자궁각임신파열의 1례

전혜자(HJ Chun),김자혜(JH Kim),정여정(YC Chung),이규현(KH Lee) 대한산부인과학회 1971 Obstetrics & Gynecology Science Vol.14 No.2

본이화의대산부인과에서 과거8년간 총분만 13942예중 자궁각임신파열은 첫예이었다. In the 8 year period from Jan. 1963 to May 1970, a single case of ruptured cornual pregnancy was experienced in a total of 13,942 deliveries at Ewha Womans University Hospital Seoul. The patient, gravida 3, para 2, 41 year of age, 20 wks pregnant woman was admitted into emergency room in may 24, 1970 with shock state followed by continuous lower abdominal pain with occasional vomiting for passed 3 days. The patient believed by herself that she has been pregnant for 5 months with last menstrual period started from Dec. 23, 1969, with 3 days duration. On the admission blood pressure was 60/30 mmHg, pulse 120/min, and the abdomen showed relatively flat and no appreciable tender or rigidity at that moment which is to be believed a usual clinical characteristics of cornual pregnancy after it`s rupture has been occured. We are suspected that was a definit acute abdomen either a ruptured malignant destructive mole or ruptured tubal pregnancy, and was operated immediatly. The operative finding showed that the right cornus of the uterus was completely ruptured and both the dead fetus with 20 wks gestation and completely separated placenta were escaped from the cornual into the abdominal cavity freely. Following total abdominal hysterectomy with bilateral salpingo-oophorectomy and 4 pints of blood transfusion given the patient was recovered well in 7 days hospitalization.

견위분만

강신명(SM Kang),전혜자(HJ Chun),강민자(MJ Kang),조정신(JS Cho) 대한산부인과학회 1971 Obstetrics & Gynecology Science Vol.14 No.7

본 이화의대에 입원한 견위분만의 발생빈도는 과거 6년간 총분만 10679명중 276명으로서 1:36즉 2.5%였다. Management of the breech delivery is still a difficult problem because there is no practical way of measurement of fetal biparietal diameter up to date, and fetal mortality remains still high. It seemed very important to evaluate the pelvic capacity and to juge the fetal size accurately by experienced obstetrician before the labor takes place in order to reduce the unnecessary fetal loss or hypoxia which affect second generations. The data to be presented are based on 276 cases of breech presentation seen past 6 years between January 1963 and December 1968 in Ewha Woman`s University Hospital, Seoul, Korea. the following results were obtained. 1. The incidence of breech delivery was one in every 38 cases or 2.5% of 10,679 cases of total deliveries during past 6 years. In this study, breech presentation associated with twins and infant weighing under 1,000gm were excluded. 2. Placenta previa is a most commonly associated etiologic factor(6 cases) in breech presentation in which the incidence is significantly high, 3 times the average one in this institute. 3. Operative delivery or Cesarean section was required in 19% of the total cases of breech presentation with 1,000gm or more of the birth weight, and in 24% of the cases of term breech presentation. 4. In cases of that anteroposterior diameter of pelvic inlet in 10cm or less, or interspinous diameter of mid-pelvis is 9.5cm or below, approximately one-half(48%) of the cases of breech presentation necessitated Cesarean section. 5. In general, the more big the infant`s birth weight the greater the incidence of Cesarean sectionrequired such as 28% done in the moderate sized infants (3.0kg-3.49kg), and 37% in the rather large infants weighing 3.5kg-3.99kg in breech presentation. 6. In careful revewing the fetal distress in vaginal breech delivery according to the birth weight, the frequency of infant with poor condition or lower Apgar Score of 6 or less were 19% of the cases among average term babies weighing 3.0kg. However in case of infant body weight exceeding 3.0kg, the hypoxic infant rate were significantly increased up to 61% of the case or 3 times the one with 3.0kg birth weight. Severe hypoxic infants with Apgar Score of 4 or less were apt to occur in the footling presentation (68%), twice as much as that in complete breech presentation. No fetal fractures or dislocation and Erb`s paralysis were seen in this whole subject. 7. When dealing with breech vaginal delivery, over all 6 cases of more than average sizd infant wighing from 3.3kg to 3.5kg or more were dead due to breech delivery whereas all alived among 132 cases of average size of infant weighing from 3.0kg-3.2kg. However, infants weighing 3.3kg or more who were deliveried by Cesarean section were all alived. In this whole series of breech presentation, no maternal death were ween except 3 cases of mild degree of cervical lacerations. 8. The corrected perinatal mortality in the vaginal breech delivery was 9.3% among the premature infants and 4.1% among the term babies.

