비정형 자궁외임신의 임상적 고찰

박상혜 ( Sang Hae Park ),이승수 ( Seung Soo Lee ),최형민 ( Hyung Min Choi ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.3

목적: 비정형 자궁외임신은 난관 이외의 부위에 착상되는 자궁외임신으로 난관임신에 비하여 드물게 발생하는 것으로 알려져 있다. 본 연구는 최근 6년간의 비정형 자궁외임신 환자의 임상적 고찰을 통하여 자궁외임신 중 비정형 자궁외임신의 임상양상과 치료방법을 조사하여 조기진단 및 치료에 기여하고자 하였다. 방법: 1999년 12월 1일 부터 2006년 12월 31일 까지 인제대학교 의과대학 일산백병원 산부인과에서 자궁외임신으로 진단받았던 325예 중에서 비정형 자궁외임신으로 진단된 61예를 대상으로 임상적 특징과 치료방법을 분석하였다. 결과: 조사 기간 동안 정상임신에 대한 지궁외임신의 발생 빈도는 9.5%이며 전체 자궁외임신에 대한 비정형 자궁외임신의 빈도는 18.8%였다. 난소임신 전 예 (6예)와 자궁각임신 (17예) 중 3예, 복강임신 전 예 (3예), 기타 유형의 비정형자궁외 임신 10예에서 처음 진단당시 정확한 임신낭의 위치를 알 수 없었으며 비정형 자궁외임신 중 6주 이전에 진단된 경우가 자궁경부 임신인 경우 6예, 복강임신의 경우 1예, 기타 유형의 경우가 4예였다. 내원당시 혈청 β-hCG값은 자궁각임신에서 가장 높게 나타났고 복강임신에서 가장 낮게 나타났다. 치료는 수술치료를 한 경우가 46예, MTX 투여가 7예, 보존적 치료를 한 경우가 9예였으며 처음 치료를 실패 한 경우가 1예였다. 결론: 본 연구의 비정형 자궁외임신에서 정확한 자궁외임신 부위의 진단율은 63.9%, 치료성공률은 98.3%였다. 본 연구결과 비정형 자궁외임신에서 진단당시 평균 혈청 β-hCG 값은 그 착상 부위에 따라 유의한 차이를 나타내었다. Objective: The purpose of this study was to evaluate the clinical characteristics and the management of the unusual ectopic pregnancies. Methods: Sixty one patients who were diagnosed as unusual ectopic pregnancies in the Department of Obstetrics and Gynecology, Inje University Ilsan Paik Hospital from December 1999 to June 2006, were retrospectively analyzed. The chief complaints, past histories, time of diagnosis, serum β-hCG concentrations and method of the management were reviewed. Results: During the designated study period, the incidence rate of the ectopic pregnancy was 9.5% of the all deliveries and that of the unusual ectopic pregnancy was 18.8% of the total ectopic pregnancies. In twenty two cases, implantation sites were not found out exactly by sonography at initial diagnosis. Theses ectopic pregnancies were cornual pregnancy (3 cases), ovarian pregnancy (6 cases), abdominal pregnancy (3 cases), and unclassified unusual ectopic pregnancy (10 cases). Unusual ectopic pregnancies which were diagnosed before six weeks of gestation were eleven cases. These unusual ectopic pregnancies were 6 cases in cervical pregnancy, 1 case in abdominal pregnancy, and 4 cases in unclassified unusual ectopic pregnancy. Initial mean serum β-hCG concentration was the highest in cornual pregnancies and the lowest in abdominal pregnancies. MTX (methotrexate) was administered in seven cases, operation was done in forty six cases, and expectant management was done in nine cases. All initial treatment was successful except one case with cornual pregnancy, which was MTX administered with alternative regimen. Conclusions: In our study the diagnostic accuracy of the unusual ectopic pregnancy was 63.9% and the successful treatment was done in 98.3% of them. There were significant statistical differences between the serum β-hCG concentrations and the kinds of unusual ectopic pregnancies (p<0.001).

