A Multi-center Study for Birth Defect Monitoring Systems in Korea

The aim of this study was to establish a multi-center birth defects monitoring system to evaluate the prevalence and the serial occurrence of birth defects in Korea. Ten medical centers participated in this program. A trained nurse collected relevant records from delivery units and pediatric clinics in participating hospitals on a monthly basis. We observed 1,537 cases of birth defects among 86,622 deliveries, which included live births and stillbirths. The prevalence of birth defects was 1.8%, and the sex distribution of the birth defect cases was 55.2% male and 41.6% female. The highest proportion of birth defects was in the cardiovascular system (17.5%), followed by birth defects involving in the genitourinary system (15.6%). Chromosomal anomalies were detected 30.0 per 10,000 births. Of these chromosomal anomalies, Down syndrome was most frequently observed. This study led to an establishment of a multi-center active monitoring system for birth defects. To better understand the serial occurrence of birth defects in Korea, it is necessary to increase the number of participating hospitals and to launch on a nation-wide multi-center study.

A Survey on Prenatal Environmental Risk Factors for Mothers of Low Birth Weight Infants in Asan-City / 예방의학회지

OBJECTIVE: In this study, we aimed to produce basic data on the prenatal environmental risk factors of low birth weight infants at a community level. METHODS: In 2000, we conducted the direct interview using questionnaire about prenatal environmental risk factors with low birth weight infant-delivered mothers and normal weight infant-delivered mothers in Asan-city, Chungcheongnamdo Province, Korea. The questions given to the mothers included past pregnancy history, menstrual status, disease history before and during the pregnancy, family history, environmental risk factors and exposure history. The responses of the two groups were compared to calculate the prenatal environmental risk factors of each group. RESULTS: Mothers' smoking was significantly associated with low birth weight infants (adjusted odds ratio (AOR) 3.27; 95% confidence interval (CI) 1.25-8.56) and preterm baby (AOR 4.20; 95% CI, 1.21-14.61). Other environmental risk factors were not significantly different between the two groups. CONCLUSION: Smoking of mothers can be a risk factor for the delivery of low birth weight infants. These results could provide the basic data on prenatal environmental risk factors of mothers of low birth weight infants and suggest research topics for further community-based evaluation.

A Clinical Study of Placental Adhesions: Placenta Accreta, Placenta Increta, and Placenta Percreta / 대한산부인과학회잡지

OBJECTIVE: The objective of this study is to investigate the clinical characteristics of placental adhesions in order to improve maternal and fetal well-beings. METHODS: We reviewed the medical records of twenty cases of placental adhesions from January 1, 1995 to December 31, 1999 in Dankook University Medical Center. RESULTS: The incidence of placental adhesions is 0.267%. Of them, the percentage of placenta accreta was 35%, placenta increta, 60% and placenta percreta, 5%. Placental adhesions were observed more often in multipara (80%) than nullipara (20%). Co-existing placenta previa (50%), previous cesarean delivery (40%), multigravidity (5 or more; 40%) and previous artificial abortion (70%) were associated with placental adhesions. 85% of placental adhesions were treated by hysterectomy in order to manage postpartal uterine bleeding. Packed red cell transfusions were necessary in 18 cases of placental adhesions (90%). Maternal complications were wound infection (10%), disseminated intravascular coagulation, throm- boembolism, stress ulcer, postoperative fever, bladder perforation, pulmonary edema, and pleural effusion etc. Fetal complications were preterm birth (30%), neonatal death (5%), and fetal death in utero (10%). CONCLUSION: This study revealed that placental adhesions show grave maternal and fetal complications. Obstetricians should examine carefully to confirm placental adhesions and prepare thoroughly the postpartal emergency-care, especially in the high-risk gravida.

