• Journal of Genetic Medicine
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• 제6권1호
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• pp.74-80
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• 2009

목 적: 임신 제1삼분기와 2삼분기에 시행하고 있는 다운증후군 선별검사 지표들이 다른 임신합병증 예측에 있어서 갖는 의의를 알아보고자 한다. 대상 및 방법: 2005년 1월부터 2006년 12월까지 만2년간 강남차병원 산부인과에서 산전진찰을 받으며 임신 제1삼분기에 PAPP-A와 NT, 2삼분기에AFP, hCG, Inhibin-A, 그리고 uE3로 다운증후군 선별검사를 시행 받고 분만한 3,121명의 산모와 이들의 신생아를 대상으로 하였다. 의무기록지 검토를 통해 산모의 나이, 임신합병증과 제태연령, 분만시와 분만후의 합병증 유무, 그리고 integrated test 시기와 각 지표의 수치를 조사하여 SPSS 프로그램을 이용하여 정규성 검정과 t-test, 그리고 로지스틱 회귀분석을 시행하였다. 결 과: 다운증후군 선별검사의 표지물질들이 다른 임신 합병증에서도 이상소견을 보였는데, 특히 조산과 자간전증 시에 AFP 수치의 증가, hCG증가, Inhibin-A증가, PAPP-A감소, NT 감소가 있었다. Inhibin-A는 자간전증, 저체중아 출산, 조산시에 임신 제2삼분기에 증가되어 있었는데 odds ratio는 각각 2.843, 1.446, 1.287이었다. AFP는 임신 24주 이전의 태아손실(odds ratio 2.868)과 조산(odds ratio 1.653)시 에 임신 제2삼분기에 증가하였고, 임신 제1삼분기의 PAPP-A는 자간전증(odds ratio 0.51)과 조산(odds ratio 0.75)시에 감소함을 알 수 있었다. 결 론: 모든 산전 클리닉에서 시행하고 있는 다운증후군 선별검사의 지표 중 특히 임신 제2삼분기의 Inhibin-A와 AFP, 제1삼분기의 PAPP-A의 이상 수치는 태반기능 관련 임신합병증인 조산, 자간전증과 저체중아 출산의 동반 가능성이 높아 이를 이용하면 이들 질환의 고위험군을 분류할 수 있으며, 이런 산모를 대상으로 보다 주의깊은 산전관리와 상담이 가능할 것으로 생각된다.

• 대한간호
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• 제29권3호
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• pp.64-78
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• 1990

The purpose of this study was to measure the degree of gravidas' knowledge of infant care activity, and to identify the factors influencing the difference of gravidas' knowledge. The subjects of this study consisted of 159 gravida visited 2 general hospitals, 2 OB/GY clinics and 2 midwives' clinics in J city for anenatal care. The data were collected from December 1 to 30, J.989. The instrument used for this study was true false type question which was developed by investigator through literature review. Data were analyzed by percentage, mean, t-test and ANOVA on significant difference with SPSS program. The results of this study were, summarized as follow: 1) The degree of gravidas' knowledge of infant care activity was 36.75, the degree of gravidas' know ledge of physical care activicy was 16.70, and the degree of gravidas' knowledge of psychosocial care activity was 20.00. 2) Among the physical care activity knowledge items, the diaper should be changed whenever it is soiled, $\lceil$shortly after feeding is over, bathing is bad$\rfloor$, $\lceil$gently patted or stroked on the back when bubbling$\rfloor$, $\lceil$10 minutes time in bathing is appropriate$\rfloor$, $\lceil$infant is crying whenever he is hungry per 3-4 hours$\rfloor$, and "room humidity controled 60 percent, more or less> were over a' percentage of 80 of right answer. Among the physical care, accivity knowledge items. $\lceil$a reason for burping was the air' he has swallowed will rise to the top of his stomach and be eructated$\rfloor$, $\lceil$burping is advisable after the feeding$\rfloor$, $\lceil$dressing of umbilical area is not necessary$\rfloor$, $\lceil$the thermometer should not be boiled for disinfection$\rfloor$, $\lceil$it is important chat the infant grasp the whole nipple within his mouth$\rfloor$, $\lceil$using alcohol sponge is bad whenever diaper is soiled", and $\lceil$when temperature is taken by the rectal method, infant legs shoud be grasped firmly_! were less than a percentage of 60 of right answer. 3) Among the psychosocial care activity knowledge items, $\lceil$it is nice, mother smile at bady frequently$\rfloor$, $\lceil$it is nice, mother praise a bady frequently$\rfloor$, $\lceil$it is nice, mother express bady's behavior$\rfloor$, $\lceil$talk frequently to the bady, the bady :should not be disturbed while feeding$\rfloor$, $\lceil$it is nice, mother see a baby face to face , $\lceil$it is nice, mother concentrate one's attention on her baby while playing$\rfloor$, $\lceil$it is nice, mother pat one's baby while he is feeding$\rfloor$, $\lceil$it is advisable, the baby is allowed to touch mother's breast while he is feeding$\rfloor$, $\lceil$it is advisable to stop feeding, if the baby protrudes one's tongue or cries while feeding$\rfloor$, $\lceil$baby is able to hear, see and smell$\rfloor$, $\lceil$it is nice, mother Concentrate one's attention on her baby while feeding$\rfloor$, and $\lceil$it is not advisable for mother to scold baby while he is crying out> were over a percentage of 80 of right answer. Among the psychosocial care activity knowledge items, $\lceil$Using' baby talks is bad when mother talks to baby> and $\lceil$it is nice, mother soothes the baby as soon as possible when he is crying I were less than a percentage of 60 of right answer. 4) There was statistically significant relationship between the degree of gravidas' knowledge of infant care activity and the demographic variables of gravida such as the age(p<0.01) and education level(p<0.01). From these results, it may be concluded that gravidas' knowledge of infant care activity is moderate level, and gravidas' knowledge of psychosocial care activity is greater than that of physical care activity. Also prenatal nursing educations should focus on subjects who have lower percentage of right answer in infant care activity knowledge items.dge items.

