고령 산모에 관한 임상통계학적 고찰

신승권,윤광혁,이명재,양영균,정병욱,정진국 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1

According to most studies, there are numerous complications of pregnancy-affecting both the mother and the fetus or neonate-among women over the age of 35. So, we have compared 542 cases of the elderly gravida over the age of 35 at the department of Obstetrics and Gynecology, Mokpo, St. Columban`s Hospital, from January 1, 1994 to December 31, 1996, with 500 cases randomly chosen young pregnant women during the same period. There results were as follows. 1. There were 542 cases of the elderly gravida among total 10706 deliveries and the incidence of the elderly gravida was 5.06%. 2. The rate of elderly gravida was increased from 4.72% in 1994 to 5.39% in 1996. 3. The maternal age distribution of elderly gravida was from 35 years to 46 years. 4. The parity of elderly gravida was that primigravida was 12.2% and multigravida was 87.8%. 5. 501 cases(92.4%) of total cases were vertex presentation and breech presentation was in 34 cases(6.3%), transverse lie in 7 cases(1.3%). 6. The preterm pregnancy was 9.2% compared with 10.4% in control group. The postterm pregnancy was 3.1% compared with 5.4% in control group. 7. The rate of cesarean section was 42.4% compared with 22.4% in control group. Among the incidence of cesarean section the highest incidence was previous cesarean section(41.3%). Other indications were elderly primigravida(28.7%), cephalopelvic disproportion(7.0%), and abnormal presentation(8.3%) in order. 8. Concerning the prenatal complication, the incidence of hypertensive disorder was 5.4% compared with 3.6% in control group. 9. The Incidence of low birth weight was 12.0% compared with 6.4% in control group. 10. The male-to-female sex ratio was 1.22: 1 compared with 1.09 : 1 in control group.

10 대 여성의 임신에 관한 임상통계학적 고찰

신승권,윤광혁,양우열,고만석,정병욱,정진국,이호형 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.5

