Risks of pregnancy and labor in advancing maternal age
Authors
안명옥
Issue Date
1982
Description
의학과/석사
Abstract
[한글]
고령임신이 고위험도 임신에 속하는 것은 주지의 사실이다. 고위험도에 속하는 연령의 상한 및 하한에는 연구보고에 따라 많은 논란이 있으나 특히 35세 이상을 「고령초산부」로 정의하여 35세 이후 산과적 고위험도의 빈도가 높다는 주장이 지배적이었다. Kane(1967) 등은 "the myth of age 35"라 하여 35세를 분리점으로 한것은 일종의 미신이며 논리적인 개념으로는 연령증가에 비례한 연령별 난이도를 생각해야 한다는 주장을 한 바도 있다. 이에 저자는 35세를 기점으로 초산부는 물론이려니와 경산부에서도 고령이 임신분만에 미치는 영향을 비교 분석함으로써 향후 이들의 처치에 도움이 될 것으로 생각하여 1975년 1월1일부터 1981년12월31일까지 만7년간 연세대학교 의과대학 부속 세브란스병원 산부인과에 입원하여 1,000 gm이상의 태아를 분만한 총 14,119예의 산모중 만 35세 이상의 고령초산부 55예와 만 35세 이상의 고령경산부 230예를 대상으로 하고 무작위추출한 만35세 미만의 비고령초산부 742명과 비고령경산부 640명을 대조군으로 선정하여 양군을 임상 통계학적으로 비교관찰하여 아래와 같은 결론을 얻었다.
1. 고령초산부는 총 분만수 14,119예중 55예로서 그 빈도는 0.39%였으며 고령경산부는 230예로서 빈도는 1.63%였다.
2. 연령의 범위는 35세부터 44세까지이며 고령초산부(58.2%), 고령경산부(52.6%) 각각 과반수 이상이 35∼36세 연령범위에 속하였다.
8. 저체중아의 빈도는 고령초산부의 9.1%, 고령경산부의 13.3%로서 대조군에 비하여 그 빈도가 높았다.
9. 주산기사망율은 고령초산부에서 36.4, 고령경산부에서 72.3으로 고령임산부 특히 고령경산부에서 현저히 높은 빈도를 보였다.
[영문]
The age of the patient is important in the assesment of a medical problem, in obstetrics as well as in other branches of medicine. But the effect of age on the course of labor and pregnancy is at beet ill defined, although many unsuspected statements concerning this relationship exist.
Elderly primiparas and fetuses are subjected to increased danger of complications of pregnancy including prolonged Labor and other risks.
In an attempt to clarify the relationship between maternal age and labor, the author attempts to compare the obstetric performance of primiparas 35 years of age or older with that of younger primiparas and that of older multiparas along with
younger multiparas.
The results obtained were as follows:
1. Elderly primipara consisted of 55 cases among a total of 14119 deliveries, with an incidence of 0.39%. The incidence of elderly multipara was 1.63%.
2. Maternal age was distributed from 35 to 44 years. The majority were in the age group of 35 and 36 years with the elderly primipara comprising 58.2% and elderly multipara comprising 52.6%.
3. Concerning the antepartal complications, the incidence of pre-eclampsia was 20.0% in elderly primipara and 7.2% in elderly multipara: the incidence of thyroid disorder was 1.8% in elderly primipara and 1.3% in elderly multipara.
The myoma of the uterus was seen in 5.4% of the cases: higher than other groups (P<0.0005). Spontaneous premature rupture of membrane comprised 20.0% of the elderly primipara and 12.5% of the elderly multipara (P<0.005). Antepartal hemorrhage was observed in 1.8% of elderly primipara and 2.6% of elderly
multipara(P<0.005). IUFD was seen in 3.6% of elderly primipara and 5.2% of elderly multipara(P<0.005).
4. The incidence of premature labor, which was 9.1% in elderly primipara and 14.4% in elderly multipara, was higher than that of other groups.
5. In elderly primiparal 90.9% demonstrated vertex presentation and 9.1% Breech. 4.3% demonstrated Breech presentation in elderly multipara. Posterior position of elderly primipara was seen in 3.6%.
6. 28.6%(15 cases) was delivered vaginally and 72.7%(40 cases) was delivered abdominally in elderly primipara: in elderly multipara, the incidence of C/S was 33.0%.
7. Among the indications of cesarean section, the highest was the elderly primipara (62.5%). Other indications were CPD, hypertensive disorder in pregnancy, breech presentation, and placenta previa in decreasing order of frequency.
8. The frequency of premature infants was 9.1% in elderly primipara and 13.3% in elderly multipara.
9. The perinatal mortality rate was 36.4 in elderly primipara and 72.7 in elderly multipara.