• Title/Summary/Keyword: 제왕절개분만

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Decision-making process and satisfaction of pregnant women for delivery method (임산부의 분만방법 결정과정과 만족도)

  • Jun, Hae-Ri;Park, Jung-Han;Park, Soon-Woo;Huh, Chang-Kyu;Hwang, Soon-Gu
    • Journal of Preventive Medicine and Public Health
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    • v.31 no.4 s.63
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    • pp.751-769
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    • 1998
  • This study was conducted to assess the attitude of pregnant women toward delivery method, understanding of the reason for determining her own delivery method, participation in decision-making process and satisfaction with delivery method after labor. Study subjects were 693 pregnant women who had visited obstetric clinic for prenatal care in the last month of pregnancy in one general hospital and one obstetrics-gynecology specialty hospital in Taegu city from February 1 to March 31 in 1998. A questionnaire was administered before and after labor and a telephone interview was done one month after labor. Proportion of women who had health education and/or counselling about delivery method during prenatal care was 24.0% and this proportion was higher for women who had previous c-section(35.5%) than others. Women thought vaginal delivery is better than c-section for both maternal and baby's health regardless of previous delivery method. About 90% of primipara and multiparous women who had previous vaginal delivery wanted vaginal delivery for the index birth, while 85.6% of multiparous women who had previous c-section wanted repeat c-section. Reasons for choosing c-section in pregnant women who preferred vaginal delivery before labor were recommendation of doctors(81.9%), recommendation of husband (0.8%), agreement between doctor and pregnant woman(4.7%), and mother's demand (12.6%). Reasons for choosing vaginal delivery were mother's demand(30.6%) and no indication for c-section(67.2%). Reasons for choosing c-section in pregnant women who preferred c-section before labor were recommendation of doctors(76.2%), mother's demand(20.0%), recommendation of husband(1.3%), and agreement between doctor and pregnant woman(2.5%). Of the pregnant women who had c-section, by doctor's recommendation, the proportion of women who had heard detailed explanation about reason for c-section by doctor was 55.1%. Mother's statement about the reason for c-section was consistent with the medical record in 75.9% . However, over 5% points disparities were shown between mother's statement and medical record in cases of the repeat c-section and mother's demand. In primipara and multiparous women who had previous vaginal delivery, the delivery method for index birth had statistically significant association with the preference of delivery method before labor(p<0.05). All of the women who had previous c-section had delivered the index baby by c-section. Among mothers who had delivered the index baby vaginally, 84.9% of them were satisfied with their delivery method immediately after labor and 85.1% at 1 month after labor. However, mothers who had c-section stated that they are satisfied with c-section in 44.6% immediately after labor and 42.0% at 1 month after labor. Preferred delivery method for the next birth had statistically significant association with delivery method for the index birth both immediately after labor and in 1 month after labor. The proportion of mothers who prefer vaginal delivery for the next birth increased with the degree of satisfaction with the vaginal delivery for the index birth but the proportion of mothers who prefer c-section for the next birth was high and they did not change significantly with the degree of satisfaction with the c-section for the index birth. These results suggest that the current high technology-based, physician-centered prenatal and partritional cares need to be reoriented to the basic preventive and promotive technology-based, and mother-fetus-centered care. It is also suggested that active involvement of pregnant woman in decision-making process for the delivery method will increase the rate of vaginal birth after c-section and decrease c-section rate and improve the degree of maternal satisfaction after delivery.

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Maternal Factors Affecting Delivery Mode of the Previous Cesarean Delivery Mothers (선행 제왕절개분만 산모의 제왕절개 후 질식분만과 반복 제왕절개분만 관련 요인)

