반복제왕절개술

설종은(JE Sul),김영신(YS Kim),김혜경(HK Kim),윤광섭(KS Youn),임헌정(HJ lm) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.11

The management of labor to insure delivery of viable infants by cesarean section has been long a subject of wide difference of opinion among obstetricians, especially with the increasing numbers of pregnants patients with a history of previous cesarean section, This study was carried out retrospectively based on the clinical charts of 2l6 consecutive patients who had had previous cesarean section, during the period from January 1976 to December 1980, at the Kwangju Christian Hospita1. The result were as foIlows: l. Overall, there were 12379 deliveries, with 732 cesarean sections, an incidence of 5.9% 140 patients, (65%), of 216 who had had previous cesarean section were delivered by repeat cesarean section, and 76 patients, (35%), by the vaginal route. 2. Among the indications for repeat cesarean section, previous cesarean section was the most frequent (4l.5%}: and the others were C.P.D. (33.6%), breech pre sentation (9.3), concomitant sterilization (8.6%). 3. The annual incidence of repeat cesarean section, varied from 47.8% to 70.1%, with a tendency to gradually increase. 4. The lowest incidence of repeat cesarean section was in the 26~30 year age group (57.3%), with a slightly higher incidence in other age groups. 5. The birth weight of 80% of infants born by repeat cesarean section ranged from 3.1kg~4.0kg. 6. Among the previous cesarean stctions, 41.2% were allowed a trial labor. Subsequently 85.4% of these delivered vaginally, for an overall 35.2% vaginal delivery rate in patients with previous cesarean section. 7. As to the type of repeat cesarean section, Low cervical transverse was the most common(84.2%). The tyre of previous cesarean section were low segment in 151 (70.6%), upper segment in 37(17.1%), and unknown in 28(12.3%). 8. Among the cases allowed trial labor, the indications for previous cesarean section were C.P.C, Breech presentation, fetal distress, postterm, and pregnancy induced hypertension, in that order 9. Perinatal mortality was 6.4% in these series. The main causes were uterine rupture

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

제왕절개술후 속발한 임신 및 분만에 관한 임상적 고찰

임용택(YT Lim),강순범(SB Kang),장윤석(YS Chang) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.4

This study was retrospectively carried out based on the clinical records of 523 patients who delivered after preⅵous cesarean section among 7,098 cases of deliveries at the Department of Obstetrics and Gynecology, Seoul National University, during the period from January 1,1976 to June 30,1982. The results obtained were as follows: 1. The repeat cesarean sections were performed in 502 cases(96.0%) including 5 cases(1.0%) of failed trial of labor and successful vaginal deliveries were completed in 21 cases(4.0%) among 523 patients. 2. The largest age group was between 25 and 29 years old(51.6%). 3. The cesarean section rate was 25.0%. 4. The preⅵous indications for cesarean section were C.P.D.(40.3%),malpre-sentation(20.7%), Prolonged labor(7.1%) and fetal distress(6.3%). 5. The number of preⅵous cesaran section was once in 458 cases(87.5%), twice in 61 cases(11.7%), and thrice in 4 cases(0.8%). 6. ln the type of cesarean section, low cerⅵcal transverse type were done in 469 cases(80.6%) in primary cesarean section, and in 480 cases(95.6%) in repeat cesarean section. Classical type were done in 33 cases(6.2%) in primary cesarean section, and in 15 cases(3.0%) in repeat cesarean section. Cesarean hysterectomy were performed in 5 cases(1.0%), 7. The incidence of uterine rupture was 1.3%. 8.The timing of the repeat cesarean section was mostly the period between 38 and 40 weeks in 414 cases(82.5%). 9. The combined surgery was performed in 336 cases(66.9%), and tubal ligation with appendectomy was most frequently performed in 122 cases(24.3%). 10. Spinal anesthesia was performed in 40.6% and general anesthesia in 56.6% of tht repeat cesarean section. The Use of general anesthesia became more popular than spinal anesthesia after 198O. 11. The transfusion of whole blood was not required in 363 cases(72.3%), and the most frequent range of blood loss was between 5O1cc. and 1,000cc. 12. the premature baby were 39 cases(7.4%), giant baby were 33 cases(6.2%) and depressed Apgar score at 1 minute(less than 6) were observed in 70 cases(13.2%). 13. The perinatal mortality rate was 32.14 per 1,000 total births. 14. No maternal death was observed and maternal morbidity rate was 29.3%. The most frequent cause was pueperal endometritis(33.3%).

