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2013 11 26 . : 2014 7 2, : 2014 8 14 : 2014 8 25 : , 134-701 455 :
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Copyright By The Korean Society of Perinatology
25 3, 2014 Korean J Perinatol Vol.25, No.3, Sep., 2014
http://dx.doi.org/10.14734/kjp.2014.25.3.140
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OECD
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Integrated Care Center for High Risk Pregnancy and Neonate - An
Analysis of Process and Problems in Obstetrics
Ho-Yeon Kim, M.D., and Chong Soo Moon, M.D.
Department of Obstetrics and Gynecology, College of Medicine,
Hallym University, Seoul, Korea
The medical environment of obstetric field has been deteriorated
seriously, which is caused by sharply declined birth rates and
several other causes in Korea. Inversely, the prevalence of high
risk pregnancy is continuously going to explode, and human
resources and facilities in delivery unit are still in shortage. It
is greatly needed to be reinforced, but rather diminished
substantively. Finally, maternal death rate of Korea has been
extremely increased. It is time that the policies for treatment of
high risk maternity in national level, no more leave the situation
unchanged. The integrated care system which treats high risk
maternity and neonate sequentially is very important in their
disease characteristics. It is sure that the integrated management
of high risk pregnancy and neonate can make an important role in
the improvement of perinatal and maternal death rate and maternal-
neonatal health care. Therefore, Ministry of Health and Welfare
made a policy that establishes ‘Integrated Care Center for High
Risk Pregnancy and Neonate’ for high risk maternity and neonate. It
is supposed to start from four centers as a demonstration project
in 2014, and will finally establish 17 centers in 11 broad
territories of the country in 2017. It will accomplish a task of
emergency center, and carry out treatment and emergency operation
at all times. In addition, it will take the roll of emergency
transfer system, data collection and analysis, and preventive
management service through public education and relations. In the
future, Integrated Care Center will play an important role in
improving maternal health care as well as obstetric
infrastructure.
Key Words : Maternal death rate, High risk pregnancy, Integrated
Care Center for High Risk Pregnancy and Neonate
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2013
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Table 1. OECD major countries birth rate in 20102
Countries France Sweden UK Denmark Finland Netherlands Korea OECD
average
Birth rate 1.99 1.98 1.98 1.88 1.87 1.80 1.22 1.74
Fig. 1. The number of live birth and birth rate in Korea.1
Ho-Yeon Kim Chong Soo Moon : - Integrated Care Center for High Risk
Pregnancy and Neonate -
- 142 -
, , ,
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2012
(1.30) ,3-7 OECD
(Table 1, Fig. 1).2, 7 2000 63
1.46, 12
23% 2012 48
1.30 (Table 2).7
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(Maternal Fetal Intensive Care Unit; MFICU)
2012
‘ ’
(Table 3).8
31.63 , 35 2000
Table 2. The number of live birth and birth rate in Korea7
Year 2000 2005 2010 2012 Live births 635,000 435,000 470,000
484,000 Total birth rate 1.46 1.07 1.22 1.30
Table 3. The definition and classification of high risk
pregnancy5
Obstetrics risk factors Medical risk factors Physical risk factors
Current pregnancy risk factors Grade I (mild)
≤1 pack/ Hb ≤9 g/dL
Grade II (moderate)
NYHA class I
(35-39, ≤15) (BMI >30 kg/m2) (>3)
/ Hb ≤9 g/dL (≥42wks)
Grade III (severe)
NYHA class II
(≥40)
(<34) (<34)
: - - : -
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2.3 (Fig. 2).10
( 35 )
.
25 30 7%
35 40 24%, 40 39%
(Fig. 3).9, 10
2000 2.1% 2008 5.5%,
2000 3.8% 2010 5.0%, 1.7%
2.7% 10 2 .7
, 2011 42.8%
(Table 4).8, 9
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1)
, 2012
( )
(Table 5).11
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2)
(%)
Fig. 2. Advanced maternal age in Korea.7
Fig. 3. High risk pregnancy rate according to maternal age in
Korea.9
Table 4. High risk pregnancy rate in Korea9
() () (%)
2008 451,790 179,465 39.7 2009 431,698 174,243 40.3 2010 457,664
193,593 42.3 2011 459,239 196,740 42.8
Table 5. The charge for medical insurance fee in Korea11
() 266,150
() 216,610
Tonsilectomy () 201,875
Ho-Yeon Kim Chong Soo Moon : - Integrated Care Center for High Risk
Pregnancy and Neonate -
- 144 -
.
