자연분만과 제왕절개분만의 입·퇴원 특성 및 진료비 분석 -심사평가원 청구 자료를 중심으로, 2009~2011

송혜숙,정준식,이난희,이병현,김윤신 한국모자보건학회 2015 한국모자보건학회지 Vol.19 No.1

Purpose: Low birth rate is one of the major social problems in Korea. This study is aimed atproviding Korea’s birth promotion policy with evidence derived from the analysis of the deliverydata available from the Health Insurance Review & Assessment Service (HIRA). Methods: We conducted an analysis on the characteristics of hospital admissions and dischargesby types of delivery using the data on claims for deliveries made to HIRA for the period of 2009to 2011. Results: Of all deliveries analyzed, 64.3% were normal spontaneous vaginal deliveries and 35.7%were deliveries by cesarean section, and among women above the age of 35, the higher the age,the higher the rate of women who had cesarean sections. On average, those who had vaginaldelivery were hospitalized for 3.3 days while those who had cesarean section were for 6.7 days. At hospital discharge, 90.1% of those who had vaginal delivery received medicine while 65.4% ofthose who had cesarean section did so. These findings were never mentioned in the previousstudies. 60% of those who had vaginal delivery were prescribed medicine for less than 3 days’use, while 49.3% of those who had cesarean section were given medicine for the same period. Interms of disease code classification, 83.3% of vaginal deliveries were categorized as single spontaneousdelivery (O80), and 49.2% of c-section deliveries were categorized as optional c-sectiondelivery with 35.7% as emergency c-section delivery. 72.7% of vaginal deliveries were includedin sub-diagnosis while 82.7% were included for cesarean section. As to the medical expensesincurred, the total medical fee and the co-payment by patients were ₩828,571 and ₩16,423 respectively for vaginal delivery and ₩1,173,769 and ₩235,522 respectively for cesarean sectionwith the expenses incurred for c-section were ₩345,198 higher for the total medical fee and₩219,099 higher for co-payment than for vaginal delivery. Conclusion: In conclusion, policy efforts should be made to support fertility raising, promotion ofvaginal delivery, and child care expansion, for example, a task force or a committee organized bythe government.

쌍태임신에서 태위에 따른 질식분만의 주산기 예후

윤정혜 ( Jung Hye Yun ),서은정 ( Eun Jung Seo ),오혜영 ( Hye Young Oh ),변아롱 ( Ah Rong Byun ),이현이 ( Hyun Lee Lee ),이순표 ( Sun Pyo Lee ),김석영 ( Suk Young Kim ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.12