제왕절개술의 임상적 고찰

한만홍(MH Han),정용환(YH Chung),최유덕(YD Choi),호삼수(SS Hoh) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.7

In recent years, the use of cesarean section has increased rernarkably, because of the emphasis that is directed toward recognition of impairment of fetal well-being. We studied on 370 patients who had cesarean section among 2481 deliveries at Gill Hospita1, Inchon, during one year period from Jan. first to Dec. 3lst l980. The results analysed were as follows: 1. 0verall incidence of cesarean section was l4.9% of the total deliveries, 2481 patients. 2. of all these 370 sections, the primary section accounted for 76.2% of the sections and the repeat sections were 23.8%. 3. The most frequent indication of the cesarean section was cephalopelvic dispropo rtion (3l.0%). Next indication were repeat (23.8%) and antepartum bleeding (10.9%) 4. The most frequent indication for primary section in multipara was henrorrhage such as placenta previa and abruptio placentae (37%). Next were malpresentation (l4.8%) and CPD (ll.l%). 5. By age, 42.8% of cases were between 25~29 years of age, below l9~-0.5% and over 40~-0.5%. 6. In the boty weight distribution of infants, the group of 3000~3499 gm was the most common (37.6%). 7. In performing the cesarean section, lower cervical transverse incision was most common (94%). Classical section was only 5 cases (l.4%) and extrapsritoneal section-7 cases(1.9%). Also cesarean hysterectomy was performed in 10 cases(2.7%). 8. Incidental operation; Tubal ligation for sterilization was most common (75.5%). The others were cesarean hysterectorny (l0.2%) and appendectomy (9.1%) etc. 9. The type of the anesthesia in cesarean section was general (99.2%) and spinal (0.8%). The epidural anesthesia was not performed in section except the vaginal delivery. 10. Of the postoperative complication, the wound infection was the most common (31.2%). The others were urinary tract infection (20.8%), endometritis (18.8%) etc. ll. There was high rate of maternal morbidity in patients with anemia(l3.0%). l2. The perinatal mortality was 4.6%. l3. There was only one maternal death (0.27%) in 370 cases of cesareans

제왕절개분만의 기왕력과 완전 전치태반과의 연관성

안현경(HK Ahn),김은성(ES Kim),한정열(JY Han),김문영(MY Kim),류현미(HM Ryu),최규홍(KH Choi),양재혁(JH Yang) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.5

N/A Objective : To determine the relationship between previous cesarean section and subsequent development of placenta previa totalis and placenta previa totalis with accreta. Materials and Methods : A retrospective review of the case records of all women delivered with the diagnosis of placenta previa totalis during the 5-year period from August 1, 1994, to July 31, 1999, at the Samsung Cheil Hospital. Results : There were 38,215 deliveries in the study period. 237(0.62%) had placenta previa totalis and 56(23.6%) of whom had a history of previous cesarean section. The incidence of placenta previa totalis was significantly increased in those with a previous cesarean section(1.19%) compared with those with an unscarred uterus(0.54%). In the group without antecedent of cesarean section, accretism risk was 11.6%, with one section or more 32.1%. The need for cesarean hysterectomy occurred more commonly in patients who had a prior cesarean delivery, 14 of 56(25%), as compared with patients with no prior cesarean delivery, 6 of 181(3.3%). Conclusion : There is a strong association between previous cesarean section and risk of subsequent development of placenta previa totalis. Patients with an antepartum diagnosis of placenta previa who have had a previous cesarean section should be considered at high risk of developing placenta accreta. Patients with previous cesarean section have a significantly higher incidence of postpartum hemorrhage and are more likely to undergo emergency hysterectomy.

The risk of emergency cesarean section after failure of vaginal delivery according to prepregnancy body mass index or gestational weight gain by the 2009 Institute of Medicine guidelines

( Ha Yan Kwon ),( Ja-young Kwon ),( Yong Won Park ),( Young-han Kim ) 대한산부인과학회 2016 Obstetrics & Gynecology Science Vol.59 No.3

Objective To evaluate the risk of emergency cesarean section according to the prepregnancy body mass index (BMI) and gestational weight gain per the 2009 Institute of Medicine guidelines. Methods A retrospective analysis of data from 2,765 women with singleton full-term births (2009 to 2012) who attempted a vaginal delivery was conducted. Pregnancies with preeclampsia, chronic hypertension, diabetes, planned cesarean section, placenta previa, or cesarean section due to fetal anomalies or intrauterine growth restriction were excluded. Odds ratios (ORs) and confidence intervals (CIs) for emergency cesarean section were calculated after adjusting for prepregnancy BMI or gestational weight gain. Results Three-hundred and fifty nine (13.0%) women underwent emergency cesarean section. The adjusted OR for overweight, obese, and extremely obese women indicated a significantly increased risk of cesarean delivery. Gestational weight gain by Institute of Medicine guidelines was not associated with an increased risk of cesarean delivery. However, inadequate and excessive weight gain in obese women was highly associated with an increased risk of emergency cesarean section, compared to these in normal BMI (OR, 5.56; 95% CI, 1.36 to 22.72; OR, 3.63; 95% CI, 1.05 to 12.54; respectively), while there was no significant difference between normal BMI and obese women with adequate weight gain. Conclusion Obese women should be provided special advice before and during pregnancy for controlling weight and careful consideration should be needed at the time of vaginal delivery to avoid emergency cesarean section.

