Treatment of open tibial shaft fracture is difficult, especially when there are severe soft tissue damage. Various complications are noted. The aims of treatment for the open fractures are to promote primary wound healing and union of the fractured bone. We have employed external skeletal fixation devices those are Hoffmann apparatus and pin & resin external fixator for the treatment of 34 cases of open tibial shaft fractures from March, 1981 to May, 1984. Each fixation method was divided into two type, one-plane bilateral frame (180' frame) and two-plane bilateral frame(120') Following results were obtained. 1. Open tibial shaft fracture was most commonly occured in age of high activity of male. 2. External fixation was very useful as a primary treatment method in open tibial shaft fracture. 3. The most common complication was pin tract infection. 4. Mean duration of fixation was 12.6 weeks. After removal of extemal fixation, 8 cases of delayed or nonunion were noted. In addition to bone graft, secondary open reduction and internal fixation with plate and screws (7 cases), only bone graft (1 case) were carried out. Good results were obtained. 5. There was no significant difference in bone union time between 180' frame and 120' frame. The complications were more frequently occured in 120' frame than in 180' frame.
External Fixators ; Fracture Fixation ; Fractures, Open ; Humans ; Male ; Methods ; Tibia ; Transplants ; Wound Healing

High-risk pregnancy is the probability of adverse pregnancy out come is increased over the generalpregnant population. Some high-risk pregnancy is the result of a medical condition present beforepregnancy. In other cases, a medical condition that develops during pregnancy causes a pregnancy tobecome high risk. The reason why high-risk pregnancy is importa nt is detecting the risk factors forhigh risk pregnancy early and preventing the complicated pregnancy. Korean society of Obstetrics andGynecology (KSOG) announced the classification of high-risk pre gnancy including 95 risk factors:obstetrics risk factors, medical risk factors, physical risk factors and risk factors of current pregnancy.However, this announcement of high-risk pregnancy by KSOG was limited for maternal-fetal healthcareproviders to apply their working and making policy. First this didn't include the conception of thecomplicated pregnancy and high-risk delivery. Second this did not separate the risk factors depend onbefore and during pregnancy. This review briefly evaluates the classification of high-risk pregnancy byKSOG and suggest the new classification including the complicated pregnancy and high-risk delivery formaternal-fetal healthcare providers.

The Mother and Child Act is the most important law set up to maintain and improve maternal-child healthcare. This act was established in 1973 and was revised to improve maternal-child healthcare. This act includes the establishment and management of a maternal-child healthcare center in the district, a maternal-child regional healthcare center in the province, and a national maternal-child medical center. In the baby boom era, maternal-child healthcare centers provided maternity care and delivery services as well as emergency obstetrical management, but those centers stopped providing maternity care in the low birth-rate era. The last revised act included the establishment of a national maternal-child medical center to care for the increase in the number of high-risk pregnancies. This review briefly evaluates the goals and roles of a maternal-child healthcare center and a national maternal-child medical center according to the Mother and Child Act, and integrates high risk pregnancies with a neonatal care center to renovate the maternity healthcare system.
Child ; Delivery of Health Care ; Emergencies ; Humans ; Jurisprudence ; Mothers ; Population Growth ; Pregnancy ; Pregnancy, High-Risk

No abstract available.

The Korean healthcare delivery system has been operating for over 30 years since 1989. Despite a positive performance—providing quality medical services to the people by distributing medical resources—there are limitations to the maternity healthcare delivery system. If the maternity healthcare delivery system was operating successfully, there should have been sufficient delivery hospitals so that pregnant women can access the appropriate maternity medical services whenever needed. Unfortunately, according to the National Health Insurance Service, the number of maternity health facilities in Korea reduced from 1,371 in 2003 to 541 in 2019. Regrettably, a larger number of obstetric hospitals and clinics have closed in medically vulnerable areas, such as farming and fishing areas, than urban areas with sufficient medical infrastructure, creating obstetrically underserved areas. In 2020, 65 out of a total of 250 cities, counties, and districts had no obstetric hospitals or clinics. To improve the collapsing maternity healthcare delivery system, a different approach is required; one in which policy support to stop the closure of delivery hospitals is emphasized. New maternity-related medical insurance payments, such as delivery labor management fees, fetal heart monitoring reading fees, and newborn care in delivery rooms fees, and active support policies are needed to prevent the closure of delivery hospitals. In this era of low fertility, because the maternity healthcare system is essential to maintain the nation, a healthcare delivery system different from the existing one must be established.