본 병원 산부인과에서 1992년 1월 1일부터 1996년 12월 31일까지 만 5년 동안 경험하였던 10대 임산부 194명과 20∼29세까지의 대조군 200명을 대상으로 임신과 분만에 따른 각종 합병증과 위험인자를 비교 분석한 결과 다음과 같은 결과를 얻었다. 1. 연도별 분포는 1992년 1.08%, 1994년 1,32% 그 리고 1996년 2.11%로 점차 증가하는 경향을 보였다. 2. 연령 분포는 14세에서 19세 사이였으며, 19세 가 58.8%로 가장 많았다. 3. 과거 임신 경 력 첫 번째 임신인 경우가 56.7% 로 가장 많고 3회인 경우가 7예(3.6%), 4회인 경우도 1예(0.5%)이었다. 4. 산전관리의 빈도는 10대 임산부에서 대조군보 다 유의하게 낮았다(p<0.05). 5. 임신 주수의 분포는 10대 임산부는 평균 40+1주 로 대조군의 40+4주와 유의한 차이를 보이지 않았고, 37주 이하의 미숙아 분만과 42주 이상의 과숙아 분 만도 대조군과 유의한 차이는 없었다. 6. 임신중 산모 체중 증가는 10대 임산부에서 평 균 11.27 kg으로 대조군의 13.26 kg보다 유의하게 낮 았다(p<0.05). 10대 임산부에서는 5.0∼9.9 kg의 체중 증가가 유의하게 높은 빈도를 보였다. 7. 10대 임산부에서 신생아 평균 체중은 3.06 kg 로 대조군의 3.36 kg보다 의미있게 낮았다. 10대 임 산부에서 1,500∼2,499 gm인 경우가 6.2%로 대조군 의 2.0%보다 유의하게 높았고(p<0.05), 4,000 gm 이 상인 경우는 대조군과 유의한 차이는 없었다. 8. 제왕절개에 의한 복식 분만율은 5.7%로 대조군 의 20.5%와 유의한 차이를 보였다(p<0.05). 9. 제왕절개술의 적응증으로는 아두골반불균형, 협착 골반이 각각 36.3%, 27.3%로 대조군보다 많았 지만 통계학적으로 유의한 차이는 보이지 않았다. 10. 분만 전 합병증은 빈혈(16%), 방광염(4.1%), 임 신중독증(3.1%)이 대조군보다 높았지만 유의한 차이 는 없었다. 11. 분만 후 합병증은 빈혈(29.9%), 요로감염(13.9 %)이 대조군보다 높았지만 유의한 차이는 없었으며, 그 밖에 방광무력증, 산후출혈, 열상등도 대조군과 유의한 차이를 보이지 않았다. 12. 신생아 합병증에 있어서 주산기 사망률, 저 Apgar score, 자궁내 발육지연, 선천성 기형에서도 대 조군과 유의한 차이를 보이지 않았다. Social and Sexual mores have been changing rapidly and the problem of teenage pregnancy continues to grow in this country. Recently, industrialization and a complex urban society unduly prolong education and delay marriage and sexual gratification, and little attention has been given to the adolescent who are more susceptible and vulnerable than adults in physical, socioeconomical and psychological aspects. Several studies indicate that good prenatal care, meticulous medical care, intensive nutritional counselings and attention to the psychological, socioeconomic problems of pregnancy reduce the perinatal death and complication rate for pregnant teenagers. The objective of the study was to compare several obstetric characteristics and outcomes of one hundred ninety four pregnant under age 20 who were delivered at department of obstetrics and gynecology, Mokpo St. Columban Hospital from January 1992 to December 1996 to those of two hundred pregnant aged 20∼29 who were chosen at random during the same period as the control group. The results were as follows; 1. The proportion of birth to teenagers increased from 1.08% of all birth in 1992 to 2.11% in 1996. 2. Almost cases were in high teen group, age of 14∼19. The majority (58.8%) were in the age of 19. 3. 110 cases (56.7%) had no previous pregnancy history. Seven patients had three times, and one patient had four times of previous pregnancy history. 4. The frequency of prenatal care was significantly lower than the control group (p<0.05). 5. The mean gestational period was 40+1 weeks, and there was no significant difference between the study group and the control group. The incidence of preterm and postterm delivery was not significant difference between the two groups. 6. The mean weight gain of pregnant teenagers was 11.27 kg, significantly smaller than the control group. The maternal weight gain of 5.0∼9.9kg was significantly higher than the control group. 7. The mean birth weight (3.06kg) of infant was significantly smaller than the control group. The incidence of 1,500∼2,499 gm birth weight 6.2%) was significantly higher than the control group (2.0%). 8. The rate of abdominal delivery (5.7%) was significantly lower than the control group (20.5%). 9. The incidence of cephalopelvic disproportion and contracted pelvis for cesarean section was somewhat higher than the control group, but not significant statistically. 10. In the antepartum complication, anemia, cystitis, and pregnancy induced hypertension occurred more frequently in the teenage pregnancy than the control group, but not significant statistically. 11. In the postpartum complication, anemia (29.9%), urinary tract infection (13.9%) occurred more frequently than the control group, but not significant statistically. 12. The perinatal mortality, low Apgar score, intrauterine growth retardation, and congenital anomaly were not significant different between the two groups.

