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2013 11 26 . : 2014 7 2, : 2014 8 14 : 2014 8 25 : , 134-701 455 : 02)2224-2259, : 02)2224-2265 E-mail : obgyn25@hallym.or.kr
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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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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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
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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)
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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 -
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2001 1,570
2012 656 60%
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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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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 -
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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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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
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Table 9. Required Manpower and Essential Facility in Integrated Care Center6
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