서울시내 5개종합병원의 임산부의 인구학적 산과학적 배경

홍성봉(SB Hong),김승욱(SW Kim),곽현모(HM Kwak),권순욱(SW Kwon),이재현(JH Lee),이원기(WK Lee),박인서(IS Park) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.4

* This investigation received financial support from the World Health Organization. * 본 논문의 요지는 1977년 10월 7일 제 40차 대한산부인과학회 학술대회에서 발표하였음. 1)고려대학교 의과대학, 2)국립서울대학교 의과대학, 3)연세대학교 의과대학, 4)5)6)경희대학교 의과대학, 7)국립의료원 Changes in the value system among Korean along with the remarkable socioeconomic development during the last three decades ever since the out-break of Korean conflicts in 1950 have ushered in nationwide movement toward family limitation. Its consequence is obviously being reflected on the reproductive patterns of Korean couples. This paper is to clarify the recent changes in reproductive pattern in terms of demographic and obstetric backgrounds of Korean wives who attended five antenatal clinics of four university hospitals and one government hospital. Primary purpose of the study was intended to investigate possible effect of induced abortion on the outcome of subsequent pregnancies. The study was carried out by interviewing the pregnant women during pregnancy and after its termination in prospective fashion. The period of contack encompassed from February, 1975 to May, 1977. Each individual was contacted twice in pregnancy and after childbirth respectively. The results obtained from the first interview of 5,843 women at antenatal clinics are as follows: 1) Women attending antenatal clinics comprises of 19 years or less for 0.2%, 20-24 years for 20.1%, 25-29 years for 57.9%, 30-34 years for 18.5%, and 35-39 years for 2.9%. Thus, women in 20s represents 78.0% of all samples. Of these primigravidae is 36.5%, while multiparae 54.3% of the total. In comparison of women 10 years earlier in Seoul, the proportion of pregnant women in 30s were 37% instead of 22.8% of the present level which is mirroring the earlier limitation of family size by much shortened reproductive activities. 2) As to educational attainments of pregnant women, the proportion of wives completed middle or high school and college are 51.8% and 43.1% respectively, whereas the comparable educational levels among wives in Seoul are 45% and 5%. Therefore, the samples appear to be representative of women in much higher socioeconomic strata of Seoulite. 3) All women have experienced 1.5 pregnancies on average in their past, while among those ever experi

INDUCED ABORTION IN RURAL KOREA

홍성봉(SB Hong) 대한산부인과학회 1967 Obstetrics & Gynecology Science Vol.10 No.6

PART I INTRODUCTION The majority of countries including Korea prohibit artifficial termination of pregnancy, yet the actual ratio of induced abortions to live births is roughly 1 to 2 in Seoul. Thus, induced abortion affects the birth rate in unban areas of Korea enormousl. (See "Induced Abortion in Seoul, Korea", 1966, by this author) The main reasons for the abortions were found to be family limitation, child spacing and economic difficulty. The author has also pointed out in the preious pubilication that the rising trend in indeuce abortion coincided with the inception of family planning as a fundametal governmental policy. A new value orientation and the family planning campaign have been propagated in the country on a wide scale. The proportion of contraceptive users in rural areas at present is comparable to that in Seoul in Spring 1964. As the proportion of practitioners in rural areas increases gradully, it is anticipated that incidence of induced abortion will follow a similar trend. The population of rural areas in Korea constitutes 70 per cent of the total. Thus, fact finding about induced abortion in rural areas is essential in order to complete the picture of induced abortion in the whole of Korea. This will complement the subject together with the data collected from Seoul in 1964. Moreover, an agricultural population maintains, in general, homegeneity of social background and rather lower economic standards, which will affect the patterns of induced abortion in comparison with that of urban areas. These are the reasons for undertaking a field study in a rural area. It is said that where the legal supervision of induced abortion is strict, exploration of factual data is difficult to undertake as has been experienced in the United States. How- ever, in Korea the proportion of women who feel guilty about resorting to induced abortion is relatively small. Furthermore, actual prosecution against criminal abortion is rarely reported unless the maternal damage subsequent to the abortion is unbearable. Wives, therefore, discuss the subject without hesitation or reticence. These provide favorable conditions for the elucidation of facts about induced abortion in Korea. DEMOGRAPHIC BACKGROUND AND SAMPLES For this study, Yongi-Gun, Chungchong-namdo, was chosen as the study area and eligibility was defind as wives aged 20 to 44 years who were living with their husbands at the time of interview. Yongi-Gun, the study area, one of counties in Chungchong-namdo Province, is located approximately in the center of South Korea, and is considered to represent one of the typical rural areas of Korea in terms of cultural, social and ecoomic conditions. This judgment is based on statistical data relative to Yongi-Gun which shows similarity in comparison with data of other counties. (The Statistical Yearbook, 1965, by the Provincial Government). Yongi-Gun, Located 75 miles away from the capital city, Seoul, had a population of 108,330 as of December 1, 1964, and comprised six Myuns or 189 Ris. Its county govern- ment is located at Chochiwon-Eup. Since the study is concerned with a typical rural area, Chochiwon-Eup and Bongam-Ri were excluded from the universe. The former is a medium- sized town where the county office is located and is more or less urban oriented. A railway station called "Chochiwon" is located here. Bongam-Ri contains military bases with a demographically aberrant population. Both were omitted from the universe because of their incompatibility with the typical rural pattern.

