Integrated Care Center for High Risk Pregnancy and Neonate - An Analysis of Process and Problems in Obstetrics

Ho-Yeon Kim; Chong Soo Moon

doi:10.14734/kjp.2014.25.3.140

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Kim and Moon: Integrated Care Center for High Risk Pregnancy and Neonate - An Analysis of Process and Problems in Obstetrics

Original Article

Korean J Perinatol 2014;25(3):140-152.

Published online: 21 September 2014

DOI: https://doi.org/10.14734/kjp.2014.25.3.140

Integrated Care Center for High Risk Pregnancy and Neonate - An Analysis of Process and Problems in Obstetrics

Ho-Yeon Kim, M.D., Chong Soo Moon, M.D.

Department of Obstetrics and Gynecology, College of Medicine, Hallym University, Seoul, Korea

Received 2 July 201414 August 2014 Accepted 28 August 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

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Keywords: Maternal death rate, High risk pregnancy, Integrated Care Center for High Risk Pregnancy and Neonate

REFERENCES

1.National Statistics Korea. National health medical survey. Cause of death statistics, maternal death rate. 2012.

2.OECD Family database. 2012.

3.Choi EH. Integrated care center for high risk pregnancy and neonate, direction of policy. Public hearing by Korean Society of Perinatology and Ministry of Health and Welfare. Konkuk University Hospital. 2013.

4.Kim YH. Integrated care center for high risk pregnancy and neonate, establishment. Public hearing by Korean Society of Perinatology and Ministry of Health and Welfare. Konkuk University Hospital. 2013.

5.Ministry of Health and Welfare. Answer for advisory opinion about Integrated care center for high risk pregnancy and neonate. Ministry of Health and Welfare. 2013.

6.Ministry of Health and Welfare. 2014 Support project guidance about Integrated care center for high risk pregnancy and neonate. Ministry of Health and Welfare. 2014.

7.National Statistics Korea. National health medical survey. Census statics survey, total birth rate.2008–2012.

8.Korean Society of Maternal Fetal Medicine. The survey on the actual conditions of delivery room and delivery of high-risk pregnancy, definition and classification of high pregnancy. Korean Society of Maternal Fetal Medicine and Ministry of Health and Welfare. 2012.

9.Health Insurance Review and Assessment Service. National health medical survey. Rate of high risk pregnancy. 2012.

10.National Statistics Korea. Census statics survey, Current state according maternal aging. 2012.

11.Health Insurance Review and Assessment Service. National health medical survey. Medical fee for system. 2012.

12.Oh SY. Assessment of emergency charge and night delivery fee in delivery unit. 2nd maternal and child health promotion subject. Public hearing by Ministry of Health and Welfare. 2013.

13.Moon CS. Installation of internet based high risk maternal and neonatal delivery system. 2nd maternal and child health promotion subject. Public hearing by Ministry of Health and Welfare. 2013.

14.Korean Society of Obstetrics and Gynecology. National health medical survey. Current state of the residentship and specialist of Obstetrics and Gynecology. 2013.

15.Korean Medical Association. National health medical survey. Current state of medical specialists according medical department. 2013.

16.Korean Hospital Association. National health medical survey. Current state of residentship supply and demand on medical departments. 2013.

17.Ministry of Health and Welfare. National health medical survey. Current state of medical vulnerable area. 2012.

18.Lee YJ., Kim SH., Seol HJ., Chung SH., Choi YS., Lee KS, et al. Changes in statics of maternal death in Korea (1995-2010). Korean J Perinatol. 2012. 23:179–87.

19.Sullivan SA., Hill EG., Newman RB., Menard MK. Maternal-fetal medicine specialist density is inversely associated with maternal mortality ratio. Am J Obstet Gynecol. 2005. 193:1083–8.

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21.Korean Society of Maternal Fetal Medicine. The survey on the actual conditions of delivery room and delivery of high-risk pregnancy, Medical current status –medical delivery system and medical vulnerable area. Korean Society of Maternal Fetal Medicine and Ministry of Health and Welfare. 2012.

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Fig. 1.

The number of live birth and birth rate in Korea.¹

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Fig. 2.

Advanced maternal age in Korea.⁷

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Fig. 3.

High risk pregnancy rate according to maternal age in Korea.⁹

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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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Fig. 5.

Change of maternal death ratio and number of new Obstetrician in Korea.^1,11,14,18

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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.

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Fig. 7.