Background: We analyzed whether a maternity waiting home (MWH) for pregnant women in an obstetrically underserved area of Gangwon-do in Korea, which has been in operation since August 2018, has improved the accessibility of a maternity hospital and pregnancy outcomes. Methods: We compared and analyzed the accessibility of maternity hospitals for 170 pregnant women who applied for the MWH from August 2018 to May 2022. Among the 170 participants, 64 were MWH users and 106 non-users. The effect on pregnancy outcomes between MWH users and non-users was analyzed in the 160 people who achieved a pregnancy outcome. Results: Although the average distance and travel time from the pregnant women’s residence in the obstetrically underserved area to a maternity hospital were 56.4 ± 1.6 km and 63.4 ± 1.4 minutes, respectively, the average distance between the MWH and the MWH users’ maternity hospital was 2.7 ± 0.2 km, and the travel time was 10.7 ± 0.6 minutes. The distance was 55.6 km closer on average and the travel time 54.1 minutes shorter. MWH users gave birth at a significantly later gestation age (38.9 ± 0.2 vs. 38.3 ± 0.15 weeks, P = 0.024) and to infants with heavier birth weights (3,300 ± 60 vs. 3,100 ± 50 gm, P= 0.024) compared with non-users. The rate of Cesarean section was significantly higher in the MWH users (47.5% vs. 44.6%, P = 0.047). The MWH users tended to be associated with a lower rate of neonatal intensive care unit admission (5.1% vs. 11.0%, P = 0.204), lower birth weight (< 2.5 kg) (1.7% vs. 8.0%, P = 0.155), and lower fetal death rate in the uterus (0% vs. 1.0%, P = 1.0) compared with non-users, but the differences were not significant. Conclusion The MWH helped pregnant women in obstetrically underserved areas by improving accessibility to a maternity hospital and lengthening gestation. As a result, neonatal birth weight was heavier for MWH users than non-users. MWHs in Korea can provide an alternative way to improve accessibility to maternity healthcare for pregnant women in obstetrically underserved areas, where it is difficult to establish maternity hospitals, and thereby will improve their pregnancy outcomes.

In an era of low fertility, the maternity infrastructure system has collapsed steeply and the number of obstetrically underserved areas has increased. To improve the maternity infrastructure, the Yoon Suk Yeol administration has announced the introduction of an essential medical support policy centered on introducing an additional delivery medical fee. The core of the essential medical policy for labor and delivery is the addition of regional medical fees, safety policy additional fees, and infectious disease-controll policy additional fees to the existing labor and delivery medical fees. The government's delivery medical additional fees will vary according region, with 200% increase in metropolitan cities, 300% increase in nonmetropolitan cities, and an additional 100% increase in the event of an infectious disease outbreak. After analyzing the government's plan to support additional fees, it is estimated that the total delivery expenses will be increased by Korean won (KRW) 236,619,748,266, and KRW 485,872,173 per maternity hospital. Even though this support plan is expected to help maintain maternity hospitals, this plan has limitations in small maternity hospitals in metropolitan cities and maternity hospitals for high-risk pregnant women. This is because the government's support policy is based on the "medical payment system by action," which is less effective in rural maternity hospitals with fewer deliveries and in training hospitals that mainly treat high-risk pregnant women rather than simple deliveries. Additionally, given the expected decline in the number of births in the future, it is estimated that the total delivery medical fees will steadily decline, as will the income per maternity hospital. To maintain a sustainable maternity infrastructure, it is essential to introduce the medical fees for operating a maternity delivery room that can be maintained, the medical fees for high-risk pregnancies, and various salary and protection support policies for obstetricians and nurses in addition to delivery medical fees.