인공유산시술의의 실태조사

홍성봉(SB Hong) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.11

Since the governmental policy toward family planning laid solid foundation in 1961, practice of induced abortion has become steadily rising trends and several surveys on induced abortion have been carried out. However, the sources of information are collected from housewives in the reproductive ages. This paper is the results of the survey based on the inberviews of providers of induced abortion. Thus, scope of information encompasses all age groups, regardless of marital status of abortees. Furthermore medical aspects of abortion are elucidated through the responses of providers. The survey was conducted by interviewing each providers at clinics and hospitals where induced abortion was practiced for five months between October, 1977 and March, 1978. The results are as follows: 1. Backgrounds of Providers: 1) Medical facilities where induced abortion was provided numbered 726 in Seoul. Of which 684(94.2%) is private clinics and 41(5.6%) being hospitals. These medical facilities correspond 33.4% of all those located in seoul, however, about 15 percent in the core of city and about one-half in peripheral regions of the city. 2) The sex ratio of induced abortion providers is about 2 to 1, whereas that of all practitioners in Korea being 5 to 1, implying higher participation of female practitioners in induced abortion practice than in orher medical specialties. 3) Providers in forties comprises one-half of all. Those beyond age of fifty is 29.6 percent contrasted with that of all practitioners 46.6 percent. Thus, induced abortion providers tend to be younger than other medical specialties. 4) Year of experience in practice is 11.4 years on average. 5) As to medical school graduated, one-third of providers are from Korea University, 17.2 percent from Seoul National University, 10.7 percent from Ewha Womens University, and 7.4 percent from Yonsei University respectively. 6) Of providers, specialists in obstetrics and gynecology constitutes 39.2 percent, and the non-specialist about 60 percent. In downtown area provi

서울시 일원의 인공유산의 최근동향

홍성봉(SB Hong) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.9

우리나라의 인공유산에 관한 최근자료에 의하면 1976년도에 전국에서 약 50만건의 인공유산이 실시된 것으로 보고된 바 있으나 저자가 실시한 1977년 10월부터 1978년 3월에 이르는 6개월간의 서울전역의 인공유산시술의의 실태조사에 따르면 해당년도에 서울 시내에서만 약 53만건의 인공유산이 실시된 것으로 추정되었다. 이 추정치가 보다 현실을 반영한 것이라고 본다면 전국에서의 인공유산수는 최소한 100만건 이상으로 추산함이 타당하다고 보아야 하겠다. 이러한 인공유산 추정치의 차이는 1) 조사시점의 차 2) 인공유산경험자의 과소보고와, 3) 자료제공자가 판이한대 기인한 것으로 추측되며 본조사를 제외한 자료는 공히 인공유산소비자조사(Consumer Survey)이었으며 특히 기혼부인을 대상으로 하였던 것에 반하여 보조사자료는 공급자를 조사대상으로 하였다는 점에 인하는 것이다. 인공유산유경험자의 인구학적 배경에 관한 기존자료는 일률적으로 30대 이상의 기혼부인으로서 수명의 자녀가 있는 경우가 그 특성이었으나 조사대상자선택기준변경으로 혼전임신 또는 약년층의 인공유산실태가 새로이 포함된 것이다. 또 기존노리성의 상존함에 비해 성행위의 현실과의 격차가 있었기에 소비자조사로는 약년층의 인공유산에 관한 자료는 그 정확을 기하기 어려웠던 것인데 시술의조사로서 기혼부조사에서의 사각지대에 대한 조사를 할 수 있게 된 것이다.