지연임신에 대한 임상적 고찰

이상룡,신승권,이명숙,류형선,윤광혁,박명호 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.3

1990년 1월 1일부터 1992년 12월 31일까지 만 3년간 목포 성골롬반병원 산부인과에서 경험한 임신 295일이상의 지연임신 698예를 대상으로 분만경과 및 태아상태에 대한 연구와 통계학적 분석을 통하여 다음과 같은 결론을 얻었다. 본 연구의 대조군은 동기간중에 분만한 임신 38주부터 42주까지의 만삭분만 10,558에로 하였다. 1. 지연임신의 발생빈도는 총 분만 12,328예중 698예로 5.66%에 해당되었다. 2. 연령별 분만수는 26-30세 군에서 389예(55.73%)로 제일 많았고, 그 다음이 21-25세 군으로 230예(32.95%)순이었으며 임신주수별 분포는 42주가 408예(58.45%)로 제일 많았고, 그 다음이 43주로서 254예(36.39%)순이었으며, 출산력별 분포는 초산군에서 6.54%, 경산군에서 4.92%로 초산군에서 약간 더 높은 빈도를 보였다. 3. 진통개시의 유형별 분포는 자연진통이 395예(56.59%)로 제일 많았고, 그 다음이 유도분만으로 261예(37.39%), 진통이 없는 경우가 42예(6.02%)이었다. 4. 태아가사율은 대조군 2.42%임에 반하여 예정일 초과군에서는 6.30%로 약 2.60배 증가하였으며, 임신주수가 증가함에 따라 태아가사율은 점차 증가하였다. 5. 분만방법에 있어서 질식 자연분만은 512예(73.53%), 제왕절개술은 139예(19.91%), 흡입분만 47예(6.73%)였으며, 특히 제왕절개술은 같은 기간동안의 대조군보다 높은 빈도를 나타냈으며, 출산력별로는 초산부에서 약 4.8배나 수술적 분만의 빈도가 높았다. 6. 수술적 분만은 모두 139예로써 이의 적응증은 CPD가 50예(35.97%)로 가장 많았으며, 그 다음이 유도분만실패 33예(23.74%), 태아절박증 24예(17.27%), 반복제왕절개술 18예(12.95%)의 순이었으며, 기타 태아위치이상, 협골반, 거대아, 전치태반이 수술의 적응증이었다. 7. 태아체중은 3.0-3.49 kg에서 지연임신군과 대조군이 각각 45.85% 및 59.07%로 제일 많았으며 4,000 gm이상은 지연임신군에서 8.60%, 대조군에서 2.36%로 지연임신군에서 약 3.64배의 높은 빈도를 보였다. 8. 주산기 사망율은 대조군에서 0.28%, 지연임신군에서 1.43%로 지연임신군에서 약 5.1배의 높은 빈도를 보였고, 임신주수별 주산기 사망율은 임신 제 42주에 0.74%, 43주에 1.57%, 44주에 6.06%, 45주이상에서 33.3%로 시일이 초과함에 따라 주산기 사망율은 급격히 증가되었다. 9. 자궁내 태아사망율은 대조군에서 0.17%, 지연임신군에서 0.72%로 지연임신군에서 약 4.2배가 높았고, 신생아 사망율은 대조군에서 00.10%, 지연임신군에서 0.72%로 지연임신군에서 약 7.2배의 높은 빈도를 보였다. A clinical observation has been made on 698 cases of postterm pregnancies out of 12,328 cases delivered at the Dept. of Obstetrics & Gynecology, St.Columban Hospital from January 1, 1990 to December 31, 1992. 10,558 cases of full term deliveries of 38 to 42 gestational weeks conducted in same period were used as the control group for this study. The results were as follows; 1. The incidence of postterm pregnancy was 5.66% with the highest incidence occurring in the 26-30 years age group. The incidence of postterm pregnancy in primipara (6.54%) was greater than that of multipara (4.92%). 2. In postterm pregnancies, the gestational weeks of 42 was most prevalent (58.45%) and 43 weeks was the next(36.3%). 3. The modes of labor onset in postterm pregnancy showed spontaneous 56.59%, induction 37.39%, and cesarean section without labor 6.02%. 4. The incidence of fetal distress was 2.42% and 6.30% in the control group and postterm group respectively. The incidence of fetal distress in the postterm pregnancy was about 2.60 times greater than that of control group and increased markedly as the gestational weeks were prolonged. 5. The modes of deliver in postterm pregnancy showed; spontaneous vaginal delivery 73.35%, vacuum extracted delivery 6.74%, cesarean section 19.91% 6. The rate of cesarean section in postterm pregnancies was 19.91% and it was greater than that of term pregnancy(17.3%). 7. As the indication of cesarean section in postterm pregnancies the cephalopelvic disproportion was the most prevalent and failed induction, fetal distress, previous cesarean section were the next in order. 8. The incidence of large fetus (weight over 4,000 gm) was 8.60 % and 2.36 % in the postterm group and control group respectively, and postterm group was about 3.64 times greater than of the control group. 9. The perinatal death rate were 0.28% and 1.43% in term and postterm pregnancy respectively. And the intrauterine fetal death rates were 0.17% and 0.72%, the neonatal death rates were 0.10% and 0.72% in term and postterm pregnancy respectively. The perinatal death rate was increased markedly as the gestational weeks were prolonged.

