과숙아의 임상 통계적 관찰

Abstract

[한글]

태반기능부전(Placental dysfunction syndrome)이 태아에 미치는 위해설(危害說)에 대해서는 많은 임상보고와 아울러 연구가 진행되어왔으나, 아직도 임신중절을 결정하는데에 많은 논난의 대상이 되는데 이는 부분적으로 환자 개개인의 차이가 있는 경우와 또는 태반기능부전에 대해 아직 완전히 규명이 되지 않았기 때문으로 본다.

1970년 1월부터 1972년 12월까지 만 3년간 연세의대 부속세브란스병원, 전주 예수병원과 원주 기독병원에서 분만한 과숙아 1,736예에 대해 임상·통계적 관찰한 결과,

1. 과숙아의 출산빈도는 15.3퍼센트였고 주산기사망율은 26.5였으며 신생아사망은 남아가 여아보다 유의하게 많았고 과숙아중 저체중아와 거대아의 출산빈도는 각기 2.2퍼센트와 7.3퍼센트였다.

2. 35세 이상의 노산(老産)과 다산(5회이상) 및 초산의 과숙아와 임신중독을 수반하는 과숙아에서 주산기사망율은 격증하였다. 과숙아와 만삭아에서 태위에 따른 빈도의 차이는 없었다.

3. 산과적 합병증이 수반된 과숙아의 주산기사망율(111.1)은 정상과숙아(12.7)보다 8.7배 높았고, 주산기사망수가 높은 산과적합병증은 임신 중독증, 조기파수 및 태반조기박리등의 순서였고, 병발빈도가 높은 합병증은 임신중독중, 조기파수 양수감염 및 전치태반등의 순서였다.

4. 과숙아 1,053예중 태반기능부전 증후군(Placental dysfunction syndrome)은 113예로 10.7퍼센트였고 태령이 많아짐에 따라 점차 높은 빈도를 보였으며 주산기사망율은 Ⅱ기에서 137.3으로 가장 높았다.

[영문]

Prolonged pregnancy has been the subject of numerous studies about the question of damage to the fetus by placental insufficiency.

It is obvious that such degeneration can occur, as every obstetrician, pediatrician and pathologist knows from personal experience. Yet there is a wide divergence of opinion regarding the significance of the risk of prolonged pregnancy and the need to avoid it by terminating the pregnancy.

This divergence is partly due to variations in the selection and evaluation of patients, but also is partly inherent in the ill-defined nature of the condition.

The present study concerns the perinatal mortality of post-term and placental dysfunction in Severance Hospital, Jonju Presbyterian Hospital and Wonju Christian Hospital births which are associated with maternal obstetric conditions from Jan.

1970 to Dec. 1972.

The perinatal mortality rate was calculated at fetal deaths plus neonatal deaths(deaths under 28 days after birth) of 42 or more weeks gestation.

The results of clinical anlysis for 1736 post-term infants were summarized as follows :

1) Incidence of post-term infant was 15.3% and its perinatal mortality was 26.5%.

2) Sex ratio of post-term infant was not statistically significant, but in neonatal mortality rate male came to somewhat higher(705) than female(30%).

3) Incidence of low birth weight and high birth weight in post-term infant were 2.2% and 7.3%. Comparing term infants, they were not statistically significant.

4) The perinatal mortality rate was increased in cases of maternal age was over 35. The rates also were higher in multipara who had delivered more than 5 times, in primipara and in toxemia.

5) The frequency of the obstetric complications influenced perinatal mortality number was toxemia, SPRM, abruptio placentae etc., and the frequency of the diseases was toxemia, SPRM, amnionitis, placenta previa etc.,

6) Incidence of placental dysfunction syndrome in post-term infant was 10.7% and perinatal mortality was mostly increased in stage Ⅱ of placental dysfunction syndrome.