for oxytocin and oxytocin total dose, but significant difference was noted between two groups in case of indication for oxytocin augmentation. There were no significant differences in the routes of delivery. Intravaginal administration of misoprostol appears to be as effective as dinoprostone vaginal tablet for labor induction at full term pregnancies. Complications associated with prostaglndin administration were not statistically different between the two treatment groups. The cost of misprostol(100 won/50ug) is much less than that of dinoprostoe vaginal tabler.

자궁내 융모상피암의 보존적 수술요법 3 례

민보은,김정혜,이남희,전미경,송진희,문정주 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.8

In treating young women for gestational trophoblastic tumor ( G.T.T. ) , all efforts are made to preserve fertility and hysterectomy is avoided unless absolutely essential. However , in some cases the operation may be lifesaving. During the last 20 years among the 310 cases of G.T.T. treated at Il Sin Christian Hospital , there were 3 cases in which hysterectomy was avoided by the excision of a localized uterine lesion thus preserving fertility.