The risk of emergency cesarean section after failure of vaginal delivery according to prepregnancy body mass index or gestational weight gain by the 2009 Institute of Medicine guidelines

권하얀 ( Ha Yan Kwon ),( Ja-young Kwon ),( Yong Won Park ),( Young-han Kim ) 대한산부인과학회 2017 대한산부인과학회 학술대회 Vol.103 No.-

Objective: To evaluate the risk of emergency cesarean section according to the prepregnancy body mass index (BMI) and gestational weight gain per the 2009 Institute of Medicine guidelines. Methods: A retrospective analysis of data from 2,765 women with singleton full-term births (2009 to 2012) who attempted a vaginal delivery was conducted. Pregnancies with preeclampsia, chronic hypertension, diabetes, planned cesarean section, placenta previa, or cesarean section due to fetal anomalies or intrauterine growth restriction were excluded. Odds ratios (ORs) and confidence intervals (CIs) for emergency cesarean section were calculated after adjusting for prepregnancy BMI or gestational weight gain. Results: Three-hundred and fifty nine (13.0%) women underwent emergency cesarean section. The adjusted OR for overweight, obese, and extremely obese women indicated a significantly increased risk of cesarean delivery. Gestational weight gain by Institute of Medicine guidelines was not associated with an increased risk of cesarean delivery. However, inadequate and excessive weight gain in obese women was highly associated with an increased risk of emergency cesarean section, compared to these in normal BMI (OR, 5.56; 95% CI, 1.36 to 22.72; OR, 3.63; 95% CI, 1.05 to 12.54; respectively), while there was no significant difference between normal BMI and obese women with adequate weight gain. Conclusion: Obese women should be provided special advice before and during pregnancy for controlling weight and careful consideration should be needed at the time of vaginal delivery to avoid emergency cesarean section.

산모의 요청에 따른 제왕절개 가이드라인 제정 이후 제왕절개율의 변화 및 고찰

김현미,성원준 한국모자보건학회 2024 한국모자보건학회지 Vol.28 No.2

Traditionally, cesarean delivery on maternal request (CDMR) has been defined as a cesarean section performed at the request of the pregnant woman rather than for medical necessity. It was thought to provide minimal benefits to both the pregnant woman and the fetus and was seen as an inefficient use of healthcare resources. However, the recent rise in the choice and use of cesarean sections is influenced not only by obstetrical factors but also by psychological and socio-cultural factors of the mother, the desire among medical providers to avoid uncertainty, and the pursuit of time and economic convenience, among other complex factors. In particular, there is a growing trend among medical professionals who prefer cesarean sections to avoid costly medical lawsuits. However, if a pregnant woman opts for an elective cesarean section due to the convenience of medical professionals or fear of litigation, even if she prefers a vaginal delivery, it would be considered an unnecessary cesarean section. When a pregnant woman desires CDMR, medical professionals should thoroughly explain the advantages and disadvantages of both attempting vaginal delivery and CDMR so that she can make an informed decision. Nevertheless, if a pregnant woman still chooses a cesarean section after being fully informed, her autonomy should be respected. In such cases, it is recommended that medical practitioners use a minimally invasive surgical method, along with appropriate preoperative and postoperative care, to reduce the morbidity of both the mother and infant and to support a rapid recovery.

