Cantrell씨 증후군 l례

차인환(IW Cha),유명숙(MS Yoo),박인서(IS Park) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.9

Cantrell씨 증후군 1예를 경험하였기에 문헌고찰과 함께 국내 최초로 보고하는 바이다. Cantrells pentalogy syndrome is characterized by absence of lower sternum, diastasis of the rectus muscles, defects of anterior diaphragm and adjacent pericardium and epigastric hernia, all associated with left ventricular diverticulum, dextrocardia, and other cardiac anomalies. We have experienced this syndrome in Korea for the first time and we are to report it with brief review of literature.

10대 여성의 임신 및 유산에 관한 의학적 고찰 ( II )

박인서(IS Park),엄승호(SH Ohm),차인환(IW Cha),정병철(BC Jung) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.1

조사대상은 대도시 종합병원에서 엄격히 선별하였다. Nowadays industrialization and a complex urban society unduly prolong education and delay marriage and sexual gratification. Teenage reach sexual maturity at an earily at an early age, leaving a 5-10 year gap between sexual maturity and sexual activity ligitimized by marriage. Furthermore little attention has been given to the adolescent who are more susceptible and vulnerable than adults in physical, socoeconomical, and psychogical aspects. For the purpose of obtaining the medical aspects of pregnancy and abortion in adolescence in Korea, 385 cases out of 28,688 deliveries at the 4 university hospitals in Seoul during the period of 1974-1978 were studies with demographic review of Korea population. The results were as follows: 1. The collection and study were carried out in 385 cases of teenage pregnancy out of 28,688 deliveries at the 4 uniuersity hospitals in Seoul. 2. The incidence of teenage pregnancy shows higher (1.3%) compared with other reports in Korea, because most of the sample resources included the referred cases married or resided with the foreigners, exclusively U.S.A. soldiers as the project of maternal and child health cares service. 3. More than tree-fourths of occupation of teenage gravida were Koreas housewife or foreigners wife (or partner). Excluding these 2 categories out of wedlock birth might occupied one fourth of sample size. 4. the average age of menarche was 14.3 years. 5. The parity of teenage gravida: nullipara were 332 cases(86.2%) and multipara were 52 cases(13.5%). 6. In the past medical history most of the teenage gravida had non-contributory one (88.8%), venereal disease was 4.0% and pelvic inflammatory disease was 2.6%. 7. 54.4% of 385 cases had more than one antenatal care 8. Fetal presentations were vertex (94.1%), breech (4.8%), face of brow(0.8%) and shoulder presentation (0.3%) respectively. 9. Modes of deliveries were vagina (84.3%) & c-section delivery (15.7%) respectively. The frequency of major obstetric complications in order were anemia (20%),toxemia(12%), PROM (9.5%), postpartum hemorrhage(9.1%) respectively. 11. 29 cases out of 385 cases were terminated pregnancy. Among them more than half cases (56.8%) were carried out in the first trimeste, 12 cases in the second trimester and none in the third trimester. 12. According to the modes of pregnancy interruption, more than half of cases (55.2%) were terminated by D & E. others wers by Bougie with pitocin & prostaglandin. Hypertonic saline method had not been used in these cases. 13. In the views of birth weight no higher incidence of prematurity (9.9%) is seen compared with that of matured mother. There was no significant difference between Koreans housewives and foreigners wives (or partners). 14. Consequence of baby: About three-fourths(74.5%) of baby turned out to be wanted baby, unwanted occupied 16.9%.

