부천지역에서 발생한 조산의 위험요인과 미숙아의 생존율
Risk factors of preterm delivery and survival rate of preterm infants in Bucheon
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목적: 본 연구는 조산한 산모와 미숙아의 특징을 중심으로 위험인자와 미숙아의 생존율과 합병증의 이환율을 알아보고자 한다. 연구 방법: 2001년 2월에서 2006년 12월까지 대학병원 산부인과에서 분만한 3,299명의 산모 중에서 조산한 산모 723명을 대상으로 산모의 평균 연령, 조산한 산모의 임상적 양상을 통한 위험인자를 분석하였다. 또한 신생아 중환자실에서 집중 치료받은 미숙아 751명을 대상으로 미숙아의 생존율, 극소 저체중 출생아 비율, 미숙아의 합병증 등에 대해 다중 회귀분석을 시행 하였다. 결과: 조산한 산모의 위험인자로서 조기양수파막 (P<0.001), 임신중독증 (P<0.001), 쌍태아 (P<0.001), 전치태반 (P=0.009)과 태반조기박리 (P=0.041)로 유의하였고, 빈혈 (P=0.170), 제왕 절개수술 기왕력 (P=0.780), 자궁근종 (P=0.848), 충수절제술 기왕력 (P=0.999)은 통계학적으로 유의하지 않았다. 미숙아의 생존율은 평균 95%, 극소 저체중 출생아의 생존율을 86%였다. 결론: 조산한 산모군 중 조기양수 파막, 임신중독증, 전치태반이 위험인자로서 통계학적인 의의가 있었고, 전체 미숙아 중 극소 저체중 출생아와 분만 시 임신주수가 33주 미만인 미숙아가 해마다 증가되는 추세이나 생존율에는 큰 차이를 보이지 않았다. 향후 조산의 원인과 이에 따른 합병증에 대한 보다 많은 전향적 연구가 필요하다.
Abstract
Objective: The aim was to compare risk factors of preterm delivery and survival rate in preterm infants. Methods: There were 723 preterm deliveries among 3,299 deliveries in our hospital from February, 2001 to December, 2006. We analyzed risk factors through women who give birth to preterm infants. The risk factors of preterm delivery were evaluated survival rate, very low-birth weight (VLBW) infant ratio, preterm infants to 751 preterm infants who was admitted at newborn intensive care unit. The data were retrospectively reviewed of hospital record and statistical analysis was performed using chi-square test and logistic regression test. Results: The incidence rate of preterm birth increased. The risk factors that preterm premature rupture of membranes (PROM) (P<0.001), pregnancy induced hypertension (PIH) (P<0.001), twin pregnancy (P<0.001), placenta previa (P=0.009) and placenta abruption (P=0.041) as women that give birth to preterm infants were statistically significant. But, anemia (P=0.170), previous cesarean section history (P= 0.780), uterine myoma (P=0.848), previous appendectomy history (P=0.999) did not statistically significant. Survival rate of total preterm infants was average 95%. And survival rate of VLBW infants was 86%. Conclusion: It was found to be risk factors for preterm delivery with PROM, PIH, and placenta previa. The VLBW infants with less than 33 gestational weeks are increased every year but total survival rate is not different. We hope that we propose to research the cause of preterm delivery and survival rate of preterm infants prospectively.
참고문헌 (23)
- Zeka A, "The effects of socioeconomic status and indices of physical environment on reduced birth weight and preterm births in Eastern Massachusetts", Environ Health, 7, pp.60~ (2008)
- 이근영, "분만과 신생아 뇌손상과의 관계", 대한산부인과학회 연수강좌, 43~57 (2003)
- Xiong X, "Quitting smoking during early versus late pregnancy: the risk of preeclampsia and adverse birth outcomes", J Obstet Gynaecol Can, 31, pp.702~707 (2009)
- Kalia JL, "Comparison of enrollment in interventional therapies between late-preterm and very preterm infants at 12 months' corrected age", Pediatrics, 123, pp.804~809 (2009)
- Shapiro-Mendoza CK, "Risk factors for neonatal morbidity and mortality among "healthy," late preterm newborns", Semin Perinatol, 30, pp.54~60 (2006)
- Shapiro-Mendoza CK, "Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk", Pediatrics, 121, pp.223~232 (2008)
- Tomashek KM, "Early discharge among late preterm and term newborns and risk of neonatal morbidity", Semin Perinatol, 30, pp.61~68 (2006)
- 대한산부인과학회, "산과학. 제 4판", pp.561~574 (2007), 대한산부인과학회
- Creasy RK, "Creasy & Resnik's Maternal - Fetal medicine: principles and practice. 6th ed" (2008), Saunders
- Shapiro-Mendoza CK, "US infant mortality trends attributable to accidental suffocation and strangulation in bed from 1984 through 2004: are rates increasing?", Pediatrics, 123, pp.533~539 (2009)
- 추병완, "도덕 발달과 도덕 교육" (2007), 하우
- Joseph KS, "Theory of obstetrics: an epidemiologic framework for justifying medically indicated early delivery", BMC Pregnancy Childbirth, 7, pp.4~ (2007)
- Longnecker MP, "Association between maternal serum concentration of the DDT metabolite DDE and preterm and small-for-gestational-age babies at birth", Lancet, 358, pp.110~114 (2001)
- Wood SL, "Endocrine disruptors and spontaneous premature labor: a case control study", Environ Health, 6, pp.35~ (2007)
- Berghella V, "Natural history of cervical funneling in women at high risk for spontaneous preterm birth", Obstet Gynecol, 109, pp.863~869 (2007)
- Rahkonen L, "Cervical length measurement and cervical phosphorylated insulin-like growth factor binding protein-1 testing in prediction of preterm birth in patients reporting uterine contractions", Acta Obstet Gynecol Scand, 88, pp.901~908 (2009)
- Iams JD, "The Preterm Prediction Study: recurrence risk of spontaneous preterm birth. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network", Am J Obstet Gynecol, 178, pp.1035~1040 (1998)
- Mamelle N, "Prematurity and occupational activity during pregnancy", Am J Epidemiol, 119, pp.309~322 (1984)
- Mercer BM, "The preterm prediction study: effect of gestational age and cause of preterm birth on subsequent obstetric outcome. National Institute of Child Health and Human Development Maternal- Fetal Medicine Units Network", Am J Obstet Gynecol, 181(5), pp.1216~1221 (1999)
- Meis PJ, "The preterm prediction study: significance of vaginal infections. National Institute of Child Health and Human Development Maternal- Fetal Medicine Units Network", Am J Obstet Gynecol, 173, pp.1231~1235 (1995)
- Petersen CB, "Socio-economic inequality in preterm birth: a comparative study of the Nordic countries from 1981 to 2000", Paediatr Perinat Epidemiol, 23, pp.66~75 (2009)
- Horbar JD, "Trends in mortality and morbidity for very low birth weight infants, 1991-1999", Pediatrics, 110, pp.143~151 (2002)
- Bastek JA, "Adverse neonatal outcomes: examining the risks between preterm, late preterm, and term infants", Am J Obstet Gynecol, 199, pp.367~ (2008)