목적: 쌍태임신에서 태위에 따른 질식분만의 주산기 예후를 비교해 보았다. 연구 방법: 2000년 3월부터 2005년 2월까지 분만한 쌍태임신 301예에서 임신 28주 미만 출생 16예, 출생체중이 1000 g 미만 6예, 자궁내 태아사망 4예, 질식분만 후 제왕절개분만 1예 등 주산기 예후에 영향을 미칠 수 있는 경우를 제외하고 연구에 부합하는 최종 274 예를 대상으로 쌍태아 태위에 따라 두정위/두정위를 A군 (133예), 두정위/비두정위를 B군 (80예), 첫 번째 아이가 비두정위인 경우를 C군 (61예)으로 나누었다. 이를 다시 분만방법에 따라 질식분만과 제왕절개분만한 경우로 나눠 각 군별 분만방법에 따른 주산기 예후를 후향적으로 비교, 분석하였다. 통계학적 분석은 ANOVA, T-test를 이용하여 p<0.05를 의미있는 것으로 하였다. 결과: A군에서 질식분만이 46예 (34.6%)로 B군, C군의 각각 5예 (6.3%), 5예 (8.2%)보다 높았고 (p<0.01), 질식분만의 임신 기간이 제왕절개분만보다 더 짧았다 (p<0.05). 제왕절개분만을 한 경우는 총 218 (79.6%)예로, A, B, C군 각각에서의 선택적 제왕절개분만 비율이 65.4%, 93.8%, 91.8%로 가장 높았다. 질식분만으로 출생한 경우 신생아 중환아실 입원비율은 A군에서 40.2%였고, 제왕절개분만을 한 경우 32.8%로 질식분만의 경우 더 높았으나 이는 대부분 저체중에 의한 경과 관찰로 평균 입원 기간은 A군의 질식분만시 17.0일, 제왕절개는 16.8일로 더 길었으나 이는 임신 기간이 더 짧았기 때문으로 5분 apgar 점수, 인공 호흡기 치료 등 주산기 예후에 차이를 보이지는 않았다. 결론: 쌍태아 질식분만은 태위가 관여함을 알 수 있었고, 두정위/두정위의 경우 분만방법에 따른 주산기 예후는 차이를 보이지 않았으므로 이 경우에서의 선택적 제왕절개분만 빈도를 줄이는 노력이 필요할 것으로 사료된다. Objective: To evaluate the perinatal outcome of vaginal delivery in twin pregnancy according to the presentation of the fetus. Methods: A total of 274 cases suitable to this objective were selected from the 301 cases of twin pregnancy delivered between March 2000 and February 2005. They were categorized into 3 groups according to the presentation of the fetus; vertex/vertex as the group A (133 cases), vertex/nonvertex as the group B (80 cases), nonvertex in the first twin as the group C (61 cases). And then each group also was divided into 2 subgroups according to the mode of delivery; vaginal delivery and cesarean delivery. The difference between the subgroups in each group as to perinatal outcome was retrospectively compared and analyzed for statistical significance. Results: The incidence of vaginal delivery in group A (46/133, 34.6%) was significantly higher than in group B (5/80, 6.3%) and C (5/61, 8.2%). A total of 218 (79.6%) cases were underwent the cesarean delivery and the most common indication of cesarean delivery was elective twin cesarean delivery in all 3 groups (65.4%, 93.8%, 91.8% respectively). The incidence of neonatal admission to the neonatal intensive care unit was, however, higher in vaginal delivery (40.2%) than in cesarean delivery (32.8%) in group A. The most common cause for neonatal intensive care unit admission was low birth weight for simple observation, and average admission dates of vaginal delivery was 17.0 days and cesarean delivery was 16.8 days. Conclusion: Vaginal delivery of twins depends on the presentation of the fetus, but no significant difference in perinatal outcome of group A were observed between the mode of delivery. Therefore attempt to decrease the incidence of elective twin cesarean delivery in group A is demanded.

Comparison of oxidative stress markers in umbilical cord blood after vaginal and cesarean delivery

( Eun Ji Noh ),( Yoon Ha Kim ),( Moon Kyoung Cho ),( Jong Woon Kim ),( Jin Wook Kim ),( Yeung Ja Byun ),( Tae Bok Song ) 대한산부인과학회 2014 Obstetrics & Gynecology Science Vol.57 No.2

Objective The purpose of our study was to investigate the effect of the mode of delivery on the oxidant and antioxidant system in umbilical cord blood. Methods We performed gas analysis of umbilical venous blood and umbilical arterial blood immediately after delivery in 38 women; eighteen women had a vaginal delivery while 20 women delivered via cesarean section at over 37 weeks gestation. We examined lipid peroxide concentration by thiobarbituric acid reaction, protein carbonyl content by 2,4-dinitrophenylhydrazine reaction, and total antioxidant capacity by oxygen radical absorbance capacity assay. Results Lipid peroxide levels in umbilical venous blood were significantly higher in patients delivering by planned cesarean section (1.81 ± 0.06 nmol/mg protein) than those with vaginal delivery (1.24 ± 0.05 nmol/mg protein) ( P < 0.05). Antioxidant capacity in umbilical venous blood was significantly higher in patients delivering by planned cesarean section (119.70 ± 0.13 μM/μL) than those with a vaginal delivery (118.70 ± 0.29 μM/μL) ( P < 0.05). There was no significant difference in the carbonyl content of umbilical venous blood or in the lipid peroxide, carbonyl content, and total antioxidant capacity of umbilical arterial blood. Conclusion Lipid peroxidation levels and antioxidant capacity in umbilical venous blood were higher in patients delivering by planned cesarean section than those with a vaginal delivery. Therefore, we propose that both the mother and neonate are exposed to higher oxidative stress during cesarean section delivery.