자궁외 임신과 자궁내 임신시 자궁내막의 병리학적 및 면역조직화학적 소견

김의정,홍순원,김규래,박찬일 대한병리학회 1995 Journal of Pathology and Translational Medicine Vol.29 No.1

자궁외 임신의 임상적 고찰

이기록(K . R . Lee),이재성(J . S . Lee),김만조(M . J . Kim),김진하(J . H . Kim),이명선(M . S . Lee),송인철(I . C . Song) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.11

N/A Objectives : This retrospective study was undertaken to evaluate for the clinical characterristics and to gain greater insight into the diagnosis and management of ectopic pregnancy. Material and Methods : This study was done 112 women with ectopic pregnancy who were admitted, operated, and confirmed by histopathological at the Department of Obstetrics and Gynecology, Pusan medical center from Jan. 1, 1995 to Dec. 31, 1999. Results : 1. The incidence of ectopic pregnancy was 2.9% (1 in 34.1pregnancy). 2. Age distribution of cases was showed the highest frequency between 25-29 years group. 3. According to past history of illness artificial abortion was 66%, laparoscopic tubal ligation was 14.3%, PID was 13.4%, previous c/s was 13.4%, appendectomy was 13.4%, previous ectopic pregnancy was 9.8%, pelvic Tuberculosis was 2.7%, tuboplasty was 2.7%, and IUD was 2.7%. 4. As to chief complaints of cases on admission, lower abdominal pain was 90.2%, vaginal spotting or bleeding was 45.5%. 5. Positive finding of culdocentesis was 80.3%, and that of urine hCG was 93.4%. 6. According ultrasonographic finding, adnexal mass was visible 50.7% among 73 cases. 7. On pelvic examination, pelvic tenderness was 90.2%, cervical motion tenderness was 77.2% among 92 cases. 8. Ectopic pregnancy was implanted on the fallopian tube 97.3%, cervix 1.8%, and ovary was 0.9% retrospectively. 9. Of total 112 cases, ipsilateral salpingectomy was 75.9%, ipsilateral salpingooophrectomy was 10.7%, total abdominal hysterectomy was 0.9%. Conclusions : Ectopic pregnancy is one of the leading causes of maternal mortality in the early pregnancy, subsequently may lead to infertility in reproductive age women. In order to minimize such problems, clinicians are particularly familiar with early diagnosis and appropriate diagnotic procedures on ectopic pregnancy.

무증상 자궁외임신에서 경질초음파의 진단 정확도

이정호 ( Jeong Ho Rhee ),박준철 ( Joon Cheol Park ),김종인 ( Jong In Kim ) 대한주산의학회 2004 Perinatology Vol.15 No.2

