모성사망에 관한 임상적고찰

전정희(JH Jeun),안미란(MR Ahn) 대한산부인과학회 1974 Obstetrics & Gynecology Science Vol.17 No.1

모성 사망의 대부분은 예방 가능한 질환으로 인한 사망이었다.(85%) 반수 이상의 환자가 너무 늦게 중환자로 도착하였거나 산전관리의 부족때문이었다. 아마 이들 중의 약간은 조산원 또는 의사의 잘못도 있다고 생각된다. 확실히 우리들은 산전관리의 중요성을 강조하는 교육과 계몽이 의료인에겐 물론 일반인에게 필요하다고 생각된다. 의사들의 잘못은 패혈증은 항생제의 남용과 그 내성 때문에 참으로 곤란한 문제라고 생각된다. One hundred and two cases of maternal deaths in Il Sin Women`s hospital were reviewed during a period of 4 years and 5 months from April 1967 to September 1971. This was done not to lay blame on any particular person but inorder to try and prevent future deaths. Major cause of deaths were toxemia (57%) and hemorrhage (28%). Over one half of maternal deaths expired in first 24 hours of admission (52%). Death rate-3.3 per 1,000 deliveryand 51.8 per 10,000 live birth. Most deaths were preventable (85%). Over one half due to patient delay and lack of prenatal care. Probably some of these are the fault of doctors and midwives too. Certainly we need to push education in the value of ante-natal care. Doctors failures were septic induced abortion, delayed in replacing blood loss. Sepsis is a difficult problem because of wide use of antibiotics and resistance to drugs.

전 제왕절개 수술후의 분만에 관한 임상적 고찰

김보경(BK Kim),전정희(JH Jeun),윤정혜(JH Yeun) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.8

1969년 1월부터 1973년 5월까지 부산 일신부인병원에서 제왕절개 수술이나 자궁절개 및 자 궁파열의 과거력이 있고 그후 다시 분만한 500례를 연구하였다. 첫 자궁절개 방법이 자궁체부 절개였던 환자는 제왕절개 수술을 반복하였고 이번 임신이나 분만중 다시 제왕절개를 해야할 이유가 잇는 환자를 제외하고 첫 자궁절개 방법이 자궁경부 라면 시도분만하여, 질분만 성공률이 79%였다. 즉 500예중 140례는 무의미한 개복수술을 피하여 정상 질분만에 성공한 것이다. 고로 적당 한 조건하에 분만을 시도해 보는 것이 좋은 방침이며 once a section alwasy a trial이라는 말도 어느 정도 타당하다고 생각된다. 1. Trial labour was attempted where the invasion at previous cesarean section was known to have been in the lower segment unless there was a recurrent or new indication for cesarean section. Where the previous operation was known to have been a classical cesarean section elective repeat operation was done except in some cases where the patients presented late in labour. 2. One hundred and forty eight cases had elective cesarean section (30%) 119(24%) emergency cesarean section 37(7%) cesarean section after failed trial labour and 196 (39%) had a vaginal delivery. 3. A trial labour was attempted in 177 cases with succeful vaginal delivery in 140 (79%) 4. Indication for elective cesarean section were cephalopelvic disproportion in 66 (45%), previous classical cesarean section in 55(37%) and abnormal lie or presentation in 13(9%). 5. Indication for emegency non-elective cesarean section were C.P.D in 49(41%) previous classical cesarean section or ruptured uterus in 27 (23%) abnormal lie or presentation in 13 (11%) fetal distress in 8 (7%) ruptured unterus in 5 (4%) and others in 17 (14%) 6. indication for cesarean section after failed trial were C.P.D in 24 (65%) fetal distress in 6 (16%) and others in 7(19%) 7. The uterine incision at the preceding operations had been lower segment in 357 (67%), upper segment in 137(26%) repair of rupture in 4(1%) and was known in 34(6%) of preceding operations were done at Il-sin 96% were lower segment.

무뇌아 임신 137 례의 산과적 고찰

김혜숙(HS Kim),김성이(SY Kim),전정희(JH Jeun),민보은(BE Min) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.3