A Study of Microbial Flora of Conjunctival Sac in Newborns

Lee, Pil Wha,Jun, Ae Kyung,Cho, Byung Chae KJO 1989 Korean Journal of Ophthalmology Vol.3 No.1

미산부의 과숙임신에서 유도분만 시 제왕절개분만율이 증가와 관련된 위험인자

지경석 ( Kyung Suk Chi ),김준수 ( Jun Su Kim ),장은정 ( Eun Jeong Jang ),심재철 ( Jae Chul Sim ),양회생 ( Hoi Saeng Yang ),이형종 ( Hyung Jong Lee ),하준영 ( Jun Young Ha ),황지영 ( Jee Young Hwang ),김도균 ( Do Gyun Kim ) 대한주산의학회 2006 Perinatology Vol.17 No.1

목적 : 본 연구는 미산부에서 과숙임신으로 인한 선택적 유도분만 시 분만 방법 결과와 관련된 인자들을 분석하고자 이 연구를 시행하였다. 방법 : 1997년 3월부터 2005년 3월까지 임신 41 완전주수 이후에 선택적 유도분만을 위해 입원한 미산부 331명을 대상으로 하였다. 관련된 인자들로 연령, 체질량지수, 임신주수, Bishop 점수, 출생체중, 태아 두위, 태아 성별을 조사하였다. 결과 : 산모의 평균연령은 제왕절개분만군에서 27.59±2.57세이고, 질식분만군에서 26.99±2.61세였으며, 임신주수는 제왕절개분만군에서 평균 290±3일(41+3주), 질식분만군에서 289±2일(41+2주)이었다. 임신 전 평균 BMI는 제왕절개분만군에서 20.42±2.36 m2/kg, 임신 후 26.70±2.82 m2/kg로 증가하였으며, 질식분만군은 19.92±2.05 m2/kg에서 25.75±2.67 m2/kg로 증가하였다. 분만 후 태아 몸무게는 제왕절개분만군에서 3460.31±358.22 g이였으며, 질식분만군에서 3363.95±361.22 g이였다. 태아 두위는 제왕절개군에서 34.59±1.18 cm이고, 질식분만군에서 34.03±1.33 cm였다. 제왕절개군 127명 중 38명(29.9%)의 분만된 신생아에서 합병증(들)으로 출생 후 바로 입원치료 했으며, 질식분만군 204명 중 24명(11.8%)에서 나타났다. 결론 : 본 연구는 산모의 체중이 증가할수록, 태아의 몸무게 및 두위가 클수록 선택적 유도분만 후 제왕절개분만의 빈도가 증가함을 알 수 있으며, 이에 따른 태아의 유병율이 증가할 수 있다는 것을 증명했다. 그러므로 선택적 유도분만 전 산과의사는 적절한 방법과 충분한 경험을 토대로 제왕절개분만과 관련된 위험인자를 평가해야 할 것이다. Objective: The purpose of this study was to evaluate the risk of cesarean section in nulliparous women who undergone induction at postterm pregnancy. Methods : The retrospective study was conducted from March, 1997 to March, 2005 by reviewing 331 nulliparous patients more than 41 weeks` gestation delivered after induction at our Hospital. The evaluated variables to assess the risk of cesarean section were maternal age, body mass index (BMI), gestational age (GA), Bishop scores (BS), fetal body weight (FBW), fetal head circumference (FHC) and fetal sex. t-test and x2-test were used to compare these categorical variables. Results: The study included 331 nulliparous singleton pregnant women undergoing elective induction for postterm pregnancy: 127 (38.4%) delivered babies by cesarean section due to induction failure, progression failure and fetal distress, whereas 204 (61.6%) delivered vaginally. The mean maternal ages were 27.59±2.57 in cesarean delivery group and 26.99±2.61 in vaginal delivery group. The average values of BMI at postterm in cesarean and vaginal delivery groups were 26.70±2.82 and 25.75±2.67 kg/m2. GA was 41.36±0.27 weeks in cesarean delivery group, whereas 41.20±0.19 weeks in vaginal delivery group. The average FBW and FHC were 3460.31±358.22 g and 34.59±1.18 cm in cesarean delivery group, compared to 3363.95±361.22 g and 34.03±1.34 cm in vaginal delivery group. Conclusion : The BMI, FBW and FHC have linked to the risk of cesarean delivery in nulliparous women who underwent elective induction. Thus, these information would provide the useful tools to assess the risk of cesarean section in postterm nulliparous patients for planning an induction.