Clinical Analysis of Fetal Congenital Anomalies / 대한산부인과학회잡지

The term congenital anomalies here refers to structural defect (congenital malformations, deformations, disruptions and dysplasias), chromosomal abnormalities, inborn errors of metabolism and hereditary disease. The prevalence of major congenital malformation (i.e., defects either incompatible with life or severe enough to interfere with normal living) is about 2% to 3%. In the past, infection was one of the major cause of perinatal morbidity and mortality, but owing to the development of antibiotics and intensive care, congenital anomalies are becoming a major cause of perinatal morbidity and mortality. Perinatal diagnosis of congenital anomalies is becoming more important because appropriate perinatal care may minimize the effect of congenital anomalies. This report was based on the 234 cases of the congenital anomalies among 8,099 newborns delivered at Dankook University Hospital from Mar. 1st, 1995 to Feb. 28th, 2000. The analyzed results were as follows: 1. The overall incidence of the congenital anomalies was 2.9%. The incidence of congenital anomalies in male newborns (141, 60.2%) was statistically significantly higher than that of female (90, 38.5%) and ambiguous (3, 1.3%). 2. The incidence of the congenital anomalies of 21-25 year old maternal age was the lowest among each other age group. The incidence of this group was 1.6%, of less than 20 year old group was 2.7%, of over 35 year old group was 2.9%. But there was no statistically significant difference among each maternal age groups. 3. There was no statistically significant difference in the incidences of congenital anomalies between parity. 4. The incidence of low-birth weight less than 2,500 g in congenital anomalies was 9.2%, which was 5.1 times higher than that of the more than 2,500 g. 5. The incidence of vertex presentation in congenital anomalies (192, 82.1%) was very high compared to breech presentation (42, 17.9%). 6. In the method of deliveries, vaginal deliveries was 131 cases (56.0%) and cesarean section was 103 cases (44.0%). 7. The incidence of the congenital anomalies in stillbirth was 28.4%, which was 13 times higher than that of the live birth. 8. The perinatal mortality rate in congenital anomalies were 93 cases (39.7%) and stillbirths were 62 cases (28.4%). 9. When classified according to the type of congenital anomalies, the rate of the incidence was 13.3% (31 cases) in central nervous system, 9.4% (22 cases) in neck and face anomaly, 6.8% (16 cases) in cardiac anomaly, 1.3% (3 cases)in pulmonary anomaly, 5.5% (13 cases) in gastrointestinal anomaly, 13.7% (32 cases) in genitourinary anomaly, 18.4% (43 cases) in musculoskeletal anomaly, 9.0% (21 cases) in skin and soft tissue anomaly, 14.1% (33 cases) in multiple anomaly and 5.5% (13 cases) in chromosomal anomaly. The most common major congenital anomalies was hydrocephalus (14 cases, 5.9%) and polycystic kidney (14 cases, 5.9%). The rate of perinatal mortality of the congenital anomalies was 38.5%, particularly it was the highest in the CNS anomalies which were 89.7%, the next 50.0% in cardiopulmonary anomalies.

Multi-center Study for Birth Defects Monitoring Systems in Korea / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to establish a birth defects monitoring system in Korea by multi-center study. This novel study was initiated in 1999, and extended to detect the frequencies and trends of birth defects in Korea. METHODS: Six centers participated in this study. The actively ascertained surveillance data was collected from May 1999 to November 2001. RESULTS: Of the 65,653 births included in this study, 1,143 (1.7%) had birth defects. About one third of them were terminated. While disease of the genitourinary tract was more frequent in isolated defects, cardiovascular disease was more frequent in combined defects (19.7% and 21.7%, respectively). Chromosomal anomalies were detected 23.5 per 10,000 births. And it showed increasing tendency for 3 years. CONCLUSION: We could establish multi-center monitoring system for birth defects successfully. But, many of the problems arising in the collection of accurate, valid, and comparable epidemiological data about birth defects have not yet been overcome. It appears that the development of joint projects at national level is essential for upgrading the quality and usefulness of this study.

Multi-center Study for Birth Defects Monitoring Systems in Korea / 대한산부인과학회잡지

OBJECTIVE: Our aim was to establish a multi-center birth defects monitoring system for evaluating the prevalence and serial occurrence of birth defects in Korea. METHODS: Seven centers participated in this monitoring system. Trained nurses actively collected the 42,015 delivery records obtained from delivery units and pediatric clinics in the participating hospitals every month. RESULTS: We observed 722 birth defects among 42,015 births including live births and stillbirths. The prevalence of birth defect was 1.7%. About one thirds of birth defects were terminated. The most frequent congenital anomalies were cleft lip and Down syndrome. The highest proportion of birth defects was 20.1% in urogenital system. The proportion of birth defects in cardiovascular system and gastrointestinal system were 17.1% and 14.1% respectively. Chromosomal anomalies and genetic syndromes represent 13.4% and 3.3% among birth defects respectively. Among chromosomal anomalies Down syndrome was at the first rank. CONCLUSION: We could establish multi-center active monitoring system for birth defects successfully. To check serial occurrence of birth defects, it is necessary to increase participating hospitals and to launch the nationwide multi-center study.