제왕절개 자궁적출술의임상적 고찰

박찬무(CM Park),박형무(HM Park),엄승호(SH Ohm),차인환(IW Cha) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.5

1. 제왕절개자궁적출술을 받은 환자 32예중 66%의 예에서 산과적 출혈에 의한 응급을 요한 수술이었다. 이의 적응증으로는 자궁파열이 6예로 18.75%를 차지하였고, 이완성 자궁출혈이 5예 (15.63%), 유착태반이 4예(12.5%) 전치태반에 의한 지혈곤란, 자궁근종, 자궁경부암 및 불임 목적으로 각각 3예씩 (9.38%)을 차지하였고 기타의 경우가 15.6%를 차지하였다. 2. 심한 출혈로 인한 쇼크 상태의 환자 즉 쿠베레어 자궁이나 지혈곤란의 경우에선 부분적 자궁적출술을 시행하였고 다발성 자궁근종의 경우는 출혈은 심하지 않았으나 수술상의 난점 으로 역시 부분적 자궁적출술을 실시하였다. 3. 수술후 21예(65.6%)에서 아무런 합병증이 없었으며, 합병증이 나타난 예에서는 창상감염 및 파열이 4예(12.5%)로 가장 많았고 요로감염 및 방광손상에 의한 방광무력증이 각각 2예 로 6.25%를 차지하였고, 그외 골반농양, 마비성 장폐쇄, 복막후강출혈등이 1예씩 있었다. 4. 산모사망은 2예(6.25%)로 비교적 높은 비율을 차지하였는데, 그중 1예는 수술중 지혈곤란 으로 사망하였고, 다른 1예는 패혈성 쇼크환자로서 수술후 골반농양, 장누공 및 패혈증으로 사망하였다. This study was undertaken to determine the present status of cesarean hysterectomy. Cesarean hysterectomy was originally devides to combat postcesarean infection and hemorrhage, and it indication have gradually been widended to include many conditions in which removal of the uterus is necessary or desirable. In this study the outcome of 32 cases of cesarean hysterectomy performed at National Medical Center during 18 years from Jan. 1962 to Dec. 1979 was discussed and evaluated. There were 21042 deliveries during this period. Cesarean hysterectomy was performed in 32 of 1360 cesarean section, an incidence of 2.35%. The incidence of cesarean section was 6.46%. The age of patients varied needed immediate emergency operations. In about 2/3 of total patients (65.6%) there were no postoperative complications There were 2 cases of maternal mortality in this series . They underwent cesarean hysterectomy for placenta previa and postpartum intrauterine infection, however, ond died of sepsis and the other of uncontrollable bleeding. To prevent these catastrophies periodic and meticulous antenatal care must be provided.

분만 예에 있어서 모성건강기록의 임상통계학적 분석 ( II )

박인서(IS Park),이규완(KW Lee),조명준(MJ Cho),박찬용(CY Park),박창서(CS Park),차인환(IW Cha) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.3