본 일신기독병원에서 1973년 1월 1일부터 1984년 12월 31일까지 12년동안 분만한 총 77,485명에서 나타난 무뇌아 임신 137레에서 관찰된 결과는 다음과 같다 1 무뇌아의 발생빈도는 출생아 1,000에 대해서 1 8이다 2 40세 이상의 고령산모에서 무뇌아 발생빈도가 높다 3 출산 횟수와 무뇌아 발생빈도 사이에는 관계가 없다 4 태아의 위치는 안면위와 둔위가 현저히 많은 빈도를 보였다 5 무뇌아는 여아에서 높은 발생 빈도를 나타냈다 6 산과적 합병증으로 양수과다, 견갑난산, 지연분만, 과숙임신이 증가했다 7 무뇌아의 재발률은 1,000분만당 43이다 This report was based on 137 cases of anencephaly among 77,485 total births at Il Sin Christian Hospital during the period between Jan 1, 1973 and Dec 31, 1984 1 The overall incidence of anencephaly was 1 8 per 1000 births 2 The incidence of anencephaly was higher when the maternal age was 40 and over, but there was no relationship between parity and incidence of anencephaly 3 The diagnosis of anencephaly was made during or after delivery in 40% of the cases, almost all of the these patients being emergency admissions In 60% the diagnosis was made during the antenatal period but of these patients 50% were already at or postterm 4 There was a significant increase of face and breech presentation compared to the overall hospital incidence: 19 4% compared to 0 1%(p<0 005) and 12 7% compared to 6 4% respectively 5 There was a reversal of the usual sex ratio of M:F=0 93 to a preponderance of females to give a ratio of M:F=1:1 23 6 These was significant increase in some obstetric complications both during pregnancy and labor or at delivery compared to the overall hospital incidence The complications with an increased incidence were hydramnios 40 2% compared to 0 3%, postmaturity 24 1% compared to 6 6%, prolonged labor 13 9% compared to 4 3% and shoulder dystocia 5 8% compared to 0 1% 7 There was a significant increase in incidence of anencepalic pregnancy 43/1000 deliveries in the next 93 viable pregnancies after the initial anencephalic pregnancy Early diagnosis of anencephaly and termination of pregnancy could be of great benifit to the mother by reducing obstetric complications and psychological stress

양수과다증 85 례의 임상적고찰

김현주(HJ Kim),홍경화(KW Hong),홍희선(HS Hong),전정희(JH Jeun) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.11

1981년 1월부터 1986년 12월까지 일신기독병원에서 진단된 양수과다임신 85예, 97태아의 임 상적 고찰의 결과는 다음과 같다. 1. 발생빈도는 1000분만당 2례(0.2%)였다. 2. 초임부에서 적게 발생하며 20-24세에 많고 25-29세에 적게 발생했다. 3. 85례중 93.8%에서 질식 분만ㅇ르 하였고, 6.2%에서 제왕절개수술을 했다. 둔위 분만이 병 원 비에 비해 10배이상 높았다. 4. 모체 및 분만에 따른 합병증으로 조기 진통이 가장 흔한 합병증이었고, 다태 임신, 임신 성 고혈압 동반이 현저히 높았으며, 태반 조기 박리와 산후 출혈의 빈도도 높았다. 5. 태아 합병증으로는 27.8%의 사산률과 54.6%의 신생아 사망률을 보였으며, 75.2%의 조산 아와 51.5%에서의 태아 기형을 보였다. 주산기 사망율이 1000분만당 824.7명이엇고, 교정 주산기 사망률도 1000분만당 505명이었다. A review of 85 cases of hydramnios which occured among 42280 delivery, an incindence 0.2% at Il sin Christian hospital between January 1st. 1981 and December 31st 1986 is presented. Hydramnios was defined as those cases in which the volume of liquor was measured as 2000 mls or more. Associated maternal and fetal conditions were evaluated and compared to the clinical course and outcome of each pregnancy. Among the 85 cases of hydramnios the associated factors was multiple gestation 12 cases (14.1%) pre-eclampsia 10 cases (11.8%) and 50 caese with congenital malformation but in 25 cases (29.1%) no cases could be found . 32 (38.9%) cases were associated with spontaneous onset of premature labour and 19 (22.4%) were associated with abnormal presentation. There were 97 infants delivery and these 73 (75.2%) were premature. The total perinatal morthality rate was 824.7 per 1000 delivery and even when it was corrected to exclude to babies with malformations incompatible with life and those under 1000gm the perinatal mortality rate was still 505 per 1000 delivery. Appropriate mangagement is essential in order to reduce maternal complications and where possible perinatal mortality and early diagnosis of fetal abnormalities by ultrasonogram is an essential part of the management.

Prostaglandin E2질정에 의한 유도분만의 효과

한선남(SN Han),김양숙(YS Kim),이진희(CH Lee),박숙현(SH Park),전정희(JH Jeun),민보인(BI Min) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.1

