노령초산부에 관한 임상통계학적 고찰

Abstract

[한글]

노령초산부는 일반적으로 35세 이상에서 첫 생존가능아를 출산하는 산모를 말하며 그들

의 출산의 위험성에 많은 연구논문들이 보고되어 왔다. 노령초산부와 그 태아에 관한 합

병증으로는 고혈압증, 임신중독증, 자궁근종, 분만장해와 사산, 조산아 및 선천성 기형등

이 증가하는 것으로 알려져 왔다. 본 연구는 1959년 2월부터 1974년 12월 말까지 세브란

스병원 산부인과에 입원 분만한 한 149례와 1964년 1월부터 1967년 8월말까지 제일병원

산부인과에 입원 분만한 29례, 총 178례를 대상으로 하여 다음의 결과를 얻었으며 1000gm

이상의 신생아를 분만한 노령초산부에 한하였다.

1. 노령초산부는 총 분반수 23095례중 178례로서 그 빈도는 0.8%였다.

2. 노령 초산부의 연령별 분포는 35세부터 46세까지 였으며 과반수(51.7%)가 35-36세

연령에 속하였다.

3. 산전합병증은 고혈압성 병변이 23.0%, 자연조기파수는 21.9%였다.

4. 태위는 두위가 163례 (91.6%) 둔위가 15례(8.4%)로서 둔위빈도가 높았다.

5. 분만방식은 질식분만이 112례(62.9%)이고 복식분만은 66례(37.1%)로서 제왕절개술의

빈도가 현저히 높았다.

6. 제왕절개술의 적응증은 아두골반불균형 48.5%로 노령초산부, 태아절박증, 자궁근종,

둔위 및 Shirodkar씨 수술후 상태 등의 순위였다.

7. 조산아는 14례로서 그 빈도가 7.9%였고 신생아 사망 2례, 사산 1례로서 주산기사망

율은 16.9이었다.

8. 선천성기형아는 단 1례도 없었다.

9. 과거력에 있어 자연유산의 빈도는 16.9%였다.

[영문]

Numerous reports had appeared in the literature citing the danger of pregnancy in

the elderly woman and it is generally agreed that a woman over 35 years is "Elderly

primipara" for obstetric purpose if she is expxriencing the birth of her first

viable baby. Elderly primiparas and fetus were subjected to danger of complication

and there was an increase in vascular disease, texemia, myoma, prolonged labor and

stillbirty, premature infant and congenital anomaly. The elderly primiparas from

the files of the department of Obstetrics and Gynecology in Severance Hospital from

February 1959 to December 1974 and the records of the Cheil February 1959 to

December 1974 and the records of the Cheil Hospital from January 1964 to August

1967 were reviewed. The fetus less than 1000gm was excluded. There were 149 cases

from Severance Hospital and 29 cases from the Cheil Hospital.

The result obtained are as followings:

1. There were 178 cases among a total of 23095 deliveries, incidence of 0.8%.

2. Maternal age was distributed from 35 to 46 year. The majority (51.7%) were in

age group of 35 and 36 years.

3. Concerning the antepartal complications, the incidence hypertensive disorder

was 23.0% that is higher comparing with 9.7% in the younger primiparas. The

spontaneouse premature repture of membrane was seen in 21.9% of the case; higher

than 12.2% in the control group.

4. 163 cases (91.6%) were of vertex presentation and breech presentation was

higher than that of total deliveries from Severance Hospital(4.3%)

5. 112 cases (62.9%) delivered vaginally and 66 cases (37.1%) abdominally.

6. Among the indication of Cesarean section, the highest was CPD (48.5%). Other

indication were elderly primipara, fetal distress, myoma, breech presentation and

post-Shirodkar operation status in order of frequency.

7. The perinatal mortality rate was 16.9.

8. No congenital malformation of infants was noted.

9. The incidence of spontaneouse abortion was 16.9%.