1980년 2월1일부터 1980년 7월31일까지 만 6개월간 국립의료원 산과에 입원, 분만한 총 551 예를 대상으로 분석 조사한 결과 다음과 같은 결과를 얻었다. 1. 총 분만 551예중 초산부가 287예(50.63%) , 경산부가 271(49.37%)이었다. 2. 산전 산모의 상태는 합병증이 없는 경우가 397예(71.24%)로 가장 많고 합병증이 있는 경 우는 임신성 고혈압 54예(10.15%) 생식기 및 골반의 이상이 20예(3.76%), 감염이 13예(2.44%) 및 산전 질출혈이 12예(2.26%)순이었다. 3. 분만 방법은 정상 질식분만이 333예(60.84%)로 가장 많고 기계분만 113예(20.58%) 및 제 왕절개술 93예(16.94%)의 순이었다. 4. 분만 중 합병증은 분만지연이 24예(초산 19예, 경산 5예)로 가장 많았고 태반계류가 15예 (4:11), hypotonic uteruie contraction 이 8예(5:3) 전치태반 7예(3:4)의 순이었다. 5. 총 분만 549예중 일반 전공의 (인턴)가 분만을 시술한 경우는 45예(8.20%)로 초산모 8예, 경산모 37예이며 나머지 502예(91.44%)는 산부인과 전공의 (레지던트)이상이 시술하엿다. 6. 제왕절개술의 적응증은 제왕술의 기왕력이 36예(38.70%)로 가장 많고 이상태위 13예 (13.98%), 전치태반 8예(8.60%)의 순이었다. 7. 신생아의 평균 1분 Apgar score는 7.65±1.07이었으며 5분 Apgar score는 7.68±1.54이었 다. 8. 평균 신생아 체중은 3125.22±598.78gm이었으며 초산은 3054.07±587.21gm이었고 경산은 3194.62±603.73gm이었다. 9. 산후 합병증은 치료를 요하였던 산욕열이 18예로 제일 많았고 치료를 요하였던 산후출혈 6예, 요로감염증 6예, 봉합술파열 1예의 순이었다. 10. 총 분만 551예 중 모성 사망은 한 예도 없었으며 신생아 사망률 은 1000명당 42.11이었다. This is a review of 551 cases of delivered women in National Medical Center from Feb. 1 to July 31, 1980. Maternity record which was designed by Korean Institute for Family Planning was checked for all delivered cases The results of these material were as follows; 1. The times of mean antenatal visit was 3.05±2.84, gestational weeks; 39.11±3.94, Hb. level ; 10.53±1.87gm%, mean age ; 28.05±3.95 year and mean educational duration 10.82±1.76 years. 2. The incidence of primary antenatal complications was 28.76% in 532 cases, of which hypertensive disorder was most one (10.15%). 3. The methods of deliveries were as follows; spontaneous viaginal delivery ; 334 (60.84%) operative one 113(20.58%) and C-section 93 (16.94%). 4. Of 82 cases of intrapartum complications, prolonged labor was major one (24 case) others were as retained placenta hypotonic uterine contration and placenata previa. etc. 5. Majority of attendant at delivery was resident or staff (91.44%). 6. Indications for cesarean section revealed as previous history of cesarean section (38.70%), malpresentation (13.98%), placenta previa (8.60%) and so. 7. The mean Apgar score at one minute was 7.65±1.07 and at 5 minutes after birth 7.68±1.54. 8. The mean body weight of newborn was 3125.22±598.78gm 9. of analized 542 cases, 42 cases had postpartum complications as purepheral fever, postpartum hemorrhage and urinary tract infection. 10. perinatal mortality rate was 42.11 per 1000 infants delivered, but maternal one was zero.

임산부의 임상통계학적 관찰 ( 제 1보 )

박인서(IS Park),주영철(YC Joo),김용철(YC Kim),박춘식(CS Park),박창서(CS Park),차인환(IW Cha) 대한산부인과학회 1980 Obstetrics & Gynecology Science Vol.23 No.2

