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都市可妊期女性의 死亡實態에 關한 調査(I)

Studies on Female Deaths in the Reproductive Ages in Seoul (Ⅰ)

대한산부인과학회지 1969년 12권 2호 p.3 ~ 8
홍성봉 (  ) - Woo-Sok University Medical College Department of Obstetrics & Gynecology

Abstract


Although vital statistics are essential as references for the management of national health programs, there is not much reliable data on vital statistics in Korea.
The author previously published studies on induced abortion in rural and urban Korea. With the continuously rising trend in practice of induced abortion it is forseeable that postabortion morbidity and mortality will rise.
In order to estimate mortality due to abortion the research should encompass as full a range as possible of estimates of mortality in the Korean female population. For this purpose` two. alternative approaches were utilized.
First, a study was made of death certificates submitted to 306 Dong offices in Seoul. The death certificate is required in order to obtain a burial or cremation permit from the authorities.
Second, the other approach included a review of medical records in hospitals in Seoul. The first approach has previously been utilized by others for the study of mortality, but their results have revealed incomprehensive or incomplete data on the mortality of women in reproductive ages. By the second approach some authors have already reported on maternal deaths based on review of . medical records from single medical institutions. Although these reports reveal some invaluable information on maternal death, they unavoidably- present limited information.
In the present paper, the author has attempted to evaluate the deaths of women of reproductive age using the full range of information on deaths in 11 medical institutions.
This approach has some advantages from the viewpoint of accuracy and reliability of medical records. On the other hand, it includes some disadvantages since information may be limited and because the selection process contains sample biases, The most certain advantage is that there is valuable information available in hospital records not revealed in death certificates.
For this purpose, eleven out of 22 hospitals in Seoul were selected which are all off icially approved postgraduate training hospitals (See Table I). With the cooperation and permission of the hospitals involved, all medical records of all female in-patients aged 15- 50 who died within these medical institution during the one year period from January l to December 31, 1967 were reviewed. The total number of eligible medical records was 510. In addition, 136 cases of death on arrival were reported which were excluded from the study due to lack of medical data and an unsatisfactory autopsy rate.
In reviewing the, 510 cases of death, the following results were obtained:
1) The leading causes of death in reproiuctive ages appear in Table 2 and 3 in accordance with the International Classification of Diseases. Leading causes are suicide (205,99/0, maternal death (1.3.3%), CVA (10.4%), cancer (9.4%), heart disease (7.4%) and tuberculosis (7.1%) in order of frequency,
2) As shown in Table 4, 68% of CVA occurs in the 40´s, 70% of cancer after 30´s, In 20´s, on the other hand, suicide and accidental death constitute 64% and 43% of each cause of death respectively, 81% of maternal death occurs in 20´s and 30´s.
3) Maternal deaths comprised 13.3% of deaths making it the second most frequent cause.
As shown in Table 5, 11 died of puerperal infection, 12 died from toxemia of pregnancy, 13 were hemorrhagic deaths, and 22 cases were due to the complications of induced abortion. 4) Maternal Mortality Rate.
The total number of deliveries in the eleven hospitals was 10, 464 in 1967. Accordingly, a maternal mortality rate is calculated at 65.0 per 10,000 deliveries. The denominator, however, is not adequate since the proportion of deliveries attended by physicians has been reported to represent only 38.7% of all deliveries in Seoul. The majority of childbirths take place at home without medical attendants. On the other hand, a majority of women at high risk of pregnancy difficulties might have been brought into the principal hospitals under study. Assuming that practically all women with potential for complications were brought into these hospitals, and using an estimate of all births in Seoul as a denoiminator, it is postulated that the lowest estimate of maternal mortality rate would be iii the proximity of 9.1 per 10,000 deliveries. The death rate of abortion is estimated in the same fashion 3.,7 per 10,000´. abortions, assuming the total number of ind: ced-abortion in Seoul in 19.37 was 60,000 (utilizing the-figure from the author´s pervious publication on induced abortion).

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