단일 기관에서의 질식분만과 제왕분만의 장단점에 대한 분석
THE PROS AND CONS OF DIFFERENT MODES OF DELIVERY AT A SINGLE INSTITUTION
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목적분만방법에 따라 분만 후 산모와 태아에 대한 영향과 부작용에 대해 비교 분석하기 위해 시행되었다. 연구방법본원에서 2007년 1월부터 2009년 7월까지 36주 이후에 단태아를 분만한 총 528명의 환자들을 후향적으로 분석하였다. 그들 중 질식분만을 한 군을 그룹 A군, 계획된 제왕절개술을 한 군을 그룹 B군, 그리고 응급 제왕절개술을 받은 군을 그룹 C군으로 나누었다. 우리는 분만 전과 분만 후에 혈색소 수치를 비교하였고 내외과적 소파술 여부와 항생제 추가 사용에 대해 평가하였다. 태아 결과 평가를 위해서는1분 5분 아프가 점수, 신생아 중환자실 입원 여부와 태변 흡입 여부를 조사하였다. 결과분만 후 혈색소 감소치와 분만 후 입원 기간은 각 그룹 간에 통계학적으로 의미 있게 차이가 있었다(1.28 g/dL vs. 1.88 g/dL vs. 2.58 g/dL, 3.5일 vs. 5.9일 vs. 6.6일; P < 0.001). 외래 방문수는 그룹 C군에서 그리고 외래에서의 항생제 사용은 그룹 A군에서 통계학적으로 의미 있게 가장 많았다. 신생아의 관점에서 볼 때 1분 5분 아프가 점수가 그룹 B군에서 가장 높았으며 신생아집중치료실 입원율과 태변흡입증후군 비율 역시 그룹 B군에서 가장 낮았다(8.0% vs. 3.2% vs. 16.3%, P =0.002; 4.5% vs. 0% vs. 7.5%, P =0.001). 결론질식분만은 출혈량, 재원기간 그리고 퇴원 후 외래 내원 횟수 면에서 좋은 결과를 가진다. 계획된 제왕절개술은 다른 분만 방법에 비해 산모의 심각한 부작용이 적고 태아의 좋은 결과를 가진다.
Abstract
Objective To compare the postpartum maternal and neonatal effects and complications according to delivery modes. Methods Five hundred twenty eight singleton pregnant women, who delivered after 36 gestational weeks in National Health Insurance Corporation Ilsan Hospital between July 2007 and July 2009, were retrospectively analyzed. They were categorized into 3 groups:group A, vaginal delivery; group B, elective cesarean delivery; and group C, emergent cesarean delivery. We evaluated the difference in hemoglobin decrement and postpartum hospital stays, medico-surgical curettage, and antibiotics usage. From the view point of neonates, 1 and 5 minute Apgar scores and Neonatal Intensive Care Unit (NICU) admission rates and meconium aspiration rates were evaluated. Results Postpartum hemoglobin decrement and postpartum hospital days were statistically different among the groups, which results were 1.28 vs. 1.88 vs. 2.68 g/dL and 3.5 vs. 5.9 vs. 6.6 days, respectively (P <0.001). Number of out-patient-department follow-up was highest in group C and additional antibiotics usage was highest in group A with statistical signifi cance. The Apgar score was highest in group B (8.0% vs. 3.2% vs. 16.3%, P =0.002). NICU admission rate and meconium aspiration were also lowest in group B (4.5% vs. 0% vs. 7.5%, P =0.001). Conclusion Although vaginal delivery showed advantage over blood loss related to procedure, hospital days and number of follow up, elective cesarean delivery has advantage carrying less severe complication of mother and better outcome for the baby than other delivery methods.
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