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박춘식(CS Park),박찬용(CY Park),박창서(CS Park),이규완(KW Lee),주영철(YC Joo) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.4
국립의료원 산부인과에서 1966년 1월 1일부터 1977년 12월 31일까지 만 12년간 임산부 사망 총 65례를 임상적으로 관찰하여 다음과 같은 결론을 얻었다. 1. 사망한 임산부는 총 65명이었고 동 기간중 총 생아출생수는 14,978명이었으며 임산부 사망률은 10만 생존분만당 434.0명이었다. 2. 임산부 사망 원인으로 가장 많았던 것은 임신중독사(32.3%)였고 출혈사(24.6%), 그리고 감염사(20.0%)의 순위였다. 3. 동 기간중 전체 산모 사망의 연도별 추세로 보면 병원사(35례)와 타 병원에서 이송되었던 례(30례) 공히 다소 기복을 보여주었으나 모두 약간씩 감소하는 경향을 보여 최근 2년간의 모성사망율은 16년간의 평균사망율의 3/4으로 감소되었다. 4. 임신중독증의 주요 임상적 사인은 폐수종, 급성 신부전증, 심장마비, 그리고 뇌출혈이었으며 계절별로 춘계에 다소 높았으나 큰 차이는 없었다. 5. 출혈사의 주요 임상적 사인은 이완성 자궁출혈 및 자궁파열이 62.5%로 대부분이었고 그의 태반조기박리, 자궁외임신, 혈액응고부전, 유산후 출혈, 경관 손상 등이었다. 6. 감염사의 주요 사인은 폐혈성 유산이 61.5%로 제일 많았다. 7. 간접사인 14례 중 11례는 융모상피암, 2례는 심장질환, 1례는 간질환이었다. 8. 출혈사는 모두 산전관호를 규칙적으로 받은 바 없었고 임신중독증도 2례를 제외하고는 산전관호를 받은 바 없었다. 9. 임신중독증사는 1회 초산부에서 52.4%, 출혈사는 4회 이상 경산부에서 37.5%로 높은 사망률 을 보였고 감염사는 여러 연령층에서 고르게 분포되었다. 임신중독증사는 30세 미만에서 85.7%, 출혈사는 31∼35세 군에서 68.8%, 감염사는 30세 미만에서 76.9%의 빈도를 보였다. 10. 입원후 사망시간으로는 임신중독증, 출혈 및 감염으로 24시간 내에 사망했던 율은 각각 57.1%, 62.5%, 61.5%로 높았으며 이상의 결과로 보아 임산부 사망을 감소시키기 위하여 임산부에게 올바른 건강교육과 산전관호의 철저, 의료인의 질적 향상, 병원시설의 확충 및 병원분만이 절대 필요하다고 본다. Clinical analysis on maternal mortality in N.M.C. was made for the period of 12 years from 1966 through 1977. The results obtained are as follows; 1. 65 maternal deaths including 35 cases of hospital death and 30 cases transferea from outside were encountered among 14978 live births. Maternal mortality rate was 434.0 per 100,000 live births. 2. The leading causes of maternal deaths were toxemia(32.3%), hemorrhage(24.6%), infection(20.1%) and choriocarcinoma(16.9%) in the frequency of order. 3. Maternal mortality showed decreasing tendency down to about 75% in the recent 2 years compared with that of 16 years ago. 4. The leading clinical causes of deaths in toxemia were cardiopulmonary insufficiency, acute renal failure, heart failure and cerebral hemorrhage. 5. The leading clinical causes of deaths in hemorrhage were atonic uterine bleeding and uterine rupture. 6. The leading clinical cause of deaths in infection was septic abortion. 7. The choriocarcinoma indicate the majority of indirect causes of maternal deaths(78.6%) and the rest of causes were cardiac valvular disease(14.3%) and infectious hepatitis(7.1%). 8. All cases of deaths due to hemorrhage did not take the regular antenatal care and all cases of deaths due to toxemia except 2 cases did not, also. 9. 52.4% of maternal deaths due to toxemia occurred in para 0 state and 37.5% of ones due to hemorrhage occurred in para 4 or more state but maternal deaths due to infection showed rather even distribution in Each para state. 10. Most of the maternal deaths were considered to be preventable one(81.5%) in viewing of the medical mismanagement at local clinics in the majority of cases(41.7%) and of delayed admission(43.4%). In order to prevent avoidable maternal deaths on the base of the study, every possible efforts should be emphasized. Particularly, information and education of the patients, high quality antenatal care, early identification of high risk patients, regular service in training of both general practioners and paramedical personne
김윤하(YH Kim),송태복(TB Song),최진(J Choi),김경훈(GH Kim),이계율(GY Lee),박창수(CS Park),김석모(SM Kim),변지수(JS Pyun) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.7
Objective: Our purpose was to investigate uric acid concentrations of maternal serum, amniotic fluid, and fetal serum in normal pregnancy and preeclampsia. Methods: 112 samples of amniotic fluid obtained from normal pregnancies 17 to 38 weeks gestation, and 28 samples of maternal serum and umbilical arterial cord serum obtained from normal pregnancies in third trimester. Samples of maternal serum, amniotic fluid, and umbilical arterial cord serum were collected from 47 women with preeclampsia in third trimester. Uric acid concentration was measured by enzymatic spectrophotometric method using the enzyme uricase. Results: Amniotic fluid uric acid concentrations increased progressively from 17 to 38 weeks gestation in normal pregnancy [17; 3.38±0.3, 24; 4.23±0.33, 28; 5.23±0.97, 34; 5.87±1.58, 38 weeks; 6.97±0.76 mg/dl, n=112, r=0.75, p<0.01]. In third trimester, amniotic fluid uric acid concentration was significantly increased in women with preeclampsia than with normal pregnancy [9.62±2.65 vs. 6.36±1.95 mg/dl, p<0.01]. Maternal serum [MS] and umbilical arterial cord serum [CS] uric acid concentration were significantly increased in women with preeclampsia than with normal pregnancy [MS; 6.33±1.55 vs. 4.37± 0.64, p<0.01, CS; 6.44±1.49 vs. 4.30±0.92 mg/dl, p<0.01]. Conclusions:Serum uric acid concentrations were significantly increased in pregnant women and fetuses with preeclampsia. Increased production of uric acid in fetus and placenta may contribute to maternal hyperuricemia and high amniotic fluid uric acid concentration in preeclampsia partly.