만기 분만아의 주산기 사망에 대한 고찰

김상우(SW Kim),오익렬(ER Oh),변지수(JS Pyun) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.6

The hospital records were reviewed of 135 infants born at or after 37 weeks of amenorrhea who suffered perinatal mortality during a 5-year period at Chonnam University Hospital. Overall perinatal mortality rate was 47.58 per 1,000 births, and the rate of subdevided groups was lowest in term infants. Half the deaths of term infants occurred intrapartum. 80.9% of intrapartal deaths was extramural cases (before the arrived at our hospital). The most frequent cause of death of term or post-term infants was extrinsic perinatal hypoxia. Further reduction in perinatal mortality for this group may require extension of perinatal care to all pregnancies. A goal for obstetrics care is that fetus alive in utero at 37 weeks of amenorrhea should not subsequently die in the perinatal period, provided no lethal malformation is present.

질용 Prostaglandin E2 투여에 의한 유도분만 효과에 관한 임상적 고찰

김상우(SW Kim),박기수(KS Park),서병희(BH Suh),목정은(JE Mok),이재현(JH Lee) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.6

유도 분만이 적용이 되는 산모 30예(초산부 15명, 경 산부 15명)를 대상으로 질용 PGE₂를 자궁경부와 질후 벽 사이에 있는 함요부에 삽입하여 다음과 같은 결과 를 얻었다. 1. 유도분만 성공율은 77%(23/30예)로 초산부 66% (10/15예), 경산부 87%(13/15예)이었다. 2. 질용 PGE₂정제 투여로부터 진통초발까지의 소 요시간은 초산부 4시간 12분, 경산부 5시간 17분으로 평균 4시간 45분이었고 투약개시부터 태아만출까지의 소요시간은 초산부 12시간 56분, 경산부 8시간 9분으 로 평균 10시간 33분이었다. 3. 유도분만 30예 중 질용 PG단독용법으로 분만유 도에 성공한 23예에서 78%(18/23예)가 정상질식분만 에 성공하였고 질식흡인분만은 22%(5/23예)이었으며, 질용 PG의 투여와 oxytocin 정맥점입을 병용한 7예 중 6에에서 결국 질식분만에 성공하였으므로 이것까지 포 함한 총 유도분만성공율은 96.6%(29/30예)이었다. 4. 질용 PGE₂1정(=3mg)투여로 유도분만에 성공 한 경우는 95%(20/21예)이었고 1정을 추가투여한 9예 중 3예가 유도분만에 성공하여 추가 투여한 경우의 성 공율은 33%이었다. 5. 분만된 신생아의 Apgar score는 1분과 5분에서 모두 7∼8이상으로 양호한 편이었고 태변염색된 경우 는 10%(3/30예)이었다. 6. 고위험군의 산모 9예에 Non Stress Test를 시행 하여 전부 reactive pattern을 관찰하였고 이중 4예에서 Contraction Stimulation Test를 추가 시행하여 모두 negative pattern으로 관찰된 바, 태아감시 도중 이상 소견은 없었다. 7. 투약 도중 질용 PGE₂에 의한 부작용을 타나내는 산모는 없었다. 이상의 결과로 질용 PGE₂는 간편하고 효과적이며 부 작용이 거의 없는 유보분만 제재로서, 5 이하의 낮은 score에도 불구하고 질용 PGE₂단독 사용으로 높은 성 공율을 보였다. Induction of labor for obstetric or medical reasons in an integral part of modern obstetric practice. The standard method employed in the authors` institution has been amniotomy and intravenous oxytocin for many years while, during the last 2 or 3 years, oral administration of prostaglandin E₂ tablets has been used before intravenous infusion of oxytocin to induce labor as well as to ripen the cerⅵx. Also a new ideal method for the induction of labour would be simple, safe, effectⅳe and noninvasⅳe, thereby increasing acceptance by the patient and reducing the risks associated with amniotomy. The intravaginal administration of prostaglandin E₂ tablets which ⅰs the easiest way to apply prostaglandin can proⅵde these benefits. This is a report to determine efficiency of vaginal prostaglandin E₂ for the induction of labor. Induction of labor was performed in the cases of 30 women between 39th and 44 wks of pregnancy who were admitted to the Department of Obstetrics of Kyung Hee University Hospital from March to May 1983. The pelⅵc score for induction was determined by Bishop scoring method, and the Bishop score of the patient of our studies were all below 5. The results were as follows. 1. The success rate in induction with vaginal prostaglandin E₂ were 66% in primigraⅵda(10 of l5 cases) and 87%(13 of 15 cases) in multigraⅵda. 2. Mean induction delⅳery time was 12.93 hours in primigravida and 8.15 hours in multigraⅵda. Time interval from medication to actⅳe labour was 4.2 hours in primigraⅵda and 5.3 hours in muitigraⅵda. 3. In 23 cases of induction of labour with only vaginal prostaglandin E₂, normal vaginal delivery was 78%(18 of 23 cases) vacuum delivery was 22%(5 of 23 cases) and in 7 cases who were failed induction delivery by vaginal PGE₂ Only, 6 cases (86%) were vaginal delivery and 1 case(14%) was cesarean delivery. 4. The success rate in case of vaginal PGE₂ 3mgs was 95%(20 of 21 cases) and of vaginal PGE₂ 6mg was 33%(3 of 9 cases) 5. Fetal Apgar score was all over 7 or 8 at 1 and 5 minutes, and meconium stained fetus was 10%(3 of 30 cases) 6. ln 9 cases of fetal monitoring patients, NST was all reactive and 4 of 9 cases who were under CST, they were all negative. 7. ln failed cases with only vaginal PGE₂, successful induction rate with combined therapy of vaginal PGE₂ and oxytocin was 86%(29 of 30 cases), and cesarean delivery was only 1 case.