• 대한간호학회지
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• 제20권2호
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• pp.153-173
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• 1990

One of the important tasks for new parents. especially mothers, is to establish warm, mutually affirming interpersonal relationships with the new baby in the family, with the purpose of promoting the healthy development of the child and the wellbeing of the whole family. Nurses assess the quality of the behavioral characteristics of the maternal-infant interaction. This study examined the relationships between primiparas pereptions of their delivery experience and their maternal infant interaction. It compared to delivery experience of mothers having a normal vaginal delivery with those having a casearean section. The purpose was to explore the relationships between the mother's perceptions of her delivery experience with her maternal infant interaction. The aim was to contribute to the development of theoretical understanding on which to base care toward promoting the quality of maternal-infant interaction. Data were collected directly by the investigator and a trained associate from Dec. 1, 1987 to March 8, 1988. Subjects were 3 random sample of 62 mothers, 32 who had a normal vaginal delivery and 30 who had a non-elective cesarean section (but without other perinatal complications) at three general hospitals in Seoul. Instruments used were the Stainton Parent -infant Interaction Scale(1981) and the Marut and Mercer Perception of Birth Scale(1979). The first observations were made in the delivery room (for vaginally delivered mothers only), followed by day 1, day 2, day 3, and 2 weeks, 4 weeks, 6 weeks and 8 weeks after birth, for a total of 7-8 contacts(Cesarean section mothers were observed on days 4 and 5 but the data not used for analysis). Observations in the hospital were made during the hour prior to scheduled feedings. The infant was placed beside the mother. Later contacts were made at home. Data analysis was done by computer using as SPSS program and indulded X² test, paired t-test, t-test, and Pearson Correlation coefficient ; the results were as follows. 1. Mothers who had a normal vaginal delivery tended to perceive the delivery experience more positively than cesarean section mothers(p＝0.002). The finding supported the hypothesis I that perception of delivery would vary according to the method of delivery. Mothers' perceptions of birth were classified into three dimensions, labor, delivery and the bady. There was a significantly different and positive perception by the vaginally delivered mothers to the delivery experience(p＝0.000) but no differences for labor or the bady according to the delivery method(p＝0.096, p＝0.389), 2. Mothers who had a normal vaginal delivery had higher average maternal-infant interaction scores(p＝0.029) than mothers who had a cesarean section. There were similar higher scores for the 1st day(p＝0.042), 2nd day (p＝0.009), and the 3rd day(p＝0.006) after delivery but not for later times. The findings supported the hypothesis Ⅱ that there would be differences in maternal-infant interaction for mothers having vaginal and cesarean section deliveries. However these differences deccreased section deliveries. However these differences decreased over time . by eight weeks the scores for vaginal delivery mothers averaged 8.1 and for cesarean section mothers, 7.9. 3. The more highly positive the pereption of the delivery experience, the higher the maternal-infant interaction score for all subjects(F＝.3206, p＝.006). The findings supported the hypothesis Ⅲ that there would be correlations between perceptions of delivery and maternal-infant interaction. The maternal infant interaction was highest when the perception of the bady and deliery was positive(r＝.4363, p＝.000, r＝.2881, p＝.012). No correlations between perceptions of labor and maternal-infant interaction were found(p＝0.062). 4. The daily maternal-infant interaction score for the initial contact after birth to 8 weeks postpartum had the lowest average score 5.20 and the highest 7.98(in a range of 0-10). This subjects group of mothers needed nursing intervention to promote their maternal- infant interaction. The daily scores for the maternal-infant over the period of eight weeks. However, there were significantly different increases in maternal-infant interaction only from the first to second day(p＝0.000) and from the fourth to sixth weeks after birth(P＝0.000). 5. When the eight items of maternal-infant interaction were evaluated separately, “Expresses feelings about her role as mother” had the highest average score, 1.64(ina range of 0-3)and “Speaks to baby” the lowest, 0.9. All items, with the possible exception of “Expresses feelings about her role as mother”, suggested the subjects' need of nursing intervention to promote maternal-infant interaction. 6. There were positive correlations between certain general charateristis, namely, both a higher economic status(p＝0.002) and breast feeding(p＝0.202) and maternal - infant interaction. There were positive correlations between a mother's confidence in her role as a mother and the perception of the birth experience(p＝0.004). For mothers who had a cesarean section, a positive perception of the birth experience was related to the duration of her marriage(p＝0.010), a wanted pregnancy (P＝0.030) and her confidence in her role as a mother(p＝0.000). Pereptions of birth for mothers who had a normal vaginal delivery were positive than those for mothers who had a cesarean section. The level of maternalinfant interaction for mothers delivered vaginally was higher than for cesarean section mothers. The relationship between perception of birth and materanalinfant interaction was confirmed. Cesarean section has an impact on the mother's perceived experience of birth which, in turn, is positively related to maternal-infant in turn, is positively related to maternal-infant interaction. Nursing intervention to enhance maternal-infant interaction should begin in prenatal classes with an exploration of the potential impact of cesarean section on the perceptions of the birth experience and continue throughout the perinatal and post-natal periods to promote the mother's ability to control with this crisis experience and to mobilize social support. Nursing should help transform a relatively negatively perceived experience into an accepted, positively perceived and self affirming experience which enhances the maternal-infant relationship.