Prenatal Environmental Exposure and Pregnancy Outcomes / 대한산업의학회지

OBJECTIVES: The aim of this study was to examine the association of prenatal environmental exposure and pregnancy outcomes. METHODS: Self-administered questionnaire survey was conducted for pregnant women with gestational age of 16-18 weeks, who visited the outpatient department of Dankook University Hospital from May 1995 to June 1999. Of all 1170 women, 762 women answered the questionnaires and the response rate was 65 %. Among them, 471 cases which has delivered at our hospital were included in this study. RESULTS: Comparing the environmental risk factors and the pregnancy outcomes, there was an association between delivery of small for gestational age infants and the ingestion of herb medicine and caffeine-containing nutritional beverages. Pregnant women with occupation were more likely exposed to environmental tobacco smoking, to ingestion of nutritional drinks and green teas, to use of video display terminals and to diagnostic radiation. CONCLUSIONS: We could get precise information from prospectively conducted questionnaire study. It is necessary to extend the study population to verify the influence of prenatal environmental factors on pregnancy outcomes.

Comparison of Analgesic Effect of Fentanyl and Butorphanol during Patient-Controlled Epidural Analgesia for Labor Pain Control / 대한마취과학회지

BACKGROUND: This study examined the efficacy of patient-controlled epidural analgesia (PCEA) during labor and compared the suitability of fentanyl and butorphanol mixed with bupivacaine. METHODS: After establishing effective epidural analgesia with 10 ml of 0.125% bupivacaine mixed with fentanyl 5 microgram/ml or butorphanol 1 mg/ml, 60 parturients in active labor were randomly assigned to one of two groups: PCEA using 0.0625% bupivacaine with fentanyl 2 microgram/ml (fentanyl group); PCEA using 0.0625% bupivacaine with butorphanol 20 microgram/ml (butorphanol group). PCEA pumps were programmed to deliver a 4 ml/hr basal infusion, 4 ml on-demand bolus, 10-min lockout intervals between doses, and a 20 ml hourly limit. Visual analogue pain scores, side effects, parturients' satisfaction scores, duration of labor and Apgar scores were recorded during and after labor. RESULTS: The quality of analgesia, side effects, duration of labor, overall satisfaction and Apgar scores didn't differ between the two groups. Average hourly infusion rates were 11.8 0.3 ml/hr (fentanyl group) and 13.9 0.4 ml/hr (butorphanol group). CONCLUSIONS: PCEA is a safe and effective method for labor analgesia and both solutions, the 0.0625% bupivacaine plus fentanyl 2 microgram/ml and the 0.0625% bupivacaine plus butorphanol 20 microgram/ml, appear suitable for PCEA use for labor pain. There is no difference in effectiveness between fentanyl and butorphanol.

Comparison of Analgesic Effect of Fentanyl and Butorphanol during Patient-Controlled Epidural Analgesia for Labor Pain Control / 대한마취과학회지