2001 1,570
2012 656 60%
(Table 6).11
,
.12,13
. 2008
Table 6. The change of obstetrics institutions in Korea11,16
A. The chronological change of obstetrics institutions opening and
closing 2008 2009 2010 2011 2012
148 203 118 156 93 148 102 148 64 90 1 1
19 14 8 7 13 11 13 14 8 8
41 33 26 24 26 23 34 19 18 17
87 155 84 125 54 114 55 115 38 65
B. The Chronological change of obstetrics institutions which take
delivery 2001 2008 2009 2010 2011 2012
1,570 839 772 732 701 656
1,137 1,376 1,361 1,346 1,365
1,161 561 501 465 435 391
1,108 1,127 1,103 1,073 1,090
A B
C
Fig. 4. The change of obstetricians in Korea.14 A) The
chronological change of new members of the specialist of obstetrics
and gynecology. B) The chronological change of sexual difference of
the specialist of obstetrics and gynecology. C) Comparison of age
distribution between the specialist of obstetrics and gynecology
and internal medicine (%).
: - - : -
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4A).11 2013 119,
87, 82
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. 2004 259
171 , 2012
90 10
(Fig. 4B).14
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(Fig. 4C).4, 12-15
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50% . 1
23% , 10
(9%) (Table 7B).16
17%
(Table 7A).16
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2012 55
(Table 8).13, 16, 17
4% 18,769
,
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7)
Table 7. The change of obstetrics residents in Korea14-16
A. The chronological secure and abandonment rate of obstetrics
residents in training hospital
(%)
(%)
(%)
2003 237 293 236 99.6 30 12.7 206 86.9 2004 223 239 211 94.6 34
16.1 177 79.4 2005 216 202 188 87.0 50 26.6 138 639 2006 217 144
139 64.1 31 22.3 108 49.8 2007 194 120 120 61.9 24 20.0 96 49.5
2008 193 111 106 54.9 16 15.1 90 46.6 2009 191 144 145 75.9 29 20.0
116 60.7 2010 193 131 124 64.2 11 8.9 113 58.5 2011 186 124 122
65.6 14 11.5 108 58.1 2012 170 121 119 70.0 18 15.1 101 59.4
B. The secure rate of obstetrics residents in training hospital in
2010 Secure rate 0 < 25% < 50% < 75% < 100% 100 %
Hospital number 25 24 29 12 7 10 (%) 23 22 27 11 7 9
Ho-Yeon Kim Chong Soo Moon : - Integrated Care Center for High Risk
Pregnancy and Neonate -
- 146 -
, , ,
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, 2008 8.4 2009 14.0
, 2012 17.2 4 OECD
(Fig. 5).1, 2, 18
1.6 6
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35
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(Fig. 5).1, 18, 20
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Fig. 5. Change of maternal death ratio and number of new
Obstetrician in Korea.1,11,14,18
412
271
31 34
14
34.6
27.6
A
B Fig. 6. Comparison of maternal death ratio and number of
Obstetrician in tertiary hospital in 2002 Korea.1, 7, 20 A) Local
difference of maternal death rate. B) Local difference of
Obstetrician number in tertiary hospital.
Table 8. A local governments lacking childbirth hospital in Korea
201217
(2012 12 )
(2) ,
(6) , , , , ,
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(4) , , ,
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55 ) 32, 23
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(Fig. 7).
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(Fig. 6).1, 5-7,
18, 20
2/10, 1/5
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27.6 14 .
3, 8,
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53% 49% .21
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3.66
2.51 .
5.5%
5 15% (231) ,
1% (5,000)
.11, 21
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. Fig. 7. Structural components of Integrated Care Center of High
Risk Pregnancy and Neonate.3, 4, 6
Ho-Yeon Kim Chong Soo Moon : - Integrated Care Center for High Risk
Pregnancy and Neonate -
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Table 9. Required Manpower and Essential Facility in Integrated
Care Center6
A. Required manpower in Integrated Care Center
^ 7 ( 4 ) 2 25
4 ( 2 ) 1, : = 1 : 0.8
4( , , ) 2 2( 1, 1, )
B. Essential facility in Integrated Care Center
^ 1
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Ho-Yeon Kim Chong Soo Moon : - Integrated Care Center for High Risk
Pregnancy and Neonate -
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