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양수과소증에서 경복부 양수주입술의 임상적 유용성에 관한 고찰
홍수정,김은성,한호원,김문영,류현미,황우열,박선희,노성훈 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.9
Oligohydramnios poses not only a diagnostic challenge but also a dilemma of management for the obstetrician. The general outcome is usually poor, no matter what causes the oligohy- dramnios. Recent preliminary studies have suggested that antepartum transabdominal amnioinfusion has both diagnostic and therapeutic roles in oligohydramnios. To evaluate the safety and efficacy of this procedure, we performed 19 antepartum amnioi- nfusion in 12cases of pregnancy complicated by oligohydramnios. Infusion(mean volume 494 ml, range 200∼800 ml) significantly increased the deepest pool of amniotic fliud to a mean of 5.71 cm(p$lt;0.005). We confirmed vaginal leakage indicating ruptured membranes in 3patients among 5cases of unknown cause of oligohydramnios. Twelve serial infusions were performed in 5 patients in order to prolong gestation long enough to improve neo- natal outcome. In neonatal outcome after serial infusions, all except one showed neonatal survival. Overall, only two of 19 infusions(10.5 %) were complicated by chorioamnionitis and transient bra- dycardia, respectively. Our findings support that antepartum transabdominal infusion seems to be a relatively safe procedure and may offer marginal clinical benefits to perinatal outcome in selected cases.
임신 제 3 기에 시행한 자가수혈의 안전성에 관한 연구
정환욱,김은성,한호원,김문영,류현미,윤재범,김재영,조동희 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.5
1991년 10월부터 1993년 7월까지 22개월동안 제일병원 산부인과를 방문한 임신말기의 산모 56명을 대상으로 91회의 자가혈액을 공혈, 예치하여 다음과 같은 결론을 얻었다. 1. 공혈부작용은 3%로 일반헌혈에서 볼 수 있는 공혈부작용과 비슷한 빈도였다. 2. 처음 공혈하기전 산모의 적혈구용적율과 분만을 위하여 입원 하였을 당시의 적혈구 용적율 사이에 통계학적으로 유의한 차이가 없었다(p$gt;0.05). 3. 공혈동안 측정한 산모의 혈압과 맥박수의 의미있는 변화를 관찰할 수 없었다. 4. 공혈전, 후 시행한 비수축성 검사와 공혈동안 시행한 지속적 태아심음감시상 1예를 제외하고 정상 반응을 보였다. 5. 신생아의 Apgar score는 출생 1분, 5분에 각각 6점 및 7점이상이고 체중은 2,530 gm에서 4,190 gm으로 평균 3,253 gm이었다. 6. 공혈에 참가한 산모가 분만후 자기혈액을 수혈을 받은 경우가 56명중 13명(23%)이였고 이중 전치 태반환자 12명중 10명이 수혈을 받았다. 이상의 연구결과로 임신 제 3기에 지속적 태아심음 감시하에서 시행한 자가수혈은 산모 및 태아에 안전하며 자가수혈의 유용성에 대해서는 전치태반의 경우나 희귀한 혈액형이 드문 지역에서는 도움이 되며 동종 혈액 수혈로의 전용을 고려한다면 임신중 자가수혈이 유용하다고 생각한다. Autologous blood donation (ABD) is now widely appreciated as a means of eliminating the trasmission of blood borne infection such as AIDS and hepatitis. However its safety for both mother and fetus, especially in the third trimester, has not been established. The aim of this study is to determine the safety and utility of autologous blood donation in the third trimester of pregnancy. Over a period 22 months, pregnant women (N=56) in their third trimester, who had a rare blood group or a predictable risk of hemorrhage, underwent 91 phlebotomies. Phlebotomies were performed at an aversage gestational age of 36.9 weeks up to three times and donated an average of 1.6 unit of blood. Changes of fetal heart rate were redorded by electronic fetal monitoring before, during and after phlebotomy. There was no significant change in fetal heart rate except in one case with temporary decrease. Changes in mean maternal diastolic blood pressure and pulse rate were not significantly different. All fetal outcomes were good. The average interval from last donation to delivery was 11.7 day. Change in mean maternal hematocrit between the initial donation and admission day for delivery was not statistically significant (p$gt;0.05). Only mild donor reactions occurred in three out of 91 (3%) phlebotomies. Thirteen patients received a total of 38 units of red blood cells (24 autologous, 14 homologous). Ten out of twelve patients with placenta previa used their autologous blood. We conclud that ABD in pregnant woman in third trimester is safe for mother and fetus. But further investigation is needed to determine its usefulness.