임신성 고혈압에 있어서의 수축검사에 관한 연구

Abstract

본 연구는 1980년 4월부터 1986년 6월까지 이화대학병원 산부인과에 입원한 임신성고혈압환자 88예를 대상으로 혈압의 중증도 및 합병증동반 여부에 따라 구분하여 수축검사(Contraction Stress test 70예) 비수축검사(nonstress test,6예) 및 진통중 태아감시 (intrapartum fetal monitoring 12예)등을 실시하여 다음과 같은 결론을 얻었다. 1. 태아심박감시와 고혈압별 태아예후를 보면 수축검사시의 양성형(positive pattern)이나 변이하강형(Variable deceleration) 을 나타낸 예의 태아장애(83.3% or 12.5%)와 주산사망(50% or 4.2%)들은 모두 중증임신성고혈압환자군에 속하였다. 2. 태아심박감시와 태아예후를 보면 수축검사시의 양성형으로 나타날 경우 음성형에 비하여 태아장애 즉 저Apgar점수( < 7 ) (1분점수 16.7% : 3.6% p < 0.05, 5분점수 66.7% : 10.7% p < 0.002) 및 주산사망(50% : 0% P < 0.0001)이 현저히 높았다. 3. 합병증을 동반한 임신성고혈압은 단순한 임신성고혈압과 비교하여 불길한 심박형의 출현시 태아장애(33.3% : 0 % p < 0.02) 및 주산사망(23.8 % : 0 % p < 0.05 )이 높게 나타났다. 또한 합병증을 동반한 임신성고혈압시의 5예의 태아사망은 모두 불길한 심박형 즉 수축검사의 양성형 및 변이하강형과 비수축검사시의 무반응성(nonreactive)으로 나타났을때 발생하였다.;The purpose of this study was to evaluate the prognostic significant of antenatal fetal monitoring in the fetal wellbeing, especially in the gravidas associated with hypertension at gestational weeks of 29 to 43 (average 38.5 weeks) who admitted to Ewha Womans University Hospital in Seoul during period of 6 years from April, 1980 to June, 1986. The data presented are based on the 88 cases of hypertension pregnancies including 45 cases of hypertension without complications, and 43 cases of complicated hypertensions(Intrauterine growth retardation and/or prematurity 15 cases, eclampsia 12 cases, abruptio placenta 7 cases, cord accidents 8 cases and gestational diabetes). In this paper will be discussed antepartum fetal monitoring assessment (contraction stress test) and correlation with fetal outcome and by the degree of hypertension. The results were as follow; 1. In viewing the fetal outcome by fetal monitoring assessment in the degree of hypertension, the fetal distress (83.3%or 12.5%) and perinatal death(50% or 4.2%) associated with ominous positive or variable deceleration pattern in contraction stress test were all indicated to be severe hypertension pregnancies. 2. When positive pattern appeared in contraction stress test in comparison with negative pattern, the incidence of fetal distress with low Apgar score( < 7) (1 min, 16.7% vs. 3.6% P < 0.05 5 min, 66.7% vs. 10.7% P < 0.002) and perinatal death rate(50% vs. 0 % P < 0.0001) were significantly high. 3. The incidence of fetal distress and perinatal death predicted by fetal monitoring assessment has been found to be very higher in the hypertension associated with complication as compared with cases with complications respectively (33.3% vs. 0% P < 0.02, 23.8% vs. 0% P < 0.05). Especially 5 cases of perinatal death in this complicated group all showed ominous fetal monitoring patterns (e.q. positive in stress test, variable deceleration in addition and nonreactive pattern in nonstress test).