BACKGROUND: This study examined the efficacy of patient-controlled epidural analgesia (PCEA) during labor and compared the suitability of fentanyl and butorphanol mixed with bupivacaine. METHODS: After establishing effective epidural analgesia with 10 ml of 0.125% bupivacaine mixed with fentanyl 5 microgram/ml or butorphanol 1 mg/ml, 60 parturients in active labor were randomly assigned to one of two groups: PCEA using 0.0625% bupivacaine with fentanyl 2 microgram/ml (fentanyl group); PCEA using 0.0625% bupivacaine with butorphanol 20 microgram/ml (butorphanol group). PCEA pumps were programmed to deliver a 4 ml/hr basal infusion, 4 ml on-demand bolus, 10-min lockout intervals between doses, and a 20 ml hourly limit. Visual analogue pain scores, side effects, parturients' satisfaction scores, duration of labor and Apgar scores were recorded during and after labor. RESULTS: The quality of analgesia, side effects, duration of labor, overall satisfaction and Apgar scores didn't differ between the two groups. Average hourly infusion rates were 11.8 0.3 ml/hr (fentanyl group) and 13.9 0.4 ml/hr (butorphanol group). CONCLUSIONS: PCEA is a safe and effective method for labor analgesia and both solutions, the 0.0625% bupivacaine plus fentanyl 2 microgram/ml and the 0.0625% bupivacaine plus butorphanol 20 microgram/ml, appear suitable for PCEA use for labor pain. There is no difference in effectiveness between fentanyl and butorphanol.

Environment and Perinatal Medicine / 대한주산의학회잡지

No abstract available.

The Relationship of Positive Antimicrosomal Antibody and Postpartum Thyroiditis / 대한주산의학회잡지

Postpartum thyroiditis is a common but frequently unrecognized disorder, affecting approximately 5% of women during the first 12 months after delivery. It is characterized by transient hyperthyroidism occurring about 14 weeks postpartum followed by transient hypothyroidism at 19 weeks postpartum. Our aim is to investigate the prevalence of positive antimicrosomal antibody in women 3 months postpartum and an association of antimicrosomal antibody with symptomatic and biochemical thyroid disorders. We used data collected from 205 women who visited Dankook University Hospital in 3 months postpartum, Our results showed that the rate of positive antithyroid microsomal antibody was 12.7% in women 3 months postpartum and the prevalence of biochemical hyperthyroidism and biochemical hypothyroidism with positive antithyroid microsomal antibody women 3 months postpartum were 26.9% and 19.2%, respectively. The prevalence of postpartum biochemical thyroid dysfuncion 3 months postpartum was 13.7%. There was no relationship between any of the following factors and thyroid antibody status: fetal distress, birth weight and infant sex, matemal age, experiences and mode of delivery, previous medical disease(such as pstrointestinal and psychotic diseases), experiences of previous abortions, gestational age and past history of thyroid diseases.

A Case-Control Study on Risk Factors of Preterm Labor / 대한산부인과학회잡지

BACKGROUND: The prevention of preterm deliveries still remains a major problem in ob-stetrics. The cause of preterm labor is poorly understood. Our purpose was to determine the risk factors for preterm labor associated with specific clinical and environmental factors. METHODS: Using a case-control design, 54 women with preterm labor and 134 controls with term labor, who were admitted to the department of Obstetrics and Gynecology, Dan- kook University Hospital from January, 1996 to August, 1996. The study groups were inte- rviewed and their medical records were reviewed. RESULTS: 1. There were no significant differences of maternal age, maternal weight at 20 weeks of gestation and maternal weight gain at the time of delivery. 2. There were no significant differences between housewives and working women. But the physical workload of the preterm labor group was significantly higher than the control group ( 16.0% vs. 4.0% ). 3. There were no significant differences in the smoking habit of mother or her husba- nd. The passive smoking of the preterm labor group was significantly higher than the con- trol group ( 43.8% vs. 26.8% ). 4. In vaginal bleeding at pregnancy, the preterm labor group was significantly higher than the control group ( 15.7% vs. 2.3% ). Especially, the third trimester vaginal bleeding of the preterm labor group was significantly higher than the control group. 5. There were no significant differences in the number of previous fullterm deliveries, previous abortions, and living children between two groups. The experience of the previous preterm deliveries of the preterm group was significantly higher than the control group ( 11. 5% vs. 0.8% ). 6. There were no significant differences of medications, consumption of alcohol, coffee, tea, green-tea, cola and nutritional beverages, the experiences of coitus, defecation numbers and accidents during pregnancy between two groups. 7. There were no significant differences in the plasma concentrations of hemoglobin, hematocrit, white blood cells, and in the blood pressure, and the body temperature between two groups. CONCLUSION: The risk factors of preterm labor were severe physical workload, vaginal bleeding at pregnancy, especially, the third trimester vaginal bleeding, and the experience of previous preterm deliveries.