Structural components of Integrated Care Center of High Risk Pregnancy and Neonate.^3, ^4, ⁶

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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

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	㟼㡰叼㙣㢨匄厐䟛	䴇丘䌯㢨吀㞏䟛		䏬匄㨔 ο ο 口
(mild)	⼤㪼凐⧫㢨匄厐䟛			⢟㨐 ≤1 pack/㢄
				Hb ≤9 g/dL 䆸⧸
				㟫㴠匠ᅡ㟿䓈㟤
Grade II	䏨䌋䯤㣠㽐	叼㘸	㽐䕘佨㢌 (35-39, ≤15㻈)	㪃䓄/㪴ガ㧔佘㥗
(moderate)	㡰叼㙣㢨匄厐䟛	NYHA class ᅵ 㴔䊀㟼	匠匄㍌㛯 (BMᅵ <30 kg/m²)	㴠㥐㴠㨄
	㢌㟼㟤㦫㟸古㷠	⧸㍓⪧厀㽔㼿㻏䘜古㘸⦨	⧯匘䏨	Hb ≤9 g/dL 䆸⧸
	㢌㟼㡰剿㟸古㷨㷠	ⰰ㘸⦨	䴜䉼䘴䊀 (>3)	䏬㢌䠔㵜㘸⦨ 台㨄
		可㼿㻠㘸⦨		䘴凐 ⤼ 㡼㴠 (≥42wks)
		㡰吀䖌㨓㘸⦨		䆼㟫㼿⼤㣼
				㩯㷨匄䴜㙣
				㩯㷨匄㹴㙣
				㣋䕘㩯䘷㨄
				⼤㪼凐⧫
Grade III	㢌㟼㽔㽐凐㦫䟛	䘴㻏匠⧸㪫	㡰剿千匀䓌䟛㙣	㞐凐䉼䘴㘼⹋ (<34㜄)
(severe)	㢌㟼㴠㼣㪼㽔䘣凐㦫䟛	NYHA class ᅵ 㴔䊀㟼	㡰剿凐⧫	㞐凐㩯䘷⳴㷨 (<34㜄)
	㥗⧸㻏㘸⦨ ⼤㪼㷨⧸	䴇丘䌯	㽐䕘佨㢌 (≥40㻈)	㡰剿佌㻏㡛㟤⪤
		㛯䬏䰼䏱㛯㙣㴠㘸⦨		厐厐䴀㪼
				㡼㴠㻏匠⧸㪫
				䴜⼤㡼㴠
				⼤䏨㞐凐䏫䙔
				㟼ㆨ⼤䏨
				㡰剿⳴㨌
				㽐⤼㉤⧸
				㼷㟼㙣

Table 4.

High risk pregnancy rate in Korea⁹

	㟼㍌㽐䕘 (䕻)	匠㣼⨨㽐䕘 (䕻)	䆼㣘 (%)
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

㴤㷠䕻㆓	匠㴤㷨吀
㟤㦫㟸古䘴㉤㷠 (1⼤㪼㡼㴠, ㋸㽐) - ㋸⥴	280,080
㟤㦫㟸古䘴㉤㷠 (1⼤㪼㡼㴠ô千㽐) - ㋸⥴	238,920
㟤㦫㟸古䘴㉤㷠 (䴜⼤㪼㡼㴠ô㋸㽐) - ㋸⥴	315,960
䉼䘴 (㋸㽐)	266,150
䉼䘴 (千㽐)	216,610
12㜄䐈䘴匼䚨㣠㽐	63,680
㉗㷨㟸㟤㷠 (䴘㷤ô㦈匄㟼䓈㢨)	311,737
䴌体㟸㟤㷠 (㦈匄㟼䓈㣄ᅵ)	583,622
ㆨ⪋刄ㆨ㷠 (㦈匄㟼䓈㢨)	308,789
㻤⧤䊀 ⨸䴸㪼刄䌈㷨㷠 (凐⽀, 㦈匄㟼䓈㣄ᅵ)	405,310
Tonsilectomy (㩯㇟)	201,875

Table 6.

The change of obstetrics institutions in Korea^11,16

A. The chronological change of obstetrics institutions opening and closing

	2008		2009		2010		2011		2㢌2
	古㨻	ⰰ㨻	古㨻	ⰰ㨻	古㨻	ⰰ㨻	古㨻	ⰰ㨻	古㨻	ⰰ㨻
㋣⪗匼	148	203	118	156	93	148	102	148	64	90
㼿凷㝻⪗䌯㤰	1	1
㝻⪗䌯㤰	19	14	8	7	13	11	13	14	8	8
䌯㤰	41	33	26	24	26	23	34	19	18	17
㢨㤰	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
㟼㍌	䉼䘴䏤㼣凐匀	1,570	839	772	732	701	656
	䉼䘴䐈䏤㼣凐匀		1,137	1,376	1,361	1,346	1,365
㢨㤰	䉼䘴䏤㼣凐匀	1,161	561	501	465	435	391
	䉼䘴䐈䏤㼣凐匀		1,108	1,127	1,103	1,073	1,090

Table 7.