Predicting factors for success of vaginal delivery in preterm induction with prostaglandin E2

김유민,박주영,성지희,최석주,오수영,노정래,김종화 대한산부인과학회 2017 Obstetrics & Gynecology Science Vol.60 No.2

ObjectiveTo evaluate the efficacy and safety of prostaglandin (PG) E2 for preterm labor induction and to investigate the predictive factors for the success of vaginal delivery. MethodsA retrospective cohort study was performed in women (n=155) at 24+0 to 36+6 weeks of gestation who underwent induction of labor using a PGE2 vaginal pessary (10 mg, Propess) from January 2009 to December 2015. Success rates of vaginal delivery according to gestational age at induction and incidence of intrapartum complications such as tachysystole and nonreassuring fetal heart rate were investigated. Multivariable logistic regression analysis was performed to evaluate the predictive factors for success of labor induction. ResultsThe vaginal delivery rate was 57% (n=89) and the rate of cesarean delivery after induction was 43% (n=66). According to gestational age, labor induction was successful in 16.7%, 50.0%, and 62.8% of patients at 24 to 31, 32 to 33, and 34 to 36 weeks, showing a stepwise increase (P=0.006). There were 18 cases (11%) of fetal distress, 9 cases (5.8%) of tachysystole, and 6 cases (3.8%) of massive postpartum bleeding (>1,000 mL). After adjusting for confounding factors, multiparity (odds ratio [OR], 8.47; 95% confidence interval [CI], 3.10 to 23.14), younger maternal age (OR, 0.84; 95% CI, 0.75 to 0.94), advanced gestational age at induction (OR, 1.06; 95% CI, 1.02 to 1.09), rupture of membranes (OR, 11.83; 95% CI, 3.55 to 39.40), and the Bishop score change after removal of PGE2 (OR, 2.19; 95% CI, 1.0 to 4.8) were significant predictors of successful preterm vaginal delivery. ConclusionAn understanding of the principal predictive factors of successful preterm labor induction, as well as the safety of PGE2, will provide useful information when clinicians consult with preterm pregnant women requiring premature delivery.

자연 분만력의 횟수가 하부 비뇨생식기의 기능에 미치는 영향

문영주 ( Yong Ju Mon ),임희순 ( Hee Sun Lim ),정재은 ( Jae Eun Jung ),조현희 ( Hyun Hee Cho ),김미란 ( Mee Ran Kim ),유영옥 ( Yong Ok Lew ),김은중 ( Eun Jung Kim ),김장흡 ( Jang Heub Kim ),김진홍 ( Jin Hong Kim ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.4

