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

다국어 초록 (Multilingual Abstract)

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.