• Journal of Preventive Medicine and Public Health
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• 제5권1호
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• pp.57-95
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• 1972

This study was conducted to assess the effectiveness of service by maternity aids concerning maternal and child health in improving simultaneously infant mortality, contraception and vital registration among expectant mothers in rural Korea, where there is less apportunity for maternal and child health care. It is unrealistic to expect to solve this problem in rural Korea through professional persons considering the situation of medical facilities and the socioeconomic condition of residents. So, we intended to adopt a system of services by maternity aids who were educated formally among indigenous women. After the women were trained in maternal and child health, contraception, and registration for a short period, they were assigned as a maternity aids to each village to help with various activities concerning maternal and child health, for example, registration of pregnant women, home visiting to check for complications, supplying of delivery kits, attendance at delivery, persuasion of contraception, and invitation for registration and so on. Mean-while, four researchers called on the maternity aids to collect materials concerning vital events, maternal child health, contraception and registration, and to give further instruction and supervision as the program proceeded. A. Changes of women's attitude by services of maternity aid. Now, we examined to what extent' such a service system to expectant mothers affected a change in attitude of women residing in the study area as compared to women of the control area. 1) In the birth and death places, there were no changes between last and present infants, in study or control area. 2) In regard to attendants at delivery, there were no changes except for a small percentage of attendance (8%) by maternity aid in study area. But, I expect that more maternity sids could be used as attendants at delivery if they would be trained further and if there was more explanation to the residents about such a service. 3) Considering the rate of utilization of sterilized delivery kit, I am sure that more than 90 percent would be used if the delivery kit were supplied in the proper time. There were significant differences in rates between the study and the control areas. 4) Taking into consideration the utilization rate of the clinic for prenatal care and well baby care, if suck facilities were installed, it would probably be well utilized. 5) In the contraception, the rate of approval was as high as 89 percent in study area as compared to 82 percent in the control area. 6) Considering the rate of pre-and post-partum acceptance on contraception were as much as 70 percent or more, if motivation to use contraception was given to them adequately, the government could reach the goals for family planning as planned. 7) In the vital registration, the rate of birth registration in the study area was some what improved compared to that of the control area, while the rate of death registration was not changed at all. Taking into account the fact that the rate of confirmation of vital events by maternity aids was remarkably high, if the registration system changed to a 'notification' system instead of formal registration ststem, it would be improved significantly compared to present system. B. Effect of the project Thus, with changes in the residents' attitude, was there a reduction in the infant death rate? 1) It is very difficult problem to compare the mortality of infants between last and present infants, because many women don't want to answer accurately about their dead children especially the infants that died within a few days after birth. In this study the data of present death comes from the maternity aides who followed up every pregnancy they had recorded to see what had happened. They seem to have very reliable information on what happened in first few weeks with follow up visitits to check out later changes. From these calculaton, when we compared the rate of infant death between last and present infant, there was remarkable reduction of death rate for present infant compare to that of last children, namely, the former was 30, while the latter 42. The figure is the lowest rate that I have ever heard. As the quality of data we could assess by comparing the causes of death. In the current death rate by communicable disease was much lower compare to the last child especially, tetanus cases and pneumonia. 2) Next, how many respondents used contraception after birth because of frequent contact with the maternity aid. In the registered cases, the respondents showed a tendency to practice contraception at an earlier age and with a small number of children. In a comparison of the rate of contraception between the study and the control area, the rate in the former was significantly higher than that of the latter. What is more, the proportion favoring smaller numbers of children and younger women rose in the study area as compared to the control area. 3) Regarding vital registration, though the rate of registration was gradually improved by efforts of maternity aid, it would be better to change the registration system. 4) In the crude birth rate, the rate in the study area was 22.2 while in the control area was 26.5. Natural increase rate showed 15.4 in the study area, while control area was 19.1. 5) In assessment of the efficiency of the maternity aids judging by the cost-effect viewpoint, the workers in the Medium area seemed to be more efficiency than those of other areas.