만기 임신전 조기파막이 모성감염 및 주산기 사망과 이환에 미치는 임상적 연구

Abstract

[한글]

조기파막의 치료는 산부인과 의사에 있어서는 아직까지 해결하지 못한 숙제로 남아있는 실정이며 한편 파막시간이 오래 될수록 태아 및 모성 감염률은 높아지고 조기분만은 저체중아를 낳고 이들은 폐 미성숙으로 인한 호흡곤란중을 직면하게 된다. 따라서 본 연구는 1990년 1월 1일부터 1992년 12월31일까지 만 3년동안 연세대학교 부속 세브란스 병원 산부인과에 입원하여 분만한 임신 37주 미만의 만삭전 산모와 그 신생아를 대상으로 하여 조기 파막군과 비조기 파막군 각각의 모성 및 신생아 이환률, 신생아 사망률을 비교하여 조기 파막이 모성 및 신생아에 미치는 영향을 분석하였으며 더 나아가서는 모성 및 신생

아의 이환률 및 사망률을 최소화하기 위한 적절한 분만시기를 알아내고자 하였다.

그 결과 전체 37주 미만의 만삭전 분만중 조기 파막률은 29% 였으며, 모성 용모양막염 발생률은 11.3%였으며 잠복기간이 36시간 이상시에 급격히 증가하였다.

주산기 사망의 주원인은 호흡곤란중 및 폐혈중으로 각각 74%, 19%였다. 신생아 이환의 주원인은 호흡곤란증, 감염질환, 및 신생아 황달 순으로 각각36%, 35%, 29%를 차지하였다.

임신주수에 따른 신생아 사망률은 34주 이상군에서는 3%였으나 30주에서 33주 사이에서는 16%로 증가하였다.

신생아 이환률은 체중 1500g 미만군에서 상대적으로 높게 증가하였다. 주산기 사망률 및 신생아 이환률은 각각 잠복기간이 12시간, 18시간 이상시에 증가하였다. 이상의 결과로 볼때 임신 34-37주 사이의 조기 파막 환자는 파막후 48시간 이내에 자연 진통이 올때까지 유도분만을 연기하고, 임신34주 미만 2000g 미만의 조기파막 환자는 감염의 증상이 없는 경우 34주까지 지연시킨후 분만하는 것이 적합할것으로 사료된다.

Clinical study of influence of premature rupture of membrane(PROM)on the maternal m

orbidity, neonatal death and morbidity.

Sang Wook Bai

Department of Medical Science, The Graduate School Yonsei University

(Directed by Professor Dong Hoon Whang)

Management of premature rupture of the membranes represents a clinical dilemma

for the Obstetrician-Gynecologist. On the other hand, the physcian knows the longer

the membranes are ruptured, the greater the risk for infection for the mother and

fetus. On the other hand, immediate delivery for the preterm fetus yeilds a

low-birth-weight infant who must face the risks of prematurity, the greatest of

which is RDS. So a retrospective study involving all preterm mother & newborn

babies who were delivered at less than 37 weeks gestation at the Department of

Obstetrics and Gynecology, Yonsei University, College of Medicine, from Jan. 1990

to Dec. 1992 during 3 years.

The purpose of this study was to compare their maternal and neonatal morbidity,

and neonatal mortality, futhermore to determine the optimal time for terminating

pregnancy to minimize matenal and neonatal morbidity and mortality, The result are

as follows.

1. The incidence of preterm PROM was 297?

2. Maternal chorioamnionitis incidence rate in preterm PROM group was11.3% and

increase in rate when the latent period was in excess of 36hours.

3. Respiratory distress syndrome was 74% and sepsis was 19% in the cause of

perinatal mortality.

4. Respiratory distress syndrome was 36%, Neonatal hyperbilirubinemia was 29% and

infections diseases was 35% in the causes of neonatal morbidity,

5. Neonatal mortality according to gestational weeks was 3% with above 34 weeks,

and 16% between 30 weeks and 33 weeks.

6. Neonatal morbidity was high in the neonate with birth weight below 1500gm.

7. Perinatal mortality and neonatal morbidity was increased in rate when the

latent period was in excess of 12 hours and 18 hours each other.

As the result, in patient with PROM whose gestational age was in 34∼37 weeks,

induction would· like to be delayed until spontaneous labor began within 48 hours

after PROM, below 34 weeks and 2000gm, delayed until 34 weeks unless there were

infectious symptoms and signs.

[영문]

Management of premature rupture of the membranes represents a clinical dilemma for the Obstetrician-Gynecologist. On the other hand, the physcian knows the longer the membranes are ruptured, the greater the risk for infection for the mother and fetus. On the other hand, immediate delivery for the preterm fetus yeilds a

low-birth-weight infant who must face the risks of prematurity, the greatest of which is RDS. So a retrospective study involving all preterm mother & newborn babies who were delivered at less than 37 weeks gestation at the Department of Obstetrics and Gynecology, Yonsei University, College of Medicine, from Jan. 1990 to Dec. 1992 during 3 years.

The purpose of this study was to compare their maternal and neonatal morbidity, and neonatal mortality, futhermore to determine the optimal time for terminating pregnancy to minimize matenal and neonatal morbidity and mortality, The result are

as follows.

1. The incidence of preterm PROM was 297?

2. Maternal chorioamnionitis incidence rate in preterm PROM group was11.3% and increase in rate when the latent period was in excess of 36hours.

3. Respiratory distress syndrome was 74% and sepsis was 19% in the cause of perinatal mortality.

4. Respiratory distress syndrome was 36%, Neonatal hyperbilirubinemia was 29% and infections diseases was 35% in the causes of neonatal morbidity,

5. Neonatal mortality according to gestational weeks was 3% with above 34 weeks, and 16% between 30 weeks and 33 weeks.

6. Neonatal morbidity was high in the neonate with birth weight below 1500gm.

7. Perinatal mortality and neonatal morbidity was increased in rate when the latent period was in excess of 12 hours and 18 hours each other.

As the result, in patient with PROM whose gestational age was in 34∼37 weeks, induction would· like to be delayed until spontaneous labor began within 48 hours after PROM, below 34 weeks and 2000gm, delayed until 34 weeks unless there were

infectious symptoms and signs.