  • Kim, Yun-Mi;Kim, Myung-Hee;Kim, Kyo-Hyun
    • Women's Health Nursing
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    • v.17 no.4
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    • pp.359-368
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    • 2011
  • Purpose: To examine delivery type of mother who have had a previous cesarean and identify maternal factors related to type of delivery. Methods: The study sample included 60,504 mothers who had delivered through cesarean section. Related variables were categorized as sociodemographic factors (age, residence, health insurance type, income level) and clinical characteristics (14 maternal factor, 4 fetal factor and pre-term). For data analysis, $x^2$ and multivariate logistic regression were conducted. Results: Among the 60,504mothers, 3,075 were delivered through Vaginal Birth After C-Section (VBAC) and the VBAC rate was 5.1%. Underage 34, the VBAC rate increased according to age increases up to 3%. Mothers residing in urban areas had VBAC more frequently than mothers in rural area. Mothers in the high and middle income levels had a greater possibility of having VBAC than mothers in lower income levels. A greater likelihood of increase in repeated cesarean section were found in mothers with maternal and fetal factors. Conclusion: Evidence based nursing practice guidelines and education programs for previous cesarean section mothers and health policy are needed to increase VBAC.

Comparative Analysis of Delivery Management in Various Medical Facilities (의료기관별 분만관리 양상의 비교 분석)

  • Park, Jung-Han;You, Young-Sook;Kim, Jang-Rak
    • Journal of Preventive Medicine and Public Health
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    • v.22 no.4 s.28
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    • pp.555-577
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    • 1989
  • This study was conducted to compare the delivery management including laboratory tests, medication and surgical procedures for the delivery in various medical facilities. Two university hospitals, two general hospitals, three hospitals, two private obstetric clinics, and two midwifery clinics in a large city were selected as they permitted the investigators to abstract the required data from the medical and accounting records. The total number of deliveries occurred at these 11 facilities between 15 January and 15 February, 1989 was 789 among which 606(76.8%) were vaginal deliveries and 183 (23.3%) were C-sections. For the normal vaginal deliveries, CBC, Hb/Hct level, blood typing, VDRL, hepatitis B antigen and antibody, and urinalysis were routinely done except the private clinics and midwifery clinics which did not test for hepatitis B and Hb/Hct level at all. In one university hospital ultrasonography was performed in 71.4% of the mothers and in one general hospital liver function test was done in 76.7% of the mothers. For the C-section, chest X-ray, bleeding/clotting time and liver function test were routinely done in addition to the routine tests for the normal vaginal deliveries. Episiotomy was performed in 97.2% of the vaginal deliveries. The type and duration of fluid infused and antibiotics administered showed a wide variation among the medical facilities. In one university hospital antibiotics was not administered after C-section at all while in the general hospitals and hospitals one or two antibiotics were administered for one week on the average. In one private clinic one pint of whole blood was transfused routinely. A wide variation was observed among the medical facilities in the use of vitamin, hemostatics, oxytocics, antipyreptics, analgesics, anti-inflammatory agents. sedatives. digestives. stool softeners. antihistamines. and diuretics. Mean hospital day for the normal vaginal deliveries of primipara was 2.6 days with little variation except one hospital with 3.5 days. Mean hospital day for the C-section of primipara was 7.5 days and that of multipara was 7.6 days and it ranged between 6.5 days and 9.4 days. Average hospital fee for a normal vaginal delivery without the medical insurance coverage was 182,100 Won for the primipara and 167,300 Won for the multipara. In case of the primipara covered by the medical insurance a mother paid 82,400 Won and a multiparous mother paid 75,600 Won. Average hospital fee for a C-section without the medical insurance was 946,500 Won for the primipara and 753,800 Won for the multipara. In case of the primipara covered by the medical insurance a mother paid 256,200 Won and a multiparous mother paid 253,700 Won. Average hospital fee for a normal vaginal delivery in the university hospitals showed a remarkable difference, 268,000 Won vs 350,000 Won, as well as for the C-section. A wide variation in the laboratory tests performed for a normal vaginal delivery and a C-section as well as in the medication and hospital days brought about a big difference in the hospital fee and some hospitals were practicing the case payment system. Thus, standardization of the medical care to a certain level is warranted for the provision of adequate medical care for delivery.