A Case of Ovarian Low-Grade Stromal Sarcoma with Thecomatous Features: So-Called "Malignant Thecoma" / 대한산부인과학회잡지

Theca cell tumors of the ovary have been generally regarded as almost invariably benign neoplasms. Even though several case reports of the malignant variant of this tumor have appeared in the world literature, but the term "malignant thecoma" is controversial and doubtful. If a thecoma ever becomes malignant, the tumor cells dedifferentiate so that they can not be recognized any longer as theca cells: instead, they proliferate as a stromal sarcoma or fibrosarcoma. We have experienced a rare case of ovarian low-grade stromal sarcoma with thecomat ous features in a 66-year-old postmenopausal woman. The clinicopathologic finding and a review of literature on ovarian stromal sarcoma and malignant thecoma were described brie fly.

Determinants of Infant Birthweight / 대한주산의학회잡지

PURPOSE:To examine the association between gestational weight gain pattern and infant birth weight and to analyse the determinant factors for infant birthweight. METHODS: We used data collected from 937 pregnant women delivered without complications in Dankook University Hospital from December 1994 to October 1995. Using multiple regression analysis we investigated the determinant, factors for infant birthweight. RESULTS: The mean pre-pregnancy weight, the mean height and pre-pregnancy body mass index of objects was 52.5 kg, 159 cm and 20.8 kg/m, respectively. The total gestational weight gain was 12.9 kg and the mean infant birthweight was 3,165 g with mean gestational age of 38 weeks. Multiparous mother was older, heavier in pre-pregnancy body weight, higher in pre-pregnancy body mass index than primiparous mother, and shows less gestational weight gain than primiparous mother. According to the IOM guidelines, we classified objects into groups of the Under-gain, the Recommended gain and the Over-gain. The Under-gain groupshows less infant birthweight and had more small-for-gestational age infants than other groups. The Over-gain group had more large-for-gestational age infants than other groups. 'I'he major determinant factors for infant birthweight were gestational age, placental weight, gestational weight gain, pre-pregnancy body mass index, infant sex, parity and maternal height. CONCLUSIONS: The results suggest that we must focus to check the gestational weight gain and the maternal nutritional status to ensure the adequate infant birthweight for prenatal care. To evaluate the infant birthweight, we must consider gestational weight gain, pre -pregnancy body mass index, infant sex, parity and maternal height including gestational age.

A Case of Cyclopia Delivered from a Diabetic Mother / 대한산부인과학회잡지

Cyclopia is a rare congenital fetal anomaly, characterized by a single median eye and a grotesquily shaped nose(proboscis) that arises from the supraorbital area. It is consistently associated with serere holoprosencephaly, which is the failure of cleavage of the prosencephalon with a deficite in the midiline facial development. Holoprosencepphaly occurs in as many as 1 to 2 % of diabetic mothers. A case of cyclopia delivered from a diabetic mother is presented with a brief review of literatures.

A Hospital Based Case-Control Study for the Effects of Maternal Anemia on the Preterm Birth andAdverse Pregnancy Outcomes / 대한산부인과학회잡지

OBJECTIVE: Maternal anemia is one of the most common hematologic disorders of the child-bearingmothers. However the role of maternal anemia in the etiology of preterm delivery and adverse pregnancyoutcomes remains a source of controversy. The aim of this study was to determine the effects of maternalanemia on the preterm birth and the adverse pregnancy outcomes. STUDY DESIGN: A total of 1,010 women aged 19~44 years, who admitted to our hospitalfor the delivery between December 1994 and October 1995, were recruited into a hospitalbaed case-control study design. 259 women complicated by maternal anemia(cases) werecompared with 751 women without maternal anemia(controls). Multiple logistic regressionanalyses were performed to control for the effects of other potentially confounding factors,including maternal age, body mass index, previous term delivery, previous preterm deliveryand previous abortion. In all logistic regression analyses odds ratio and 95% confidenceintervals were calculated. RESULTS: The prevalence of maternal anemia(hemoglobin<10g/dl) was 25.6%. Therewas a positive linear relationship between the prepartum hemoglobin concentration and thepostpartum concentration. There was no significant differences of the incidence of pretermbirth and the neonatal morbidity, such as poor Apgar scores, fetal distress, congenitalanomaly, birth trauma, admission to neonatal intensive care unit, resuscitation and sepsisbetween case and control groups. Small for gestational age and low birth weight were associatedwith an somewhat decreased risk of maternal anemia and large for gestational age, notmacrosomia, was associated with an 70% increased risk of maternal anemia at the time ofdelivery. Maternal anemia was associated with 6.5 fold increases in the risks of postpartumbleeding, 8.5 fold increases in the postpartum transfusion and 80% increases in the puerperalfever respectively. CONCLUSIONS: Maternal anemia was not associated with increased risks of preterm birthand the neonatal morbidty. However there was a significant relationship between maternalanemia and postpartum maternal morbidity, such as postpartum bleeding, postpartum transfusionand puerperal fever.