In order to determine the clinical usefulness of Prostaglandin E2 vaginal pessary in the induction of labour a stable 3mgm Prostaglandin E2 pessary supplied by Korea Upjohn Ltd. was used in the induction of labour in 66 patients admitted to Il Sin Women`s Hospital, Busan, between November 1982 and February 1983. In 19 cases the maximum does of 6mgm was used, a second 3mgm pessarybeing inserted 8~15hrs after the first pessary. Results 1. PGE2 pessaryalone was successful in inducing labour in 32 patients, 48.5%, and was considered to be a definite aid in a further 19, 28.8%. 2. In addition to the 32 patients already delivered or in active labour the action of cervical ripending was seen in an additional 9 patients in that the Bishops score increased by 3 points within 15 hours after the insertion of one 3mgm pessary. 3. In cases successfully induced by PGE2 pessary the average interval between rupture of the membranes and delivery was very short. 2.7hrs, and the average duration of labour was 5.4hours. 4. The overall Cesarean section rate was 21.2% but none was done for failed induction. The main indication was C.P.D., 11 out of 14 patients. 5. The incidence of postpartum hemorrhage, that is a loss of 500cc or more, was slightly higher than the overall hospital incidence. 6. Side effects were minimal. One patient vomited but only 10mls and among 29 pre-eclamptic or eclamptic patients in only 10 was there a change in the blood pressure, an increase by 20mmHg in 7 and decrease by 20mmHg in 3, within 3 hours of insertion of the pessary. 7. There were no episodes of fetal distress that could be attributed to PGE2 administration. 8. The factors possibly affecting the success rate, Bishop`s score, parity, gestational age and indication for induction were analysed. The indication for induction and gestational age were significant factors but parity and Bishop`s score had no affect on the outcome. Among patients with hypertensive complications of pregnancy there was a high success rate but a very low success rate in patients with post mature pregnancies and in these cases apart from one patient there was no other obstetric indication for induction. The high success rate in preterm pregnancies was irrespective of parity of Bishops score but there was always a definite obstetric indication for induction in these cases and this is considered to be the more important factor. This study also shows that the PGE2 pessary is simple to use, acceptable to the patient, has almost no side effects and can be safely used in all cases in which vaginal delivery is possible with a high rate of success. It is planned to continue the use of PGE2 pessary when it is commercially available.

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

골반경 수술 219 예의 임상고찰

정미은(ME Jung),안현일(HI Ahn),백미경(MK Baek),양정미(JM Yang),전정희(JH Jeun) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8

1995년 1월부터 1997년 12월까지 시행한 골반경 수술 219예를 고찰하여 다음과 같은 결과를 얻었다. 1. 골반경 수술 환자의 연도별 분포는 1995년 33예, 1996년 53예, 1997년 133예였다. 2. 골반경 수술의 적응증으로는 자궁외임신이 118예 (53.9%)였고, 난소 낭종 42예(19.2%), 불임 20예(9.1%)였 고 난소 낭종에서는 자궁 내막종이 17예로 제일 많았다. 환자들의 평균 연령은 31±6.7세였다. 3. 환자들의 평균 출산력은 0.77회였고, 대부분 2회 이 하의 출산력을 가졌다(94.6%). 4. 복부 수술의 기왕력이 있었던 경우는 36예로 전체의 16.44%였고, 복강경하 난관결찰술이 12예로 가장 많았다. 5. 골반경 수술의 종류로는 난관절제술이 115예로 31.5%, 유착박리술이 47예로 12.9%, 난소낭종절제술이 36예로 9.9%순이었다. 6. 평균 실혈량은 LAVH가 500 cc, CISH가 150 cc였으 며 그 외 대부분은 100 cc 이하였다. 7. 술 후 입원 기간은 2일이 86예로 39.3%였고, 1일이 83예로 37.9%, 3일이 20예로 9.1%였다. 8. 골반경 수술의 합병증이 발생한 경우는 26예로 전체 의 11.8%였고, 38℃ 이상의 고열이 13예로 가장 많았다. From January 1995 to December 1997, a total of 219 cases pelviscopic surgery was performed at Il Sin Christian Hospital. To evaluate the safty and efficacy of pelviscopic surgery, we reviewed indication of operation, mean age, parity, history of abdominal operation, type of operation, duration of hospitalization and complication retrospectively. The number of pelviscopic surgery have risen from 33 cases in 1995 to 53 cases in 1996 and 133 cases in 1997. The most common indications were 118 cases for ectopic pregnancy (53.9%) and 42 cases for ovarian cyst (19.2%), 20 cases for infertility (9.1%) in order. Among the ovarian cyst, endometrioma was the most common. The mean age of patients was 31±6.7 years old and mean parity was 0.77. In most cases, mean blood loss was lesser than 100 cc except 500 cc in LAVH, 150 cc in CISH, 106.7 cc in ectopic mass removal. The postoperative hospital stay was varied from 0 day to 10 days, but usually 2 days. The 26 cases had complicated and the most common complication was fever above 38℃. In conclusion, it is evident that pelviscopic surgery is lesser invasive technique, has lower complication rate and shorter the length of hospitalization. So, we expect the number and indication of pelviscopic surgery will be increased in future.