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Clinical Evaluation of Cesarian Section Anerohesia (제왕절개술 마취에 대한 임상적 고찰)

  • Park, Dae-Pal
    • Journal of Yeungnam Medical Science
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    • v.3 no.1
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    • pp.63-66
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    • 1986
  • Maternal and fetal effects of anesthesia for 423 cesarian section, performed during the past three and quarter years period in this hospital, have been evaluated. It is emphasized that the selection of anesthetic agent and method should depend upon the physical status of the patients and the ability of both obstetrician and anesthesiologists. Author results were as follows: 1. The incidence of c-section was 13.9% of total deliveries. 2. More than about three fourths of total cases were emergency cases. 3. Almost all cases were operated under general anesthesia. 4. The good physical states of patients resulted in better Apgar score of infants. 5. The shorter the interval from induction of anesthesia to delivery, the better was the Apgar score of infants.

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Factors on the Gap between Predicted Cesarean Section Rate and Real Cesarean Section Rate in Tertiary Hospitals (상급종합병원의 예측 제왕절개분만율과 실제 제왕절개분만율의 격차 관련요인)

  • Kim, Yun-Mi;Kim, Se-Young
    • Women's Health Nursing
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    • v.18 no.3
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    • pp.200-208
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    • 2012
  • Purpose: This study was aimed to examine the gap between predicted cesarean section rate and real cesarean section rate and it's determining factors of 44 tertiary hospitals. Method: This study is a cross-sectional analysis using the data of 25,623 deliveries in 2009 drawn from homepage of Health Insurance Review and Assessment Service. Data were analyzed with t-test, F-test, Scheff$\acute{e}$ test, and logistic regression. Result: There were statistically significant differences in the gap of cesarean section rate (more gap indicates higher quality of delivery) by grade of nurse staffing and delivery cases. Hospitals with nurse staffing grade 1 to 2 had more possibility to be classified into higher grade in quality of delivery (OR 5.67, 95% CI 1.07-30.08). Also hospitals with over 500 delivery cases had more possibility be classified into higher grade in quality of delivery (OR 4.92, 95% CI 1.14-21.23, respectively). Conclusion: The finding suggests that grade of nurse staffing may influence the real cesarean section rate because nurses do a vital role to prevent unnecessary cesarean section. Further study is required to provide evidence that nurse staffing influence on patient outcome and cost-effectiveness in order to obtain adequate number of nursing staffs.

체세포 복제란 이식우의 번식 생리학적 특성에 관한 연구(II) 복제 수정란 이식우의 분만 시 태반 및 혈중 TGF-$\beta$1 및 Progesterone의 분비 양상

  • 성환후;장유민;임석기;최재혁;우제현;양병철;노환국;임기순;장원경
    • Proceedings of the KSAR Conference
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    • 2002.06a
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    • pp.55-55
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    • 2002
  • 본 연구는 체세포 복제 가축의 정상 분만율이 낮은 원인을 규명하고, 복제란 이식우의 분만전후 생리적인 특성을 검토하기 위하여 혈중 또는 태반내 TGF-β1 과 progesterone 농도를 분석하여 검토하였다. 축산기술연구소에서 자체 생산된 체세포 복제란을 자연 발정이 유기된 수란우에 이식하였으며, 분만 예정일 하루 전에 제왕절개수술을 실시하여 태반 및 혈액을 채취하여 실험에 공시하였으며, 대조구의 시료는 분만직전에 제왕절개수술을 실시하여 공시하였다. (중략)

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Development and Evaluation of Breastfeeding Promotion Program for Mothers with Breast Engorgement following Cesarean Birth (유방울혈이 있는 제왕절개분만 산모를 위한 모유수유 증진 프로그램의 개발 및 평가)