임산부의 임신중 생활실태에 관한 관찰 ( IV )

홍성봉(SB Hong),박인서(IS Park),김승욱(SW Kim),곽현모(HM Kwak),박재현(JH Bark) 대한산부인과학회 1980 Obstetrics & Gynecology Science Vol.23 No.1

이미 보고한 바 서울시내 5개 의료기관을 순방한 5,000여명의 임부의 임신기간중의 일상 신체활동양상과 임신중의 직업관계, 약물복용 및 흡연실태 등을 조사한 바를 보고한 바이다. This paper is produced grom the data by interviewing exoectant mothers at 5 medical institutes in Seoul during the period of 20 months between February, 1975 and September, 1976, aiming primarily to elucidate possible association between induced abortion and the outcome of the subsequent pregnancies. Women attending antenatal clinics were interviewed twice before deliverisd and twice afterward. At the first contact 5,843 women were interviewed and 5,024 at the second between 24 and 32 weeks of their gestation periods. This paper is mostlt focussed on behaviors during their pregnancies and main results are summarized as following: 1.As shown in Table 1, 42.3 percent of women sit mostly, 47.5 percent half sit and half walk. the remainder, 10.2 percent mostly sit and walk in pregnancy. The proportion of women sitting mostly from extended family surpasses those from nuclear familt by 7.3 percent, which is probably due to the heavier household works among the former. Women sitting mostly are more often among those in twin pregnancies than singleton whereas those walking or standing mostly show more frequent occurrence of hypertension and edema, probably associated with their lower socio-economic backgrounds. The similarity is found with puerperal complication. 2.At the first interview about one-fourth of women is found to be gainfully em- ployed wgicgis reduced to one-sixth at the second interview. As illustrated in Table 2, collge graduate continues to wof=rk in 22.6 percent, middle or high school level 9.8 percent and primary scheel level 17.5 percent respectively. During the pregnancy, about 5 percent of women is enhahed in either heavy work or handling dust or chemicals, and appears to result in complications and malformations of their newborn more often than others.(see Table 3) 3.During the preganacy 27.4 percent of women experiences either surgical opera= tion, roentgen examination, inoculation or ultrasonic proxedure without an appreciable difference in outcome of preganacy and morbidity of the neqborns. 4.Women during pergnancy take medication for the therapeutic reasons in two -fifths. Multipara tends to take medicine less often compared to primigravida or women with experience of induced abortion in the past(See Table 4). 5.In Korea, smoker among expectant mothers is negligible(0.6%).

유산

홍성봉(SB Hong) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.5

유산은 산부인과 영역에서 임신전반기에 발생하는 출혈성임신합병증의 대표적인 것이다. 그러나 유산으로 인한 출혈은 임상적으로는 임신후반기 또는 분만을 전후한 출혈의 양상에 비하면 비교적 경미한 출혈이나 임상가로서는 흔히 조우하는 효과로서 출혈의 제목하에 유산문제를 다루어 보는 것은 의의가 있는 것이다. 유산의 정의를 임신기간으로 보아서는 20주 이전에 임신이 중절되는 경우를 칭하나 학자에 따라 또는 법 률상의 규정에 따라서는 28주까지를 유산으로 정의하는 경우가 있다. 대체로, 20주 이전의 임신산물의 중 량은 500gm 이하이며 자궁외 생존가능성이 없는 것으로 규정되어 있다. 그러나 근소한 예에서는 500gm 이하의 태아가 생존하였다는 예가 보고는 되어 있다. 20-28주 사이는 미숙산이라고 칭하며 태아체중은 500 내지 999gm에 해당되는 것이다. 이 기간중에 중절된 태아는 생존가능성이 있다고 보는 것이다. 유산이 자연히 발생된 경우를 자연유산이라 칭하며 인위적으로 중절된 경우를 인공유산이라 칭한다. 인공 유산은 다시 의학적 이유로 모체의 건강상 임신중절하는 경우를 의학적 유산이라고 칭하며 기타 사회경제 적 등의 이유로 한 경우를 비의학적 유산, 만일 유산이 감염증을 합병한 경우는 감염성유산(septic abortion)이라고 칭한다. 자연유산은 총 임신의 10% 내외로 보고되어 있으며 인공유산은 국가에 따라 상 당한 차이가 있어서 한국의 경우는 인공유산의 경험률은 최근 성적에 의하면 서울에서는 약 40%, 중도시 에서는 33%, 농촌에서 19% 인공유산의 경험을 가지고 있다.