임신중기 양수천자술에 의한 산전유전질환 진단

전정희,서성숙,황혜란,전성숙,박숙자 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.9

1990년 8월부터 1993년 3월말까지 일신기독병원에서 실시한 125예의 양수검사상 다음과 같은 결과를 얻었다. 1. 35세이상의 연령군이 25.6%로 대조군에 비해 현저히 높았다. 2. 산전유전질환 진단목적으로 시행한 양수검사의 적응증은 모체혈청 태아단백이상, 이전 염색체이 상아 출산기왕력 및 고령산모의 빈도순이었다. 3. 양수천자의 성공률은 97.6%이고 배양성공율은 88.7%이며 합병증의 빈도는 0.8%이었다. 4. 비정상적인 핵형 발견률은 3.4%이고 이중 임신중절이 절대적으로 필요한 경우는 0.8%이었다. One hundred twenty five3 women were attending the antenatal clinic of Il Sin Christian Hospital had a midtrimester amniocentesis between August 1990 and March 1993. The result were analized in reference to maternal age, indication of amnocentesis, sucess rate and pregnancy outcome. 25.6% were aged 35 and over significantly higher than overall 2.7% for this age group. The major indications was abnormal maternal serum alpha feto-protein 25.6%, previous chromosomal abnormality 22.4%, advanced maternal age 21.6% previous fetal anomaly 16.0%. The success rate of aspiration of amniotic fluid was 97.6%but culture rate of fetal cell case 88.7%. The abnormal karyotypes were found in 4cases(3.4%) that 3 cases of 9 inversion and 1 case of Truner syndrome. The complication rate of amniocentesis was 0.8% i.e. 1 spontaneous abortion 1 day after repeat aspiration. The pregnancy outcome was full-term delivery 87.7% premature delivery 1.3%, termination of pregnancy 5.5% and FDIU or spontaneous abortion 5.5%

습관성유산 환자에서의 차후 임신예후에 관한 임상고찰

전정희,홍희선,이은희,홍옥련 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.1

1982년 11월에서 1987년 12월까지 일신기독병원 산과를 내원, 입원, 분만한 습관성유산의 기왕력을 가진 유산군 100명중 자궁외임신 2례와 쌍태임신 1례를 제외시킨 97명을 연구군으로, 같은 기간에 본원을 내원, 입원, 분만한 초임부 100명을 임의 추출해서 자궁외임신 1례, 쌍태임신 2례를 제외시킨 97명을 대조군으로 각각의 임신결과를 분석하였다. 1. 모성합병증으로 태반용수박리의 빈도가 10%로 대조군 1%에 비해 현저하게 높았다. 2. 성공적 만삭임신율은 72%, 초임부 대조군 89%였다. 3. 유산율 10%, 조산율 18%로 대조군 3%, 8% 보다 의미있게 높았다. 4. 저 체중아의 빈도는 5.7%로 대조군 15.9%보다 낮았다. 5. 선천기형의 빈도가 6.9%로 대조군 1.1%보다 높았다. 6. 신생아사망율 81%, 주산기 91%로 현저히 높았다. 7. 모성연령, 신장, 교육정도, 분만 과거력, 태아성별, 자연유산횟수 등은 임신결과에 영향을 미치지 않았다. A retrospective clinical evaluation of ninety-seven women with a prior history of habutual abortion (three or more consequtive spontaneoud abortions) was done to determine the effect of prior abortions on subsequent pregnancy outcome. The incidence of abortion was 10 %, prematurity rate 18 %, neonatal death rate 81/1000 live births, congenital anomaly 6.9 % and perinatal mortality rate 91/1000 deliveries. The incidence of all of these being higher than that in the control group of singleton primigravida pregnancy. However, the incidence of small for gestational age 5.7 % was lower than in the control group 15.9 %. The successful term pregnancy rate was 72 %. A history of previous successful delivery, the number of recurrent abortions, maternal age, height, education and sex of infant did not influence the pregnancy outcome of the study group. This data on pregnancy outcome should be useful in reproductive counseling among women with recurrent pregnancy losses.

진단적 복강경 305 례의 임상적 고찰

전정희,이선희,이유희,허성희 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.9

A clinical analysis of 305 consecutive cases of diagnostic laparoscopy from Jan. 1986 to Dec. 1994 was performed. Suspected ectopic pregnancy was the most common indication(51.4%) and the next was infertility(39.2%). In 74% of 157 patients with suspected ectopic pregnancy, the diaagnosis was confirmed by diagnostic laparoscopy which avoided unnecessary laparotomy in 26% of these patients. In 67.5% of 120 infertile patients, pelvic abnormalities were found. Tubal occlusions and pelvic adhesions were the most common abnormalities. In investigating tubal patency, there was a discrepancy rate between hysterosalpingographic and laparoscopic findings in 30% of the infertile patients. The false positive rate of HSG was 8.0%. The false negative rate of HSG was 22.1%.