  • Cho, Jeongsug;Ahn, Sukhee
    • Journal of Korean Academy of Nursing
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    • v.44 no.2
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    • pp.170-178
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    • 2014
  • Purpose: This study was to develop a breastfeeding promotion program and to test effects of the program on levels of breast discomfort, breast size, sodium in breast milk, and type of feeding in mothers with breast engorgement following cesarean birth. Methods: A non-synchronized non-equivalent control group pretest-posttest design was used in this study. The participants were 70 postpartum mothers who were admitted to a postpartum care center and experienced breast engorgement following cesarean birth. The planned nursing intervention was the breastfeeding promotion program consisting of breast massage and 1:1 breastfeeding education, counseling, and support focusing on individualized problem solving provided for 10 days. Fifty-three women completed the program (experimental group 26, control group, 27). Measurements were level of breast discomfort, breast size, sodium in breast milk and type of feeding at pre and posttest. Results: Women who participated in the program experienced lower scores for breast discomfort, greater decrease in breast size, lower levels of sodium in breast milk, and practiced breastfeeding more than those in the control group. Conclusion: Results indicate that this breastfeeding promotion program is effective in reducing breast engorgement and improving breastfeeding practices, and is therefore recommended to enhance breastfeeding promotion practice in postpartum care centers.

A Study on the Insurance Contribution and Health Care Utilization of the Regional Medical Insurance Scheme (1개 군지역 의료보험제도에서의 보험료 부담수준별 병.의원 의료이용에 관한 연구)

  • Lee, Sang-Il;Choi, Hyun-Rim;Ahn, Hyeong-Sik;Kim, Yong-Ik;Shin, Young-Soo
    • Journal of Preventive Medicine and Public Health
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    • v.22 no.4 s.28
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    • pp.578-590
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    • 1989
  • This study was conducted to assess the equity in the regional insurance scheme through analysis of the computerized data from one regional insurance society and National Federation of Medical Insurance. We analysed the insurance contribution and benefit by the classes based on total and income-related contribution per household. The major findings of this study are as follows : 1. The average proportion of income-related contribution among the total was 39.2% and the upper classes show higher proportion of the income-related contribution. 2. The upper classes show higher health care utilization rate than the lower classes. It suggests that the lower classes have relatively large unmet medical needs. 3. The analysis through the Lorenz curve reveals that there exists transference of contributions from the upper to lower classes. But the cumulative percentage of insurance benefit is smaller than that of the number of the insured. It implies that regional medical insurance scheme in Korea has still some inequity in the context of social security principles.

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The Difference between Clinical Manifestations and Feeding or Delivery Methods in Healthy Full-term Neonates and Those with Nosocomial Rotaviral Infection (수유 및 분만방법에 따른 신생아실 로타바이러스 원내감염의 증상 차이)

  • Lee, So Young;Kim, Hyun Ji;Kim, Mi Young;Kim, Won Duck;Lee, Dong Seok;Kim, Doo Kwun;Choi, Sung Min
    • Clinical and Experimental Pediatrics
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    • v.46 no.5
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    • pp.454-458
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    • 2003
  • Purpose : Rotavirus is the main cause of infantile diarrheal disease worldwide. The purpose of this study is to assess the difference between clinical manifestations and feeding or delivery methods in healthy full-term neonates and those with nosocomially-acquired rotaviral infection. Methods : The study was conducted on 348 babies who were delivered in Dongguk University Kyongju Hospital from Jan 1 to June 30 in 2001. Stool specimens were collected from clinically symptomatic neonates. We studied the rate of positive stool rotazyme ELISA tests and positive symptoms. We compared the frequency of clinical manifestations according to the feeding methods [breast feeding(BF) or formula feeding(FF)] and the delivery methods[normal vaginal delivery(NVD) or Cesarean section(C/sec)]. Results : Rotavirus was detected in 152 of 348 babies. The rate of positive rotazyme ELISA test was 43.7% in healthy full-term symptomatic neonates. The most common symptom of rotaviral enteritis was mild fever; the others were watery diarrhea, abdominal distension, vomiting, delayed weight gain, irritability, poor oral intake and dehydration. Compared with FF neonates, BF neonates have lower frequency of symptoms, especially watery diarrhea, delayed weight gain and poor oral intake. The symptomatic frequency was higher in FF and NVD neonates than BF and C/sec. Conclusion : The symptoms of rotaviral enteritis were less frequent in BF or C/sec delivered neonates. BF appeared to alleviate the rotaviral enteritis but further studies are needed. The cause of the lower frequency of symptoms in C/sec delivered neonates was unknown.