Misoprostol complications in second-trimester termination of pregnancy among women with a history of more than one cesarean section

( Marzieh Jamali ),( Mahmood Bakhtiyari ),( Fatemeh Arab ),( Masoumeh Mirzamoradi ) 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.3

Objective This study aims to investigate the complications due to misoprostol administration for second-trimester termination of pregnancy among women with history of 2 or more cesarean scarring. Methods The cohort of this retrospective study included 678 subjects who required second-trimester pregnancy termination, from 2013 to 2015 and treated with vaginal misoprostol of 100 to 400 μg. The subjects were divided into 3 groups based on their history of cesarean sections: without a history of cesarean section, with a history of one cesarean section, and with a history of more than one cesarean section and uterine scaring. Results The results showed that the success rate of misoprostol administration for pregnancy termination was 95.72%. The rate of bleeding as a complication was significantly higher in subjects with a history of more than one cesarean section than in other participants (risk ratio [RR], 2.24; 95% confidence interval [CI], 1.11-4.0). The incidence of uterine rupture was higher in the group with a history of more than one cesarean section than in other groups. However, no significant difference was observed between the groups (RR, 1.44; 95% CI, 0.27-7.6). There was a significant relationship between the need for other auxiliary treatments in the pregnancy termination and the history of uterine scarring (RR, 3.3; 95% CI, 1.23-9.1). Conclusion The present study showed that pregnancy termination using smaller divided dose of misoprostol in patients with previous history of cesarean scarring may be associated with lower incidence of uterine rupture.

자연 분만 및 예정된 제왕절개 수술 랫드에 있어서 모성 행동의 차이에 대한 검토

이상규,강현구,김일화,정재민,황대연,김철규,채갑용,조정식,Lee, S.K.,Kang, H.G.,Kim, I.W.,Jeong, J.M.,Hwang, D.Y.,Kim, C.K.,Chae, K.R.,Cho, J.S. 한국수정란이식학회 2007 한국동물생명공학회지 Vol.22 No.3

포유류에서 옥시토신은 다양한 기능을 가지고 있는 신경뇌하수체 호르몬이다. 옥시토신은 주로 젖의 분비를 일으키고 분만 시 자궁의 수축 및 모성 행동과 관계가 있다. 모성 행동은 스트레스에 의해 억압을 받으며 옥시토신에 의해 촉진된다. 본 연구는 제왕절개의 스트레스와 자궁내 옥시투여에 따른 모성 행동의 변화를 알아보기 위해 수행되었다. 본 실험 결과, 자연 분만 예에서 스트레스를 준 개체와 스트레스를 주지 않은 개체에서 새끼의 생존율을 비교한 결과, 스트레스를 준 군에서 새끼의 생존율이 낮아 스트레스가 모성 행동에 영향을 미친다는 것을 확인하였다. 제왕절개 수술을 실시한 예에서 옥시토신을 투여한 군은 마취의 회복 후 일정 시간이 경과한 다음 새끼를 잡아먹는 식자증이 나타난 반면, 옥시토신을 투여한 군에서는 마취에서 회복한 다음 곧바로 새끼를 확인한 다음 살해하는 행동을 보였다. 결과적으로 새끼를 관리하고자 하는 모성 행동을 발현하기 위해서는 말초에 옥시토신을 투여하는 것은 의미가 없다는 것을 확인하였으며, 분만 시 모체에 대한 스트레스는 새끼의 관리에 좋지 않은 영향을 미친다는 것을 확인하였다. 또한, 본 실험은 랫드를 대상으로 제왕절개라는 새로운 스트레스의 실험적 이용, 임상적으로 제왕절개시 수행하는 자궁 내 옥시토신 투여의 임상적 평가, 그리고 제왕절개 수술을 실시한 다음 마취 회복 후 새끼를 탐색하는 모성 행동관찰의 요인을 추가한 새로운 실험이라는데 의의가 있다. Oxytocin is a neurohypophyseal hormone which has multiple functions in mammals. Mainly, oxytocin regulates milk ejection and has an effect on uterine contraction and is related to maternal behavior. Maternal behavior is believed to be suppressed by stress and facilitated by oxytocin. In the cesarean section, oxytocin may be administrated into uterus to promote uterine involution. The present study aimed to test the effect of oxytocin into uterus on maternal behavior of rats with cesarean section. It was measured the effects on maternal behavior of oxytocin infused into uterus in rats with cesarean section as a stressor. In the first experiment, pup survival rate of between a control group and a group with laparotomy as a stress in natural parturition rats was compared. In the second experiment, survival rate for 2 weeks and maternal pup searching behavior (MPSV) were observed in one cesarean sectioned group without oxytocin and the other cesarean sectioned group with oxytocin. Infanticide was observed in stressed group in the first experiment while a normal maternal behavior was observed in a control one. In the second experiment, MPSV was only observed in a cesarean sectioned group with oxytocin and infanticide was observed in two groups except one rat which is thought to be affected by oxytocin as operated relatively late. This is the first study to show that the administration of oxytocin into uterus in the cesarean section is not involved in the regulation of maternal behavior in rats. In conclusion, this study proves the needs of oxytocin into brain in cesarean section related rats model and further study of maternal behavior list, like MPSV.