The Relationship of Maternal Physical Characteristic Change and Neonatal Weights: the Comparison between 1989 and 1999 / 대한산부인과학회잡지

OBJECTIVE: This study was organized to find out whether there are differences between pregravid weight, body mass index, weight gain during pregnancy and birth weight in 1989 and 1999. Also it was designed to find out the factors which influenced the birth weight changes. METHODS: A total of 725 (313 in 1989, 412 in 1999) pregnant women who had term delivery in the department of Obstetrics and Gynecology, Hanyang University Hospital were recruited for the study. Pregravid weight, body mass index, weight gain during pregnancy, body weight at the time of delivery and birth weight were examined through medical records retrospectively. RESULTS: Pregnant women in 1999 were older (29.7 +/- 3.7 yr vs 28.3 +/- 3.2 yr, p=0.0001), pregravid weight (54.0 +/- 7.5 kg vs 50.7 +/- 5.5 kg, p=0.0001), height (159.6 +/- 4.8 cm vs 158.5 +/- 4.7 cm, p=0.002), body mass index (21.2 +/- 2.8 kg/m2 vs 20.2 +/- 2.1 kg/m2, p=0.0001), weight gain during pregnancy (13.6 +/- 4.8 kg vs 12.8 +/- 4.6 kg, p=0.016) and birth weight (3103 +/- 652 gm vs 2993 +/- 843 gm, p=0.025) compared with those in 1989. The frequency of overweight (BMI>26) in pregravid was significantly higher in 1999 (9.4%) than in 1989 (1.9%) (p=0.0001). Weight gain during pregnancy were lower in over-weight pregravid than in normal or under-weight pregravid in both year, but birth weight was not different according to pregravid weight in both years. Compared to the weight gain during pregnancy less than 16 kg, women who gained weight more than 16 kg during pregnancy were significantly taller and weighed more at the time of delivery, and showed increased birth weight than those who gained weight during pregnancy less than 16 kg in both years. Weight gain during pregnancy was higher in over-weight pregravid than normal or under-weight pregravid in 1999 (p=0.012). The gain of body weight at the time of delivery in 1999 compared to those in 1989 is the most important factor for the birth weight change between two years. The increased pregravid weight, greater weight gain during pregnancy, and increased BMI also had an impact on the increasing birth weight in 1999. CONCLUSION: It is considered that physical characteristics of pregnant women in 1999 have been changed compared to those in 1989, and this change might be responsible for a birth weight increase.

Clinical study of Failure to Progress as an Indication for Cesarean Section / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate the appropriateness of diagnosis of the failure to progress (FTP) and accompanying emergency Cesarean section in university hospital and possibility of reducing emergency Cesarean section among these patients. METHODS: Chart review of 680 patients who had underwent emergency Cesarean section with diagnosis of FTP between January 1996 and December 2002 at Hanyang University Medical Center was carried out for this study. Among patients who underwent normal vaginal delivery during the same period, 300 patients were randomly chosen for control group. Comparison between these two groups on maternal physical properties, management during delivery, birth weight and sex of babies were made. Also, differences of labor management among obstetrical staff were compared RESULTS: Compared to the vaginal delivery group, FTP group patients showed older age (29.1 vs 27.7 yr) (p=0.000), shorter stature (158.4 vs 159.8 cm) (p=0.001), and heavier body weight (68.2 vs 65.7 kg) (p=0.000) suggesting unfavorable outcome Also, birth weight of the newborn infant was heavier compared to the normal delivery group (3350 vs 3181 g) (p=0.001). In addition, the frequency of PG E2 use was higher (45% vs 35%) (p=0.001) and hours of oxytocin use was longer (6.3 vs 4.2 hr) (p=0.000) in FTP group. The distribution of delivery time in FTP group was around four or more hours in comparison to the normal delivery group in which the judgement was made that there was as inclination for sufficient effort for the purpose of a normal delivery. On one side, cervical dilatation was less than 3 cm, there were 44 people in a group with less than 70% effacement of cervix in which 40 of these people (excluding 4) were capable for a normal delivery with additional effort. Moreover, in the case of the failure to progress group, active labor management can decrease the rate of cesarean section to about 5.8% (40/680). CONCLUSION: The results of this study suggests the possibility that frequency of cesarean section could be reduced through the efforts of active labor management. However, there are a variety of factors leading to cesarean section that must be analyzed along with social and national support.