전치태반 ( Placenta previa ) 에 관하여 ( 1963 - 1968 )

강신명(SM Kang),이일준(IJ Rhee),이경자(KZ Lee),김수자(SJ Kim) 대한산부인과학회 1970 Obstetrics & Gynecology Science Vol.13 No.8

Management of placenta previa is still a difficult one although expectant policy has been introduced for past 20 years in order to minimize the high neonatal mortality resulting from prematurity and intrauterine anoxia. The data to be presented are based on 73 cases of placenta previa seen among total deliveries of 10779 in Ewha Women`s University Hospital, Korea for past 6 years period. 1. Our incidence of placenta previa is considered somewhat high, 148:1 or 0.67%. It is unknown that whether or not this related to the frequency of induced abortion. 2. Placenta previa has occured more often in multigravidas(64.4%) than primigravidas or 4 times as frequent in primigravias as in multigravidas with para 4. 3. The frequent of toxemia associated with placenta previa was considered to be high, 17% or 3times the average incidence(Ewha) 4. About half(45%) cases of placenta previa was a sort of total placenta previa which was most serious one, requiring all(26 cases) Cesarean section and needed average 4 pints of blood transfusion. 5. Approximately half or 47.7% cases of placenta previa had delayed admission until labor pain occur following vaginal spotting has first time been noticed. More instructive prenatal education is emphasized. 6. The policy of waiting has been applied in the maximum of 41% cases of placenta previa. However there is a limitation that it seemed to be wise to perform the definitive operative delivery without delay more than 37th week of gestation becaue it prone to cause sudden, massive hemorrhage after that. 7. Vaginal delivery able been done in 1/5 cases of placenta previa which is all mild one requiring less than 2 pints of blood transfusion. 8. The majority cases(79.2%)of placenta previa, particularly all cases of total placenta previa (45% cases of sections)were treated by Cesarean sections and required more than 4 pints of massive, rappid blood transfusion. Of these sections 2 cases of Cesarean-hysterectomy were encountered inevitably in order to prevent uncontrolable hemorrhage. 9. A comparative study of low cervial Cesarean sections both to the anterior and posterior type of placenta previa(17&11 cases respectively) revealed no any differences either in view point of blood transfusion erquired or fetal loss corrected. Thus the potential risk of classical section seemed to be avoided. 10. Fetal mortality under the waiting policy is still limitted and high; 24% of loss in premature baby which is considered twice the average premature loss, and 3.4% loss(or 1.7% of corrected fetal loss)in term baby. There was no maternal mortality in this series. 11.A operative large sterized pads packing into the low segment to minimize the massive oozing is believed to be a life saving procedure and able to substitute any unexpectant hysterectomy. There was no significant postoperative infections in this procedure as aften seen in preoperative vaginal packing which is no longer been used.

산후자간에 관하여 ( 1964.1 - 1966.12 )

우복희(BH Woo),조행원(HW cho),김수자(SJ Kim),이일준(IJ Rhee) 대한산부인과학회 1968 Obstetrics & Gynecology Science Vol.11 No.7

Postpartum eclampsia is one of the serious complication during the puerperium although it is not common. We have encountered 13 cases of postpartum eclampsia which occured smong a total of 6040 deliveries in Ewha Womans University Hosptial, Seoul during the period from 1964 to 1966, the incidence being one case per 500 deliveries, Postpartum eclampsia constitues approximately 2.8% of all cases of Toxemia or 31% of all cases of eclampsia. Over all the incidencies were considered very high. 1. The majority cases (92%) of Postpartum eclampsia were occurred in the multiparas, and that never had prenatal cares (91%). Approximately 2/3 cases of Postpartum eclampsia have occurred after home delivery without modern obstetrical care (poor socio-economic group). 2. It is emphasized that careful Pstpartum care during first 5-10 days of puerperium shoud not be neglected to prevent or minimize these or other postpartum complications. 3. October is the peak month for Postpartum eclampsia in Seoul. This was similar to that of occurred in Miami area, although it is uncertain that whether or not it could be corelated with the mean temperature or the mean relative humidity. 4. The severity of Postpartum eclampsia depended on the degree of elevation of uric acid, and also the delayed occurrence appeared to be more severe with increased convulsion. 5. A careful study of family history seemed very important even in the puerperium since perfectely normotensive mother having family history of hypertension particularly on the parents side appeared to be a good candidates for the sudden onset of post partum eclampsia. 6. The mean weight of newborn baby from the mother of postpartum eclampsia was decreased approximately 650-850 Gm as compared with normaly expectant newborn weight, however there was no fetal death.

태반조기박리 ( Abruptio placentae ) 의 6년간 관찰 ( 1963 - 1968 )

강신명(SM Kang),김수자(SJ Kim),이경자(KZ Lee),이일준(IJ Rhee) 대한산부인과학회 1970 Obstetrics & Gynecology Science Vol.13 No.8

Abruptio placenta is a serious complication in pregnancy when dealing with maternal death as well as fetal loss especially in the country having high incidence of toxemia. 1. We have encountered 34 cases of Abruptio placentae which occured among a total of 10,640 deliveries in Ewha Womens University Hospital, Seoul during the period of 6 years from 1963 to 1968, the incidence being one case per 330 deliveries or 0.32%. Although this incidence was considered relativity low both the maternal & fetal death rate were markdly high. 2. The leading causative predisposing factor of the abruptio pladentae in this series was toxemia occupying one-third(38%) of the cases. The other known cause was shortness of the umbilical cord(26%) including it`s strangulation. Indeed every efforts to prevent the toxemias of pregnancy are important at present among the numerous caucative factors. 3. The majority of placentae occured between age of 30&40, and more in multigravidas(88%). It was interesting to notice that more than one-half(56%) of the cases of abruptio placentae had a tendency of prematurity occuring from 27 to 37 weeks of gestation period. 4. Abruptio placentae with concealed hemorrhage was serious in it`s nature. However the fetal death rate were considered to be high(80%) even in the mild group which probably due to the delayed admission from the patient side. 5. The average amount of blood transfusion needed was 3 pints in the mild cases, and 6 pints or more in the severe cases. 6. About one-half(56%) of the abruptio placentae were treated by Cesarean section mostly for the severe cases with shock or for the fetal distress. The perinatal mortality was reduced to 53% in these section group. 7. The incidence of prenatal care undergone was very low(only 18%). Both quantative and qualitive prenatal care would be important to prevent abruptio placentae, and it should be warn if any toxemic state or sudden pain develops in multigravidas, over 30 year of age, particularly during 27-37 weeks of gestation. 8. The prognosis of the patient with abruptio placentae admitted in 4 hours after it`s onset was much fair than the delayed in which revealing the partial or less than one-half area of the placental detatchment with some hopeful(25%) fatal salvage. Therefore the abruptio placentae should be terminated promptly in 2~4~8 hours after the accident has occurred.