경구용 및 질용 PGE₂의 유도분만 효과에 관한 임상적 비교고찰

김상우(SW Kim),서병희(BH Suh),이재현(JH Lee) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.12

유도분만의 적용이 되는 각각 30명의 산모(초산부 15예, 경산부 15예)를 대상으로 각각 경구용 PGE₂는 경구로, 질용 PGE₂정제는 질후벽 자궁경관밑에 투여 하여 다음과 같은 결과를 얻었다. 1. 유도분만 성공율은 경구용 PG군에서 67%(20/30예)이었는데, 초산부 60%(9/l5예), 경산부 73%(11/15 예)이 있고, 질용 PG군에서는 77%(23/30)로 초산부 66%(10/15예) . 경산부 87%(13/15예)이었다. 2. 진통초발까지의 소요시간은 경구용 PG군에서 평균 7시간 13분, 질용 PG군에서 평균 4시간 45분이었으며, 투약개시부터 태아만출까지의 소요시간은 경구용 PG군에서 평균 18시간 37분, 질용 PG군에서 10시간 33분으로 진통초발시간과 태아만출까지의 소요시간이 질용 PG에서 월등히 빨랐다. 3. 경구용 PG군에서 정상질식분만은 70%, 질식흡인분만 23%, 제왕절개술 7%이었고 질용 PG군에서는 정상질식분만 80%, 질식흡인분만 17%, 제왕절개분만 3%이었다. 4. 경구용 PG군에서 분만된 신생아의 Apgar score는 1분에서 7이상이 90%(27/30예) , 5분에서 7이상이 100%이었고, 분만된 신생아가 태변염색된 경우는 17% (5/30예)이었다. 질용 PG군은 분만된 신생아의 Apgar score가 1분, 5분에서 모두 7~8이상으로 양호한 편이었고, 태변염색된 경우는 10%이었으며 특기할 만한 신생아의 이상소견은 발견할 수 없었다. 5. 경구용 PG에서 투약도중 나타난 부각용은 오심 10% (3/30예) , 구토 3% (1/30예)이었고 질용 PG군에서는 부작용이 없었다. 6. 경구용 PG와 Oxytocin정맥점적주입을 병용하여 시도한 유도분만 10예중 80%(8/10예) 에서 유도분만에 성공하였으므로 경구용 PG에 의한 총유도분만 성공율은 93% (28/30예) 이었고 질용 PG와 oxytocin정맥점적 주입을 병용한 7예증 6예에서 질식분만에 성공하였으므로 질용 PG에 의한 총유도분만성공율은 96.6%(29/30 예) 이었으며 1예에서만 제왕절개술이 시행되었다. 이상의 결과로 미루어 보아 경구용 PG나 질용 PG가 특별한 부작용이 없으면서 높은 유도분만성공율을 보이고 있으며 질용 PG가 경구용 PG보다 진통초발까지의 시간과 태아만출까지의 시간이 비교적 빠르게 나타났고 경산부에 비하여 성공율이 약간 떨어지는 초산부는 PG단독사용보다는 oxytocin정맥점적주입의 병용에 의한 유도분만으로 좋은 성과를 거둘 수 있다고 생각된다. Intravaginal Prostaglandin E₂ on the Unfavorable Cervix Induction of labor for obstetrics or medical reasons is an integral part of modern obstetric practice. The standard method employed in the authors, institution has been amniotomy and intravenous oxytocin for many years while, during the last 2 or 3 years, oral administration of prostaglandin Es tablets has been used before intravenous infusion of oxytocin to induce labor as well as to ripen the cervix. Also a ideal method for the induction of labor would be simple, safe, effective and noninvasive, there by increasing acceptance by the patient and reducing the risks associated with amniotomy. The intravaginal administration of prostaglandin E₂ tables which is the easiest way to apply prostaglandin can provide these benefit. This is a report to compare the efficiency of oral PG for the induction of labor. Induction of labor was performed in the cases of each 30 women between 39th and 44th weeks of pregnancy who were admitted to the Dept. of Obstetrics and Gynecology of Kyung Hee Univ. Hospital from June 1981 to May 1983. The pelvic score for induction was determined by Bishop scoring method. and the Bishop score of the patient of our studies were all below 5. The result were as follows. 1. The success rate in induction with oral PGE₂ were 60% in primigravida(9 of 15 cases), 73%(11 of 15 cases) in multigravida. The success rate in induction with vaginal PGE₂ were 66%(10 of 15 cases) in primigravids, 87%(13 of 15 cases) in multigravida. 