목적: 자연분만력이 하부 비뇨생식기의 기능과 대변실금의 유병율에 어떠한 영향을 받는지 알아보고자 한다. 연구방법: 검진을 위해 산부인과 외래를 방문한 여성 중 연구에 동의한 여성을 대상으로 POP-Q (Pelvic Organ Prolapse Quantitation) stage를 측정하고 하부 비뇨기계 기능을 평가하기 위한 Bristol female lower urinary tract symptom (BFLUTS) 설문지, 그리고 변실금의 정도를 파악하기 위한 self-report questionnaire for fecal incontinence and constipation assessment 설문지를 사용하였다. 대상은 35~45세 사이의 폐경 전 연령군만 포함하였으며, 골반내장기에 대한 수술력이 있는 경우, BMI 25 이상의 비만 여성이나 만성 폐질환, 흡연자, 심혈관계 질환의 병력이나 대장질환이 있는 여성, 만성변비환자로 약물을 복용하거나 수술을 받은 과거력이 있는 여성은 대상에서 제외하였다. 결과: POP-Q에서 측정하는 8개 측정지점을 분석한 결과, Aa, Ba, Ap, Bp, Tvl 에서 자연분만력이 0인 환자 군과 1 이상인군 사이에 유의한 차이를 보였다 (P<0.05). 변실금의 발생율은 자연분만력 0회인 경우 4%, 1회인 경우 29%, 2회인 경우 32%, 3회 이상인 경우 26%로 나타났다. 분만력이 0회인 경우, 분만력이 1회 이상인 군에 비해 유의하게 변실금의 발생율이 낮은 것으로 나타났으나 (P<0.05), 분만 횟수에 따른 차이는 보이지 않았다. 요실금 증상 (BFLUTS-IS)의 유병율은 분만력이 높아질수록 증가하는 것으로 나타났다 (Pierson correlation coefficient 0.9, P<0.05). 성생활의 장애 유무를 묻는 BFLUTS-Sex 질문에서는 분만력이 증가할수록 성생활에 장애를 느끼는 환자의 비율이 증가하는 것으로 나타났다(Pierson correlation coefficient 0.7, P<0.05). 결론: 본 연구의 결과 자연분만력이 요실금 및 변실금의 발생율과 밀접한 관계가 있음을 알 수 있으며, 골반저 장애 및 성생활 장애의 주된 원인으로 작용함을 알 수 있었다. Objective: The purpose of this study was to evaluate if the number of normal vaginal deliveries influences lower urogenital system function and the incidence of incontinence. Materials and methods: The POP-Q (Pelvic Organ Prolapse Quantitation) examination was performed in 217 premenopausal women who visited our hospital for routine check up. They were asked to fill in the Bristol female lower urinary tract symptom (BFLUTS) and self-report questionnaire for fecal incontinence and constipation assessment questionnaires. Exclusion criteria included patients with a history of pelvic surgery, BMI >25, chronic lung disease, cardiovascular disease, colon disease or smoking. Results: There was a significant difference between the vaginal delivery group and none vaginal delivery group in the point Aa, Ba, Ap, Bp and Tvl in POP-Q (P<0.05). The patients were classified into four groups (0, 1, 2, above 3) according to the number of vaginal deliveries, and the incidences of fecal incontinence were 4%, 29%, 32%, 26% in each group, respectively. The incidence of fecal incontinence was significantly lower (P<0.05) in those who did not deliver vaginally, while no difference was observed in the number of vaginal deliveries. The BFLUTS-IS (incontinence symptom) score was higher in the patients with higher number of vaginal deliveries (P<0.05). There were also more patients with sexual dysfunction as was shown by the BFLUTS-sex questionnaire (P<0.05) in those patients with higher number of vaginal deliveries. Conclusion: We observed that the number of vaginal delivery is significantly associated with the incidence of fecal and urinary incontinence, and also that it was a major cause of disorders of the pelvic floor and sexual dysfunction.

질식분만이 회음부 하강과 음부신경 말단운동근 잠복기에 미치는 영향

허민희,최윤미,우상욱,김세중,홍기천,김종화,우제홍 대한대장항문학회 2000 Annals of Coloproctolgy Vol.16 No.2

분만방법 유형이 골반바닥근육 기능에 미치는 영향

권유정,이현옥 대한고유수용성신경근촉진법학회 2017 PNF and Movement Vol.15 No.3

Purpose: The purpose of this study was to investigate of the effects of the mode of delivery on pelvic floor muscle function by examining bladder base movement and urinary incontinence. Methods: This study was conducted on 100 females who had delivered in the previous 3–8 months. There were 2 groups: 56 vaginal deliveries and 44 cesarean section deliveries. Prior to the study, a survey was conducted on the subjects’ general status, delivery mode, urinary incontinence, and physical activity. The groups could not be blinded due to scar tissue from the operations. The function of the pelvic floor muscle was observed with the bladder base movement using transabdominal ultrasound during pelvic floor contraction. To objectify and measure the subjective symptoms of subjects suffering from urinary incontinence, an incontinence quality of life (I-QoL) test was administered. Statistical analysis of the data was performed using SPSS version 20.0. An independent t-test was used to assess the statistical significance of pelvic floor muscle function between the 2 groups after delivery. Results: The movement of the bladder base in the pelvic floor muscle function was decreased in the vaginal delivery group, but the difference was not significant. Urinary incontinence was significantly increased in the vaginal delivery group. Conclusion: The function of the pelvic floor muscles was better in the cesarean section group and the incidence of urinary incontinence was relatively low in this group. Therefore, vaginal delivery requires more efforts to restore the function of the pelvic floor muscles than cesarean delivery.

질분만에 따른 음부신경 손상 및 그 회복 양상

이상전,박진우 대한대장항문학회 1997 Annals of Coloproctolgy Vol.13 No.1