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쌍태아의 통계적 관찰

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 Statistical study on twins 
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쌍태아는 태아의 출산, 성장, 발육, 주산기사망 및 이환율에 이르기까지 단태아와는 다르다. 국내에서 다태아에 관하여 몇 편의 보고가 있었으나 증예가 부족하였고 다태아의 일부에 관한 내용이었다. 따라서 한국에서 아직 체계화되어있지 않은 쌍태아에 관한 빈도, 재태년령별 체중치, 첫째-둘째아별 체중치. 남-여아별 체중치, 주산기사망율, 주산기사망 원인 및 쌍태아의 태위 및 분만방법에 따른 사망률 등에 관하여 통계적인 관찰을 하였다. 대상은 1963∼1974년의 12년간, 세브란스병원에서 출산된 쌍태아와 1970∼1972년의 3년간 원주연합기독병원 및 전주예수병원에서 출산된 쌍태아 606예를 대상으로 하였다. 쌍태아 빈도는 전체적으로 78.3:1 이었는데 세브란스병원 79.6:1 원주기독병원 64.3:1 전주예수병원 80.0:1이었다.

성별빈도는 남아 295예, 여아 311예로 여아가 약간 많았다.

재태연령별 평균 체중은 태령 40주에서 2.617±471gm으로 최고치였으나 한국 단태아의 평균 체중보다 약 600gm이 낮았다. 첫째아는 태령 40주에 2.675±439gm, 둘째아는 태령 41주에 2.613±474gm으로 최고였다. 남아는 40주에서 2.576±441gm, 여아는 39주에 2.721±355gm으로 각각 최고치였다.

주산기사망율은 전체적으로 143.6였고 세브란스 병원 139.0, 원구기족병원 148.1 전주에수병원 178.6이었다. 주산기사망 원인은 태아사망 33예(37.9%), 신생아사망 54예(62.1%)로 신생아사망이 높았고, 신생아 사망원인은 조산 및 호흡기장애(68.5%), 미숙아(14.8%), 무기폐(5.5%), 감염(3.7%), 그외 선천성 기형, 두부 외상 및 질식 등의 순서였다. 태아사망은 관련된 모체 및 태아의 질환은 조기파수, 양수과다증, 임신중독증, 지상태아, 모체심장병 등의 순서였다. 쌍태아태위에 따른 주산기사망율은 정상위 131.0, 비정상위 179.3 이었고, 분만방법에 따른 주산기사망율은 자연질 분만 253.4, 비자연질 분만 82.2였고 제왕절개술은 둘째아의 주산기사망이 첫째아보다 높았다.


There are large differences between twins and singletons in incidence, growth and development, perinatal death rate, morbidity, etc.. Accordingly, if the statistics for singletons are applied to twins, the result is inappropriate.

The purpose of this study was to determine the incidence of twin pregnancies, compare intra-uterine body weight with gestational age, estimate the perinatal mortality rate, investigate other factors related to maternal or fetal disease, and make comparisons with other reports of Korean and Western workers.

We submitted to analyze 303 twins pregnancies in 3 areas. For 12 years from Jan, 1963 through Dex. 1974, there were 248 twin pregnancies among 19, 730 deliveries over 20 weeks of gestation at Severance Hospital, for 3 years from 1970 through 1972, there were 20 twins pregnancies among 1,730 deliveries at Wonju Union

Christian Hospital, and 28 twin pregnancies among 2,242 deliveries at Jeonju Presbyterian Hospital.

Data obtained were as follows :

1. The incidence of twin pregnancy was 78.3:1 in the 3 areas, the sex ratio of the twins were male 295, female 311(M/M 113. F/F 121. M/F 69).

2. Birth weight related to Gestational age

1) The mean birth weight of twins at 40 weeks of gestation was 2,617±471gm, and smaller than singletons by 600 gm at 40 weeks of gestation.

2) The birth weight of 1st twin at 40 weeks of gestation was 2,675±439 gm, 2nd twin at 41 weeks of gestation was 2,613±474 gm.

3) The body weight of male at 40 weeks of gestation was 2,576±411 gm, female at 30 weeks of gestation was 2,721±355gm.

3. Perinatal mortality

There were 33 cases of fetal death and 54 cases of neonatal death among 606 twin, and the perinatal mortality rate was 143,6 over the 3 areas. The mortality rate of 2nd twins was higher than 1st twins(125.4 : 161.7).

The overall principal cause of neonatal death was prematurity with respiratory complication(68.5%), other causes of neonatal death were immaturity(14.8%), atelectasis(5.5%), septicemia(3.7%), congenital anomaly and birth trauma in

descending order.

The leading cause of fetal death related to maternal or fetal diseases were SPRM, hydroamnions, toxemia, placenta previa, materna heart disease, fetus papyraceus, intra-uterine infection, macerated fetus and ancephalus etc.

The perinatal mortality rate of transverse lie, face presentation, and compound presentation were higher than that of cephalic or breech presentation. The perinatal mortality rate of spontaneous vaginal delivery was higher than that of the low forcep delivery. 2nd twin delivered by C-section had a higher perinatal death rate than 1st twin.
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