난소근종 1 예

이지신,신승권,김하봉,윤광혁,양해관,이성봉 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.8

저자들은 45세된 환자에서 난소에 발생한 평활근종 1예를 경험하였기에 간단한 문헌고찰과 함께 보고하는 바이다. Although smooth muscle is sometimes seeing a minor component of benign ovarian mullerian epithelial tumors, primary smooth-muscle tumors of the ovary are rare. These tumors only originate from smooth muscle in the walls of blood vessels in the cortical stroma, in the corpus luteum and in the ovarian ligaments at there point of attachment of the ovary. These tumors are usually asymptomatic and are usually found incidentally during operations or at autopsies. A case of 45-year-old woman with a leiomyoma of the ovary which was experienced on our hospital recently is presented with a review of literatuers.

임신중 고혈압성 질환의 임상적 고찰

신승권,김하봉,류형선,윤광혁,박명호 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.3

1988년 1월부터 1992년 12월까지 만 5년간 목포 성골롬반병원 산부인과에 입원 분만하였던 산모 총 17,755명중 502명의 임신중 고혈압성 질환 환자를 대상으로 임상통계학적으로 조사분석한 결과 다음과 같은 결론을 얻었다. 1. 총분만수에 대한 임신중 고혈압성 질환의 발생빈도는 2.83%였고, 매년 감소하는 경향을 보였다. 2. 분류에 의하면 경증 자간전증이 56.98%(286예), 중증 자간전증이 38.25%(192예), 자간증이 1.59%(8예), 만성 고혈압성 혈관질환이 3.18%(16예)였다. 3. 연령별 분포는 발생수는 25-29세군에서 가장 많았으나, 임신중 비고혈압성 질환군과 비교하였을때 35세이상에서는 높은 빈도를 보였다(p$lt;0.05). 4. 분만횟수별 발생수는 초산부에서 가장 많았고, 임신중 비고혈압성 질환군과 비교하였을때도 초산부에서 발생빈도가 가장 높았다(p$lt;0.05). 5. 계절별 분포는 동계에 가장 높은 분포를 보였으나 계절간의 의의있는 창를 보이지는 않았다. 6. 모체 혈액형에 따른 발생빈도는 A형에서 가장 높았다. 7. 태아 성별은 남아에서 53.7%로 빈도가 더 높았으나 큰 차이는 보이지 않았다. 8. 다태임신시 발생빈도는 18.75%로 단태임신에서의 임신중 고혈압성 질환의 발생빈도보다 월등히 높았다. 9. 임신기간과 신생아 체중은 임신중 고혈압성 질환군과 임신중 비고혈압성 질환군을 비교하였을때, 임신중 고혈압성 지롼군에서 조산과 저체중아의 발생빈도가 월등히 높았다(p$lt;0.05). 10. 산전관리 횟수는 전혀 산전관리를 받지 못한 경우가 32.1%였으며, 1회의 산전관리만을 받은 경우는 36.6%였다. 11. 분만방법은 질식자연분만이 30.9%, 질식유도분만이 21.9%, 질식흡입분만이 7.8%, 제왕절개술에 의한 분만이 39.4%였다. 12. 모성합병증은 빈혈 24.5%, 산후출혈, 4.6%, 태반조기박리 3.4%였고, 모성사망은 0.2%(1예)였다. 13. 태아 및 신생아 합병증은 자궁내 발육지연이 20.3%였고, 사산아는 0.8%, 신생아 사망은 3.6%였다. 14. 혈소판치가 10만/mm^3이하로 감소된 경우는 4.5%였다. This clinical study was undertaken for evaluation of 502 cases associated with hypertensive disorders in pregnancy, who were admitted to department of Obstetrics and Gynecology, St.Columban Hospital from January, 1988 to December, 1992. The results were as follows; 1. The incidence of hypertensive disorders in pregnancy (HDIP) was 2.83% of total deliveries. 2. Using the classification of American committee on Maternal Selfare, the incidence of hypertensive disorders in pregnancy was as follows; Preeclampsia, mild: 56.9% Preeclampsia, severe: 38.25% Eclampsia: 1.59% Chronic hypertensive vascular disorders: 3.18% 3.The highest number of HDIP was observed in the age group of 25-29, but the frequency of disease was higher in the age group above 35 years old. 4. According to parity, the higher frequency was noted innullipara. 5. Among four seasons, 29.5% of the patients were occurred in winter which was the most prevalent season, but a significant difference in seasonal distrubution was not noted. 6. Among four blood type, 44.8% of the patients were occurred in blood type A which was followed by B,O,AB,in orders. 7. There was slightly higher male predominance in fetuses of the hypertensive disorders in pregnancy, but a significantl difference was not seen. 8. The incidence of HDIP in twin pregnancy was 18.75%. 9. As to the gestational age and the birth weight, the preterm and the low birth weight were higher incidence in HDIP group than non-HDIP group. 10. The disease was more prevalent in women who did not take antenatal care. 11. 60.6% of the patients were delivered vaginally, 30.9% spontaneous, 21.9% induced, 7.8% with vacuum extraction and 39.4% of the patients were performed cesarean section. 12. As to maternal complication, anemia was found in 24.5$, postpartum hemorrhage in 4.6%, abruptio placentae in 3.4% and maternal death in 0.2%. 13. As to fetal complication, intrauterine growth retardation was found in 20.3%, stillbirth in 0.8% and neonatal death in 3.6%. 14. The mean level of platelet count was 226,800 /mm^3, and the group less than 100,000 was 4.5%