Epidemilogy of Respiratory Distress Syndrome

홍성봉(SB Hong),박용균(YK Park),이규완(KW Lee),유동화(DH Yoo) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.7

1980년 1월 1일부터 1984년 12월 31일까지 고려대학교 의과대학 혜화병원 산부인과에서 최근에 분만한 총 4,879예중 호흡곤란증후군이 발생한 46예를 대상으로하여 아래와 같은 결론을 얻었다 1 발생빈도는 0 94%이었다 2 성별로는 남아가 80 4%로 많았다 3 체중별로 보면 2500gm미만에서 67 5%가 발생하였다 4 제태기간에 따른 빈도롤 보면, 37주이하에서 69 5%의 높은 빈도를 보였고, 동기간의 전체 분만에서 보면, 정상 제태기간에서는 0 33%만이 발생한 반면 조산아의 경우 337예중 30예인 8 90%에서 호흡곤란증후군이 발생하였다 5 산모의 연령별로 보면, 동기간의 전체분만중 30∼34세군이 2 17%, 35∼39세군이 2 08%의 높은 빈도를 보였고, 25∼29세군은 0 93%의 빈도를 보였다 6 3회 경산에서 2 35%, 1회 경산에서 1 05%로 초산의 0 90%보다 높았다 7 제왕절개술에서 1 24%로 질식분만의 0 83%보다 높은 빈도를 보였다 제왕절개술의 경우 그 적응증은 uterine hypoperfusion이 52 9%로 반수이상을 차지했다 8 쌍태아의 경우는 17 4%이고, 제2아에서 50 0%로 높은 빈도를 보였으나 통계학적 의의는 없었다 9 계절별로 보면 가을, 봄이 34 8%, 30 4%로 여름(13 0%)보다 높은 빈도를 보였다 10 호흡곤란증후군에서는 89 1%로 신생아가 사망했고, 그 사망시기는 2일이내가 87 8%를 차지했다 This is a review of 46 cases of Respiratory Distress Syndrome in 4879 deliveries at Hae Wha General Hospital, Korea University from January 1, 1980 to December 31, 1984 The results were summerized as follows: 1 Overall incidence of RDS was 0 94% 2 The incidence of RDS in male baby was remarkably higher than that of female baby (80 4% in male baby & 19 6% in female baby ) 3 The rate of RDS in low birth weight (under 2500Gm)was 67 5% 4 The rate of RDS in preterm (before 37wks) was 69 5% The overall incidence of RDS in preterm(8 90%)was higher than that of term bady (0 33%) 5 The overall incidence of RDS by maternal age was 2 17% in the age group of 30-34 years old, 2 08% in the age group 35-39 years old, and 0 93% in the age group of 25-29 years old 6 The incidence of RDS in para 3 (2 23%) and para 1 (1 05%) women was higher than that of primiparous(0 90%) 7 The incidence of RDS was higher in C/S (1 24%) than vaginal delivery (0 83%), the most common indication for C/S was uterine hypoperfusion, i e placenta previa and abruptio placenta (41 1%, 5 9%) and fetal distress (5 9%) 8 The rate of twin delivery in RDS was 17 4% and second baby was prevalent (50 0%), but there was no statistical significance 9 The incidence was higher in autumn and spring (34 8%, 30 4%) than summer season (13 0%) 10 The mortality was 89 1% & among these 87 8% were died in first 2 days after birth