결론 1961년 1월 1일부터 1978년 12월 31일까지 국립의료원 산부인과에 입원하여 분만한 21,650예에 대하여 다음과 같은 결과를 얻었 다. 1. 총 분만 21,650예 중 산전, 분만, 산욕기에 합병증이 없었던 경우는 14,665예(66.7%)이며 합병증이 있었던 경우는 6,985예 (32.3%)이었다. 2. 연령 분포는 25-29세군이 48.4%로 가장 많았고 전체 산모의 평균 연령은 28.0세로 초산부는 25.3세, 경산부는 29.1세이었다. 3. 총 분만 21,650예 중 8,032예(37.1%)는 초산부이었고 13,618예(62.9%)는 경산부로 평균 분만 횟수는 1.4회이었다. 4. 제태기간은 38-41주군이 80.3%로 가장 많았다. 5. 태위는 두위가 93.5%, 둔위가 4.2%, 횡위가 0.5%, 안면위가 0.3% 등의 순이었다. 6. 분만 방법은 자연분만이 16,534예(76.4%), 흡입분만이 2,746예(11.4%), 제왕절개술이 1,689(7.8%), 둔위만출이 49.6예 (2.3%), 감자분만이 438예(2.0%), 개두술이 17예(0.1%)의 순이었다. 또한 제왕절개술의 빈도는 점차 증가하는 경향이었다. 7. 전체 태아의 평균 체중은 3,056gm이었고 재태기간에 따른 평균 체중은 30주 이하의 군이 811.2gm, 30-33주군이 1,1591.0gm, 34-37주 군이 2,289.8gm, 38-41주 군이 3,213.1gm, 42주 이상의 군이 3,454.5gm이었다. 8. 분만 방법에 따른 출혈량은 자연분만시 184.5ml, 흡인 및 감자분만시 260.1ml, 제왕절개술시 608.2ml이었다. 9. 재태기간에 따른 태반의 중량은 30주 이하의 경우 322.3gm, 30-33주가 460.0gm, 34-37주가 523.5gm, 38-41주가 640.0gm, 42 주 이상이 803.9gm이었다. 10. 합볍증은 자간전증이 44.1%, 산후출혈이 12.3%, 조기파수가 9.2%, 태반계류가 7.6%, 자간 및 아두골반 불균형이 각각 6.1% 등의 순이었다. 11. 평균 주산기 사망율은 32.1이었다. 12. 자궁내 태아삼ㅇ의 원인은 원인불명이 71.6%, 태반조기 박리가 6.3%, 임신중독증이 5.5%, 횡위가 3.7%등의 순이었으며, 신 생아 사망의 원인은 조숙아가 41.7%, 원인불명이 30.1%, 선천성 기형이 12.3%, 분만시의 외상이 4.5% 등의 순이었다. Vital statistics is essential to perfom and program maternal-chaild services, Maternal-child welfare is an index of socioeconomic and educational status of their country. For the purpose of obtaining clinical and statistical data, 21,650 women who had been admitted and delivered at National Medical Center were studied during the period from Jan. 1961 to Dec. 1978. The result were as follows: 1) The collection and study were carried out in 21,650 cases: 14,665 cases(67.7%) with normal and 6,985(32.3%) with complications during antepartum, and/or intrapartum, and/or postpartum, respectively. 2) The group of 38-41 gestational week occupied majority of casese(80.3%) 3) Nullipara were 8,032 cases(37.1%)and 13,816(62.9%) in multipara, with the mean parity of 1.4. 4) The age group of 25-29 was most commoc(48.4%). The average age of all cases was 28.0 year old. 5) The incidence of presentation was as follows: vertex:20,549(93.5%) , breech: 931(4.2%) , shouder: 98(0.5%), face: 65(0.3%), brow 8(cases) and compound 2(0.0%) 6) There werw 16,534 cases(76.4%) of spontaneous vaginal delivery and others were vacuum 2,476(11.4%), forceps438(2.0%), breech extraction 496(2.3%), Cesarean section 1,689(7.8%), and craniotomy 17(0.1%). The incidence od Cesarean section had a tendency to gradual increment. 7) The mean birth weight of total cases was 3,065gm and those by week were as follows : less than 30 weeks: 811.2gh, 30-33 week: 1,591.0gm 34-37 weeks: 2,289.8gm, 38-41 weeks: 3,213.1gm and more than 42 weeks: 3,454.5gh. 8) The mean blood loss in cases of spontaneous vaginal deliverywas 184+_24.6ml and 260+_30.4ml in operative vaginal delivery. The cases of Cesarean section had 608.2+_54.2ml in average blood loss. 9) The placental weight by weeks was as follows: less than 30 weeks: 322.3gm, 30-33 weels: 460.0gm, 34-37 weeks: 523.5gm, 38-41 weeks: 640.0gm, and more than 42 weeks: 803.9gm 10) The major complications in complocated cases(6,985) were preeclampsia(44.1%), postpartum hemorrhage(12.3%), premature rupture of membranes(9.2%), retainedplacenta(7.6%) eclampsia and cephalopelvic disproportion(6.1%) repectively. 11) The mean perinatal mortality rate was 32.1. 12) The majority of stillbirth got unknown causes(71.6%), but those of neonatal death were prematurity(41.7%), unknown (30.1%), congenital anomalies(12.*%), obstetric trauma(4.5%) and so on.