분만 시 무균처치와 산후감염의 이환율과의 관계에 대한 연구

Abstract

The puerperal infection is one of the major of maternal death, and although it is preventable through an effective prenatal as well as postnatal care its morbidity is increasing due to bacterial resistant to an effective antibiotics.

The primary purpose of this study was to investigate the puerperal morbidity of 949 parturients who were admitted to the Obstetrics and Gynecologic department of Ewha Womans University Hospital from January 197l to September 197l.

Among the 949 parturients, especially 40 normal parturients were selected(20. control group was given complete aseptic care during labor and delivery and post delivery; 20, compare group was given the ordinary care practiced during labor and delivery and maternal ward of Ewha Womans University Hospital ) for bacteriologic test on vaginal flora twice, on admission and on complete cervical dilatation of each parturient. The results obtained from this study were as follows; 1. Majority of parturients' age were 21 to 35 years old(90.83%), and educational level of 949 parturients was above high school. A large number of parturients' socioeconomic level(according to their husband' job) were moderate. 2. Among the 949 parturients, multipara(55.9%) were a little more than primipara(44.1%) and 38.84% of parturients had experienced abortion. 3. In delivery types, normal deliveries (84 cases )were more than cesarean section deliveries(145 cases).The puerperal morbidity after normal deliveries was 0.5%,and cesarean section deliveries, 23.45%. 4. Among 949 parturients incidence of hemorrhage cases (500 cc or more breeding) showed the higher puerperal morbidity(24.86%) than other cases(breeding less than500 cc, 7.83%). 5. The majority of parturients (81.03%) had been taking antenatal care, but most of them were taken irregular antenatal care. On the other hand, on admission, the parturients with complication were 30.32%, and their puerperal morbidity showed much higher (7.02%) than those with no complication(2.71%). 6. The incidence of puerperal morbidity in premature ruptured. membrane was higher(10.91%) then normal parturients (1.73%). 7. In the result of aseptic care during labor and delivery and postdelivery, the number of cultured bacteria was less in control group than compare group(in control group, on admission 17, on complete cervical dilatation 12; in compare group, on admission 21, on complete cervical dilatation 21). The most common bacterias were Staphylococcus(control group 14 on admission, compare group 16 on admission), and next Streptococcus, E - Coli, Bacillus Subtilus, in order. Also in control group the number of colony were reduced (43%) more than in compare group . Transient temperature elevation from 37℃ to 37.4℃ were noted in compare group(50%) than in control group(30%), and there was no one indicated above 38℃. In conclusion, the aseptic care is the best way of preventing puerperal infection as well as decreasing the puerperal morbidity. Therefore the most important nursing care is the aseptic care for each parturient during labor and delivery and postdelivery and also all the instruments must be cleaned and sterilized.