The change of obstetrics residents in Korea^14-16

A. The chronological secure and abandonment rate of obstetrics residents in training hospital

㨐䰼	㟫㤰	㙀㤰	⪗南	⦫䌌㣘 (%)	㷨䟘㛯䰼 Ⱄ凐㡰	㷨䟘㛯䰼 Ⱄ凐㣘 (%)	㴜刄䓌㢈㤰	㴜刄䓌㣘 (%)
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

Table 8.

A local governments lacking childbirth hospital in Korea 2012¹⁷

劔䉼	㴤劐劔 (2012亼 12㤬䘰)
䊀㽐 ⑵	叫㻤劔, 凐㡛劐
千凐 (3)	匄㍤㴤, 㢨㦫㴤, 㨐㍤劐
叫㤰 (6)	匠㻏劐, 㩯劔劐, 㩯㩯劐, 㢈㟤劐, ⰷ㏃劐, ⦬㍤劐
㉗䉿 (6)	勌㽐劐, 䴘㩯劐, 䌌㣀劐, 㧛㍤劐, 㢴㻏劐, 㙣ⰷ劐
㉗佘 (4)	匼䜟㴤, 䊀㨔劐, ㍓㩯劐, ⼤㪸劐
㟼䉿 (凐	匠㏃劐, 䓌㜄劐, 㷤㏃劐, 㦼㜄劐, 㡼㴜劐, 㡛㷨劐, 㘼㪸劐
㟼佘 (8)	匠㻤劔劔䟀劔䴜㪄劔䌌㻤劔㴤㪼劔㨔㪄劔㡰㻤
	劔 ⪘ⰷ劔
千䉿 (10)	匠䟇劐, 劐㣼劐, 䋷⦬劐, 㻏㜄劐, 㧿䲫劐, 㧿㩯劐, 㥈䙷
	劔㢌㻤劔㍓䰼劐㍓㹟劐
千佘 (10)	匠㻏劐, 佘⪌劐, 㽐㍓劐, 㢨䟇劐, ㏃享劐, ⪨䰧劐, ⪘㪸
	劐, ⪘㩯劐, ⪗㍤劐
㋣匼	55

㜄) 㽐䊀㢈匄䌯㢨㤰㢌㨺䵬㙀㨓 32匍, 㽐䊀㢈匄吀㡸㣄佨䉼䘴㴜㢌㨺䵬㙀㨓 23匍

Table 9.

Required Manpower and Essential Facility in Integrated Care Center⁶

A. Required manpower in Integrated Care Center

㻄⻐	⪼㷨㢈䟛
㽐䕘·⼤㪼ㆨ䜴㻄⻐	㽐䊀㢈匄㢨㽔 7䕻㢌㼿(㽐匄㟼䴌㟼䓈㢨 4䕻㢌㼿 Ⱄ⪘)
	䘸㈘⹋㙣㢨⪧匄㟼䓈㢨 2䕻
	叼⧈㽔 25䕻㢌㼿
㴠㼣㪼ㆨ䜴㻄⻐	㴠㼣㪼䴌䴇㢨㽔 4䕻㢌㼿(㴠㼣㪼㻈䊀㟼䓈㢨 2䕻㢌㼿 Ⱄ⪘)
	叼⧈䬏凷 1䬏凷, 叼⧈㽔㷨 : 䌯㼿㷨 = 1 : 0.8
匠㣼⨨㡼㴠㽐䕘㢌㹟㻄⻐	叼⧈㽔 4䕻(㢌㹟㼿䴌, 匠㣼⨨䉼䘴㟫䌌㷨㘯, 匋匋䌌厌㽔㨻)
匠㣼⨨㡼㴠㢨䜴㟫䌌㻄⻐	㪐䈈䠐㵜㥌㟼凐㽔 2䕻
匠㣼⨨㡼㴠㧸䏗匀䙔㻄⻐	⩷㟫㢈䟛 2䕻(㎻㡼㨐劔㤰 1䕻, 㨐劔㤰 1䕻, 匋匋䌌厌㽔㨻)

B. Essential facility in Integrated Care Center
㻄⻐	㴤㻜	凐㜀
㽐䕘·⼤㪼ㆨ䜴㻄⻐	㽐䕘㟼㥗㷨㷠㴜	1古㢌㼿
	匠㣼⨨㡼㴠㽐䕘䉼䘴㴜	2古㢌㼿
	㽐䕘-⼤㪼㘯㛯ㆨ䜴㴜	6䌯㼿㢌㼿
㴠㼣㪼ㆨ䜴㻄⻐	㴠㼣㪼㹴㼣㴜	1古㢌㼿
	㴠㼣㪼㘯㛯ㆨ䜴㴜	20䌯㼿㢌㼿

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