Up to 5% of pregnant females experience chronic hypertension, which is linked to poor pregnancy outcomes, and along with hemorrhage, is considered one of the main causes of maternal morbidity and mortality. The combined occurrence of preeclampsia, cesarean sections, preterm birth, birth weight less than 2,500 g, neonatal unit admission, and perinatal death was higher in females with chronic hypertension. Pregnancy with systolic blood pressure of 140-159 mmHg or diastolic blood pressure of 90-109 mmHg was considered to have mild-to-moderate chronic hypertension. Blood pressure management during pregnancy is a very important issue and is directly related to fetal growth and maternal health. Many studies have reported that antihypertensive therapy during pregnancy halves the incidence of severe hypertension in all types of hypertensive diseases. However, guidelines for optimal blood pressure management goals during pregnancy remain unclear. This is because the benefits to the mother from lowering blood pressure are uncertain, and there is a risk of fetal disorders due to the possibility of reduced uteroplacental blood flow. In light of a recently released CHAP (Chronic Hypertension and Pregnancy) randomized controlled trial, the purpose of this review was to provide a summary of the current recommendations for pregnant females with mild-to-moderate chronic hypertension.

Preeclampsia (PE) is a multisystem disorder that is an important cause of maternal and perinatal deaths. Currently, delivery is the only final treatment for PE. This practice is usually accompanied by premature birth, which inevitably increases neonatal morbidities. Aspirin is a non-selective non-steroidal anti-inflammatory drug that irreversibly inhibits cyclooxygenase enzymes involved in converting arachidonic acid to prostaglandins and thromboxane. Aspirin inhibits thromboxane A2 production via platelet aggregation, thereby increasing the prostacyclin/thromboxane A2 ratio and reducing platelet aggregation. Since the first case report of aspirin’s potential use during pregnancy was reported in 1978, many studies have attempted to confirm the effect of aspirin on PE, and the results have been controversial. However, this preventive strategy is generally accepted in clinical practice. As evidence for aspirin’s prevention of PE has been accumulating, a recent study investigated the effectiveness of aspirin at high doses of 150 mg, which is higher than before. However, there is an ongoing debate about how much aspirin should be used during pregnancy and when to start aspirin therapy. Guidelines for the use of prophylactic aspirin during pregnancy vary slightly among countries and groups. In this article, we review and summarize the evidence regarding the use of aspirin for PE prevention.

Pulmonary aspergillosis is classified as a saprophytic, allergic, and invasive disease. Chronic necrotizing pulmonary aspergillosis is categorized as an invasive pulmonary aspergillosis. Most invasive pulmonary aspergillosis have acute and toxic clinical features but chronic necrotizing pulmonary aspergillosis is characterized by a sub-acute infection, most commonly seen in patients with altered local defense system from preexisting pulmonary disease of in mild immunocompromised patients. Pulmonary artery aneurysm due to this infection is termed as a mycotic aneurysm, etiology of which are tuberculosis, syphilis, bacteria and fungus. We report a case chronic necrotizing pulmonary aspergillosis complicating pulmonary aneurysm is a 62 year-old man who was presented with cough, sputum, and fever. Chest radiographs showed a rapid, progressive cavitary lesion and pulmonary artery aneurysm. Angioinvastion of aspergillus was revealed by pathology after operative removal of left upper lobe containing the pulmonary artery aneurysm. He was treated with itraconazole.
Aneurysm* ; Aneurysm, Infected ; Aspergillus ; Bacteria ; Cough ; Fever ; Fungi ; Humans ; Immunocompromised Host ; Invasive Pulmonary Aspergillosis* ; Itraconazole ; Lung Diseases ; Pathology ; Pulmonary Artery* ; Pulmonary Aspergillosis ; Radiography, Thoracic ; Sputum ; Syphilis ; Tuberculosis