2. Mean induction delivery time of oral PGE₂ group was 18 hours 37 minutes and time interval from medication to active labour was 7 hours 13 minutes. Mean induction delivery time of vaginal PGE₂ group was 10 hours 33 minutes and time interval from medication to active labour was 4 hours 45 minutes 3. In oral PG group, normal vaginal delivery was 70%, vacuum delivery was 23%, cesarean delivery was 7%, In vaginal PG group, normal vaginal delivery was 80%, vacuum delivery was 17%, cesarean delivery was 3%. 4. In oral PG group, over 7(at 1 minutes) of Apgar score was 90%, over 7(at 5 minute) was 100% and meconium stained fetus was 17%(5 of 30 cases). In vagina1 PG group, over 7 of 8(at 1 and 5 minutes) of Apgar score was all and meconium stained fetus was 10%(3 of 30 cases). 5. In oral PG group, 11 of 12 cases(91%) of fetal monitoring patients showed reactive pattern. In vaginal PG group, 9 cases of fetal monitoring patients were all reactive pattern. Their NST results were all reactive and 4 of 9 cases were applicated with CST(their results were all negative) 6. Maternal side effects during oral PG induction were nausea(10%, 3 of 30 cases). vomiting(3%, 1 of 30 cases), but they were disappeared spontanecusly without specific treatment, and there was no side effects during vaginal PG induction. 7. In failed cases with only oral PG, successful induction rate with combined therapy of oral PG and oxytocin was 93%(23 of 30 cases) and 2 cases of cesarean delivery were carried out. In failed cases with only vaginal PG, successful induction rate with combined therapy of vaginal PGE₂ and oxytocin was 97%(29 of 30 cases) and only 1 case of cesarean section was carried out.

자궁내 태아발육지정에 대한 임상적 고찰

오익렬(ER Oh),김상우(SW Kim),이기호(KH Lee) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.3

Antenatal diagnosis of intrauterine growth retardation (IUGR) is very important to obstetrician and pediatrician because of high perinatal mortality and long-term morbidity after birth. For the diagnosis and prevention, it is valuable to know the clinical characteristics of IUGR. This study was based on 509 cases of IUGR-infants in a series of 5,975 deliveries at Department of Obstet. and Gynecol., Chonnam University hospital from the 1st. of January 1979 to the 31st. of December 1983. The results were as follows: 1) The incidence of IUGR was 8.5% of total deliveries, and it was much higher in primigravida, below 24 year-aged and above 35 year-aged women, induction and breech deliveries, and female infant group. And it increased in proportion to the gestational age. 2) Among 463 IUGR-mothers, 57.2% were demonstrated the complications; obstetric complications (29.4%) such as pregnancy induced hypertention and hemorrhage: gestational complications (19.0%) such as twin pregnancy, postdate, and congenital anomaly: medical complications (8.9%) such as chronic hypertention, chronic renal disease, and heart disease. 3) In comparison of the admission duration between IUGR and non-IUGR infants, who survived, shorter admission dates were used for IUGR group, and the incidence of jaundice was higher in non-IUGR infants than IUGR infants.

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