주산기사망에 대한 임상적고찰 = Perinatal Mortality

국문 초록 (Abstract)

1) 1968년 1월 1일부터 1972년 12월 말일까지 만 5년간 본원 산과병동에서 분만한 총 7,007 명의 산모로부터 출산된 7,102명의 출산아 중 주산기사망은 278명으로 주산기사망률은 생존 아출산 1,000명에 대하여 39.7에 해당하였다. 2) 주산기사망률은 초산부군에 비하여 2∼5회 경산부군에서 높았고 6회 이상의 다산부군에 서 가장 높았다. 반면 신생아사망률은 2∼5회 경산부군에서, 사망률은 초산부군에서 가장 낮 았고 6회 이상의 다산부군에서는 양자 공히 가장 높았다. 3) 다태임신에서 단태임신에 비하여 주산기사망률이 높았다. 4) 주산기사망의 49.3%가 조산아이었고 50.7%가 성숙아였다. 출산시 체중이 많을수록 주산 기사망률은 감소되었고, 4,000g 이상 군에서는 성숙아군에 비하여 그 사망률이 다소 증가되 었다. 5) 주산기사망 274명 중 65.7%는 산전관호를 받지 않았던 산모로부터, 34.3%는 산전관호를 받았던 산모로부터 출산된 예였다. 6) 태위에 따른 주산기사망률은 둔위분만례에서 172.2로 두위에 비하여 약 6배 높았고 횡위 에서는 564.1로 가장 높았다. 신생아사망은 둔위분만에서 많았고 사산률은 횡위에서 많았다. 7) 분만방법은 총 7,102명에 대하여 자연분만이 72.7%로 가장 많았고, 흡인분만 12.6%, 제와 절개술 8.5%, 인공개조둔위분만 4.5%, 겸자분만 148.9 등의 순이었다. 8) 신생아사망의 시기는 88.3%에서 24시간 이내에 발생하였고 주산기사망의 71.9%가 사산 이었다. 9) 주산기사망의 원인은 저산소증, 임신 중 고혈압증, 이상태위, 선천성기형, 감염 등의 순이 었고 저산소증은 주산기사망예의 29.6%에서 사인으로 간주되었으며 이에 대한 최대 원인은 정상위태반조기박리였다. 임신 중 고혈압증의 빈도는 전 분만예에 대한 24.1%였고 자간증에 서 주산기사망률은 자간전증에 비하여 2.4배 높았다. 그리고 주산기사망 274예 중 임신 중 고혈압증이 원인이라고 생각된 예는 15.7%에 해당하였다.

다국어 초록 (Multilingual Abstract)

The perinatal mortality has always attracted great interest and this wide interest has been readily explained by the complexity of the biological problems as well as certain definite factors connected with the perinatal period. The present clinical observation of the perinatal mortality at the Obstetric Ward of the National Medical Center, Seoul, during the years of 1968 to 1972, was based upon an obstetrical analysis of all deliveries during this 5 years. During this period there was a total of 6,913 single births with 93 twins and one triplet. Total number of births, therefore, were 7,102 and of these 6,905 were live births. Two hundred and seventy four perinatal deaths occurred throughout the above period. Perinatal mortality comprised all the dead infants with a birth weight above 1,000 gm who had died either before, during labor or in the first 7 days after birth. The results of clinical analysis were summarized as follows : 1. The perinatal mortality rate was 39.7 per 1,000 live births. For the last 2 years the perinatal mortality rate rose about 10 per 1,000 live births mainly due to increase of the neonatal death rate in prematures while the stillbirth rate remained stationary. The early nionatal death rate was 11.2. 2. The perinatal mortality rate was higher in 2 to 5 parity group than in primiparous group and highst in 6 or more. The nionatal death rate was the lowest in 2 to 5 parity group and the highst in 6 or more. 3. The perinatal mortality rate among pleural births were higher than single births. 4. One hundred thirty five babies (49.3%) among 274 perinatal deaths weighted between 1,000∼2,499 g and 139 babies (50.7%) weighed more than 2,500g. There was an inverse relationship between birth weight and mortality rate. 5. Perinatal deaths were more frequent in mothers who had not recieves prenatal care than in mothers who recieved it, even one or more times. 6. The perinatal mortality rate in breech presentation was higher than in cephalic and highst in transverse presentation. In breech presentation the fetuses were more often subject to birth traumas as compaired with ceplalic presentation and the risk of prolapse of the umbilical cord was increased in transverse presentation. Therefore the neonatal death was more frequent breech and the stillbirth rate was highst in transverse presentation. 7. The mode of deliveries were consisted of 72.7% of spontaneous delivery, 12.6% of vacuum extraction, 8.5% of cesarean section, 4.5% of assisted breech delivery, 0.7% of forceps delivery and 1% of moscellaneous modes. The perinatal mortality rate was lowest in the spontaneous delivery group (24.9) and was gradually increased by orders of vacuum extraction 37.6, cesarean section 61.9, assisted breech delivery 77.7 and forceps delivery 148.9. 8. The majority of neonatal deaths occurred within 24 hours after birth (88.3%) and the majority of perinatal deaths occurred during ante or intrapartum (71.9%). 9. The most common cause of perinatal deaths was related to hypoxia (29.6%) of which the most common contributing factor was abruptio placentae. Hypertensive disorders in pregnancy was present in 24.1% of all deliveries with a perinatal mortality rate of 25.5. About half of perinatal deaths were associated with prematurity.