자궁외임신

김자혜(JH Kim),강민자(MJ Kang),전혜자(HJ Chun),강신명(SM Kang) 대한산부인과학회 1971 Obstetrics & Gynecology Science Vol.14 No.7

1963년 1월부터 1969년 12월까지 7년간에 걸쳐 본 이화여자대학교 의과대학 산부인과에서 자궁외 임신으로 진단 입원하여 수술받은 313예에 대하여 조사한 결과 아래와 같은 결론을 얻었다. 1) 자궁의 임신의 발생빈도는 매 41분만에 한 즉 2.43%였다. 2) 호발연령층은 31-36세군이 34.8%로 제일 많았고, 경산회수 1-2회가 36.2%로 제일 많았다. 3) 자궁외 임신환자의 과거력에 있어서 소파수술이나 임신중절수술을 받은 경험이 있는 경우가 50.4%로 많았고, 다음이 개복수술을 받은 경우로 13.1%였다. 4) 임상증상으로는 하복통이 92.7%로 제일 많았고 다음이 질출혈로서 68.6%였다. 월경이 걸른 경 우는 53%였으며 4-11주 걸른 경우가 87.3%였고, ruptured type 자궁외임신은 85%였었는데 culdecentesis 양성율은 68%였다. 5) 오진한 경우는 단 5예로서 1.60%였고, Novak의 15-30%보다 훨씬 낮았다. 6) 입원에서 수술까지의 시간적관계는 80%에서 입원 2시간 이내에 수술할 수 있었고, 쇼크환자의 40%에서 30분 이내에 수술할 수 있었다. 7) 난관임신이 90%였고, 그 중 ampullar 부위가 44.4%로 제일 많았고, 8예의 cornual 부위와 2예 의 자궁경관임신이 있었다. 8) 쇼크상태로 입원한 경우는 27.8%였고, 난관이 파열된 경우는 85%였다. 9) 수술은 주로 난관절제수술을 하였고, 47.9%에서 incidental appendectomy를 하였으나, 이로 인 한 후유증은 하나도 없었다. 도착사(D.O.A.)는 1명 있었으나, 자궁외임신의 치료, 수술을 받은 환자중에서는 사망자가 없었다. Ectopic pregnancy is rearly an urgent and dangerous one. Diagnosis of the certain cases are still remain difficult such as unruptured one, associated with pelvic inflammatory disease, chronic ectopic pregnancy or sort of one refered from other clinic after D & C done under the impression of incomplete or complete abortion. We would like to imphasize that every minor vaginal surgery or curettage should be aseptic and active prevention on the tubal infection never be ignored in order to minimize the high incidence of ectopic pregnangy. The data to be presented are based on 313 cases of ectopic pregnancy operated on at the Ewha Woman`s University Hospital, Seoul Korea for past 7 years(1963-1969). The results were obtained as follows; 1. The incidence of ectopic pregnancies were 1:41 or 2.43% of deliveries. 2. approximately one-third (34.8%) cases of ectopic gestation have occurred at middle age group ranging from 31 to 36 year of age. 36.2% of the total subject were found to be multiparous women 1 or 2 parities. 3. It is important to notice that one-half (50.4%) cases of ectopic gestation were one who had at least one episode of curettage or induced abortion. 13% cases of all subject were one with past history of laparotomy for some lesion. These factors were strongly suggestive of a casusative factors followed by relatively silent plevic infection, which an not be ignored. 4. Most frequent symptoms of ectopic pregnancy were lower abdominal pain(92.7% of the cases) and vaginal spotting (68.6%). Skipped menstruation were about one-half (53%) of the cases and it was generally (87.3%) delayed 4 to 11 weeks. the means of culdecentesis is considered a safe and useful measures, but it`s diagnostic accuracy or positive findings were slightly more than 1/2 or 68% of the cases although the most (85%) cases of ectopic pregnancy were encountered as known ruptured type. 5. Misdiagnosed case for ectopic gestation were only 5 cases (1.60%) in which considered significantly lower in comparison with some other report of 15 to 30%. 6. We believe that times required from admission to surgery were very adequate Most of the cases (80%) were operated on within 2 hours, especially patients with severe shock or 40% of over all cases with shock were undergone surgery in 30 minutes. 7. The incidence of tubal pregnancy were 90% of the total subjects. It`s most frequent site were ampullar portion (44%), then often isthmic protion (15.3%). Less common varities were 8 caes of cornual pregnancy and 2 cases of cervical pregnancy encountered. 8. Approximately one-quater (27.8%) cases of ectopic pregnancy were in critical shock state on the admission. Most cases (85%) were ruptured one on the admission except rare incidence (15%) of unruptured lucky one. 9. The treatment of choice in tubal pregnancy is removal of the affected tube except extensively ruptured angular pregnancy which should need prompt total hysterectomy and other additional surgery for concomitant lesions. We carried out incidental appendectomy on 80% cases of the ectopic gestation without any postoperative complications or any increased incidence of recurrent ectopic geatation. Fast pressure blood transfusion through multiple route is mandatory in emergancy or operating room. There was no mortality except 1 case of D. O. A..