충청지역에서 발생한 쭈쭈가무시병의 임상상, 원인균의 혈청형 및 혈청역학적 연구

김선영,김윤성,박장규,윤태영,강재승,송인숙,최명식,최인학,차창룡,이우곤,박종우,이증훈,장우현,유영해,윤광혁,송계용 대한감염학회 1989 감염 Vol.21 No.2

From September to december 1987, eighty-six cases of tsutsugamushi disease were diagnosed by indirect immunofluorecent test or by isolating the causative agent in Chungcheung area. Their clinical features and patterns of antibody response to R. tsutsugamushi were analyzed. For the indenfication of prevalent antigenic types of R. tsutsugamushi in Chungcheung area, twenty-seven strains isolated were tested by indirect immunofluorescent test. To assess the extent of exposure to R.tsutsugamushi of a general population in Korea, the prevalence of antibody was investigated in 6,572 sera obtained from the residents of Chungcheung area by indirect immunofluorescent test. The female patients slightly outnumbered the male patients. More cases (68%) were older than 40 years of age. The epidemic peaked in October. The mean incubation period estimated was about 8 days. The major clinical features were fever and chill, headache, rash, eschar, and lymphadenopathy. Increased serm transaminase was the most singificant laboratory findings. Abnormalities in the chest roentgenography were often observed. The antibody titer rose rapidly 5 days after the onset, reached its peak at 20 days (1:640), and then declined agradually until 7 months(1:20). The seroype of 23 out of the 27 isolates wase found to be karp, one was Gilliam, and 3 isolates could not be classified by using polyclonal mouse hyperimmune sera. The prevalence of antibody to R.tsutsugamushi in the residents of Chungcheung area was 4.8%. The prevalence of antibody was higher in the female than in the male. The prevalence was higher in the residents of age above 40 years than below 40 years, and was the lowest in the children less than 10 years of age. Of the 318 positive sera from normal residents, only 2 sera showed the titers higher than 1:80.

한국에서 발생하는 scrub typhus의 혈청학적 진단을 위한 면역형광항체가의 평가

장우현(W.H. Chang),김익상(I.S. Kim),최명식(M.S. Choi),최인학(I.H. Choi),기선호(S.H. Kee),김주완(J. W. Kim),박장규(J.K. Park),이증훈(J.H. Lee),김윤성(Y.S. Kim),윤태영(T.Y. Yoon),송인숙(I.S. Song),윤광혁(K.H. Yoon),김석용(S.Y. Kim),강성귀(S.K. 大韓微生物學會 1989 大韓微生物學會誌 Vol.24 No.3