The Relationship between Maternal Body Mass Index, Gestational Weight Gain Patterns and Preterm Birth / 대한산부인과학회잡지

Objective: To examine the association between maternal body mass index, gestation-al weight gain pattern and preterm delivery, using Institute of Medicine(IOM) guidelines. Methods: We used data collected from 937 pregnant women delivered without comp- lications in Dankook University Hospital from December 1994 to October 1995. Results: The mean maternal weight gain was 12.9 kg. The mean maternal weight gain in the underweight group(BMI>19.8), in the normal weight group(BMI:19.8~26.0) and in the overweight group(BMI>26.0) was 13.5 kg, 12.6 kg and 11.5 kg, respectively. Compared to the IOM recommendations for total weight gain, we classified objects into groups of the Under-gain, the Recommended gain and the Over-gain. The Under-gain gr- oup was 3.23 times more likely to preterm birth than other groups;the odds ratio was 3.23 and 95 % confidence interval was 2.16~4.84. Pre-pregnancy body mass index was not associated with the increased risks of preterm birth. Conclusions: The results suggest that maternal Under-gain during pregnancy, but not pre-pregnancy BMI, was associated with the increased risks of preterm birth. Therefore, it is important to identify women, whose weight gain are inadequate to the recommended ranges and to encourage them to take adequate nutritional intakes.

An Introduction on the Changes of the Occupational Health and Safety Systems in Germany: from the 19th Century to the Weimar Republic / 의사학

The purpose of this paper is to introduce and summarize the developmental process of the occupational health and safety systems from the 19th century to the Weimar Republic in Germany. The German occupational health system has changed with its unique character reflecting its sociopolitical backgrounds. In the 19th century, Germany, as the aftercoming capitalistic country in Europe, showed a flourishing industrial development. But this industrial development evoked many side effects, including long working hours, bad work environment, frequent occupational accidents and occupational diseases. The health and safety systems for German workers were established under the influences of the political interest groups and the social movement. In 1884 Bismarck made the law of the occupational accident insurance(Berufsgenossenschaft) in order to oppress the movement of socialists and radical workers and to secure his regimes. Then the way to control the work conditions of factories had three paths: technical supervision by the autonomic engineers, factory inspectors from the occupational accident insurance and the governmental factory supervisors. In the Weimar Republic the needs of the protection for both workers and machines were rising and became one of the main tasks of the government. Therefore, in 1925 the law for the occupational diseases was first established and then some occupational diseases were acknowledged as the occupational accidents and insured by the occupational accident insurance. Many factory doctors, factory hygienists, factory engineers and chemists organized the specialists' supervising and consulting groups for the occupational health and safety. And the workers themselves also started to participate in the factory committee in order to guard their own health and interests.

Concepts of Occupational Exposure Limit and Their International Comparisons / 대한산업의학회지

This paper focuses on the origin of the concepts of occupational exposure limit, and traces the history and development of thoughts and regislations of various countries and organizations concerning the founding principles upon which it is based. The concepts of establishing standards for occupational chemicals in workplace air constitute a social consensus or agreement about acceptable levels of occupational hygiene. The level of scientific development of a country and the discussion of experts in the field of occupational health play an important role. The physician in occurational health has to be especially concerned to discover and estimate the risks to anyone particularly susceptible to exposures within the hygienically acceptable conditions.