도시가임기여성의 사망실태에 관한 조사 ( I ) - 서울시소재 11개 주요의료기관의 입원환자를 중심으로 한 검토

홍성봉(SB Hong) 대한산부인과학회 1969 Obstetrics & Gynecology Science Vol.12 No.2

Although vital statistics are essential as references for the management of national health programs, there is not much reliable data on vital statistics in Korea. The author previously published studies on induced abortion in rural and urban Korea. With the continuoualy rising trend in practice of induced abortion it is forseeable that postabortion morbidity and mortality will rise. In order to estimate mortality due to abortion the research should encompass as full a range as possible of estimates of mortality in the Korean female population. For this purpose two alternative approaches were utilized. First, a study was made of death certificates submitted to 306 Dong offices in Seoul. The death certificate is required in order to obtain a burial or cremation permit from the authorities. Second, the other approach included a review of medical records in hospitals in Seoul. The first approach has precviously been utilized by others for the study of mortality, but their results have revealed incomprehensive or incomplete data on the mortality of women in reproductive ages. By the second approach some authors have already reported on maternal deaths based on review of medical records from single medical institutions. Although these reports reveal some invaluable inform- ation on maternal death, they unavoidably ppresent limited information. In the tresent paper, the author has attempted to evaluate the deaths of women of reproductive age using the full range of information on deaths on 11 medical institutions. This appoach has some advantages from the viewpoint of accuracy and reliability of medical records. On the other hand, it includes some disadvantages since information may be limited and because the selection process contains sample biases, The most certain advantage is that there is valuable information available in hospital records not reveraled in death certificates. For this purpose, eleven out of 22 hospitals in Seoul were selected which are all off icially aproved postgraduate training hospitals(See Table I). With the cooperation and permission of the hospitals involved, all medical records of all female in-patients aged 15-50 who died within these medical institution during the one year period from January 1 to December 31, 1967 were reviewed. The total number of eligible medical records was 510. In addition, 136 cases of death on arrival were reported which were excluded from the study due to lack of medical data and an unsatisfactory autopsy rate. In reviewing the 510 cases of death, the following results were obtained: 1) The leading cauess of death in repro luctive ages appear in Table 2 and 3 in accordance with the International Classification of Diseases. Leading causes are suicide (25.9%), maternal death (13.3%), CVA(10.4%), cancer(9.4%), heart disease(7.4%) and tuberculosis(7.1%) in order of frequency. 2) As shown in Table 4, 68% of CVA occurs in the 40`s, 70% of cancer after 30`s, In 20`s, on the other hand, suicide and accidental death consrtitute 64% and 43% of each cause of death respecrively. 84% of maternal death occurs in 20`s and 30`s. 3) Maternal deaths comprised 13.3% of deaths making it thr second most frequent cause . As showns in Table 5, 11 died of puerperal infecrion, 12 died from toxemia of pregnancy, 13 were hemorrhagic deatjs, and 22 cases were due to the complications of induced abortion. 4) Maternal Mortality Rate The total number of deliveries in the eleven hospitals was 10,464 in 1967. Accordingly, a maternal mortality rate is calculated at 65.0 er 10,000 deliveries. The denominator, however, is not adequate

난소암의 조기진단

홍성봉(SB Hong) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.9

난소암은 10만 인구당 10 내지 18명의 발생빈도로 보고되어 있으며 모성암의 3%를 차지하고 있다. 1964년 New York의 사인보고에 의하면 자궁경부암으로 인한 사망보다 난소암으로 인한 사망 부인수가 더욱 증가되고 있다고 한다. 이 사실은 난소암치료의 해결을 못 본 까닭에 조기진단에 의존할 수 밖에 없다는 현실을 시사하는 것이다. 그런데 난소암의 조기발견이 지난한 이유로서는 1) 난소암의 조기발견이 유일한 방도는 pelvic mass의 진 단인데 허다한 경우 기능성 난소종양을 제외하고는 그 조기발견은 임상적으로 난제로 되어 있으며 심지어 난소암의 말기에서도 난소의 이와같은 소견이 뚜렷하지 않은 경우가 허다한 것이다. 2) 난소암의 증상 또 는 증후가 비특이적이며 다양 한데 있으며 3) 난소암의 발병은 대단히 완서하여 난소암수술당시 병변이 난 소에 국한된 경우는 30%에 불과하며 또 초진당시 20 내지 80%는 말기에 해당한 경우라고 한다. 4) 난소암 은 양성난소종양으로부터 예기치 않은 사이에 악성화할 수 있다는 사실등이다.

한국의 분만양상에 관한 고찰 (IV) - 출산순위 및 출산성비 -

홍성봉(SB Hong) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.6

1. Along with increasing practice of fertility control the proportion of the first childbirth of all births has been steadily increased fro one-thirds(34.4%) in 1976, two-fifths (40.9%) in 1981, and to one-half(51.4%) in 1985. Accordingly the proportion of childbirths beyond the third of birth order has becom much smaller (10.3%) in 1985, compared with the figure of 36.3% in 1976 . Thus one-tenths of mothers gave birth more than three in 1985. 2. Likewise tho proportion of mothers beyond age of thirties who gave birth has been decreasing from one-fourths (25.0%) on-sixths(17.1%) and one-tenths(10.4%) respectively at each calendar year above mentioned , In short 90 percent of all births in 1985 occurred among mothers in their 20s. 3. Sex ratios at each birth orders ranges from 107 to 109 during the period 1976-1980 and is somewhat inversely associated with age of mothers. However the trends is reverased in datas for the period 1981-1985. 4. Sex ratios by birth order ranges from 106 to 107 for the period 1976-1980 whereas the ratios for the period 1981-1985 increases along with the high birth order. 5. Sex ratios at third birth or beyond shows astoundingly high for births registered in 1985 particularly in the south-east region of Korean Peninsula, ranging from 140 to 500. The phenomena is likely to be suggestive of surgical intervention for selective procedures during antenatal period, which should be condemned and rectified.