목적 : 경질초음파의 자궁외임신 진단 정확도를 평가하고 최종 진단으로서의 임상적 안정성을 확인하기 위함. 연구방법 : 58명의 자궁외 임신 의증 환자 중 급성 증상으로 응급 수술을 시행한 14명을 제외하고 재태기간 37일 이상 또는 융모성성선자극호르몬 혈중치 1,500 mIU/ml 이상에서 경질초음파 진찰상 자궁내 임신낭이 확인되지 않은 44명의 환자를 연구 대상으로 정하였다. 모든 대상 환자에서 복강경과 초음파 소견을 비교하고 수술 표본은 병리조직 검사를 통해 확인하였다. 초음파, 복강경 소견, 병리조직 검사 결과가 일치하는 경우를 바른 진단으로 간주하여 경질초음파의 진단 정확도를 계산하였다. 결과 : 44명의 연구 대상군 중 42예에서 경질초음파상 자궁외임신 부위로 의심할 수 있는 소견이 있었으며 우측 난관, 좌측 난관, 우측 자궁간질부, 좌측 자궁간질부가 각각 20, 15, 3, 4예씩이었고 정상 초음파 소견이 2예이었다. 42예 중 41예에서 복강경 및 병리조직 검사상 자궁외임신이 확인되었는데 1예에서는 자궁외임신 부위가 일치하지 않았고 1예에서는 자궁외임신 부위를 확인할 수 없었다. 정상 초음파 소견을 보였던 2예에서는 복강경 소견도 정상 소견을 보였다. 경질초음파의 자궁외임신 진단에 대한 민감도, 특이도, 양성예측도, 음성예측도는 각각 100%, 50%, 98%, 100%였다. 결론 : 경질초음파는 매우 유용하고 신뢰할 수 있는 진단 수단이며 융모성성선자극호르몬과 경질초음파를 혼용한 진단 결과는 진단 복강경을 대체할 수 있으리라 사료된다. Objective : To assess diagnostic accuracy of the transvaginal ultrasonography and confirm the clinical safety as a final diagnosis in the asymptomatic ectopic pregnancy. Methods : Total 58 women which were suspected with ectopic pregnancy were recruited during 1 year period. Women without sonographic evidence of the intrauterine gestational sac with serum β-hCG level beyond 1,500 mIU/ml or gestational periods beyond 37 days were included (n=44), and women with acute symptom were excluded (n=14). We performed the laparoscopy and compared them with the ultrasonographic findings. We regarded the cases with accordance between two findings as an accurate diagnosis, and calculated diagnostic accuracy. All surgical specimens were confirmed by the pathological examination. Results : Of 44 subjects, we suspected ectopic pregnancy by ultrasonography in 42 patients and classified as right fallopian tube (20 cases), left fallopian tube (15 cases), right interstitial (3 cases), left interstitial (4 cases), normal finding (2 cases). Of 42 cases, 41 cases were confirmed as an ectopic pregnancy by laparoscopical and pathological examination. There were two cases of inaccurate diagnosis, in one case, suspected site was not concordant, in another case, ectopic pregnancy focus was not identified in laparoscopy. In 2 cases with normal ultrasonographic findings, any other findings suspicious of ectopic pregnancy were not identified in laparoscopy. By 2X2 contingency table analysis, sensitivity, specificity, positive predictive value, negative predictive value of the transvaginal ultrasonography for diagnosis of the ectopic pregnancy were 100%, 50%, 98%, 100%, respectively. Conclusion : Diagnostic capability of the transvaginal ultrasonography in the ectopic pregnancy was very powerful and reliable, and sonographical diagnosis may replace the diagnostic laparoscopy if medical treatment is intended.

신선 비공여 체외수정 및 배아이식 후 자궁외임신의 발생과 연관된 위험요소에 관한 연구

유상우 ( Sang Woo Lyu ),원형재 ( Hyung Jae Won ),윤태기 ( Tae Ki Yoon ),이우식 ( Woo Sik Lee ),곽인평 ( In Pyung Kawk ),조정현 ( Jung Hyun Cho ),한지은 ( Ji Eun Han ),김수희 ( Soo Hee Kim ),김유신 ( You Shin Kim ),석현하 ( Hyun Ha 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.6

목적: 이 연구는 신선 비공여 체외수정 및 배아이식 (IVF-ET) 후에 발생하는 자궁외임신의 위험 인자를 알아보기 위하여 시행하였다. 방법: 2002년 1월부터 2005년 12월까지 본원에서 신선 비공여 IVF-ET 후에 임신된 총 2,326주기를 대상으로, 환자들의 특성과 ART 관련 요인들을 의무기록을 통해 후향적으로 조사하였다. 자궁외임신 발생과 관련된 위험요인을 찾기 위해 카이자승 검정과 다변인 로지스틱 회귀 분석을 사용하였다. 결과: 임신된 2,326주기 중에서 자궁외임신은 135예로 5.8%의 발생률을 보였다. 자궁외임신의 대부분은 난관임신 (79예, 58.5%)과 겸한임신 (40예, 29.6%)이었으며, 주로 복강경수술을 통해 치료하였다 (87.4%). 정상적인 자궁강내 임신군과 비교하였을 때 난포의 최종 성숙을 위해 hCG 투여 당일에 측정한 혈청 estradilo의 농도와 채취된 평균 난자수는 자궁외임신군에서 유의하게 높았다 (2,228.9 vs 1,906.9 pg/ml, p=0.022; 13.8 vs 11.6, p=0.001). 단일변인분석에서 자궁외임신에 대한 위험성은 불임의 원인으로 난관 요인을 가지고 있는 여성에서 유의하게 높았으며 (OR 1.7, 95% CI 1.20~2.35), 남성 요인을 가지고 있는 여성(OR 0.7, 95% CI 0.47~0.94)과 ICSI를 시행한 여성 (OR 0.7, 95% CI 0.50~0.98)에서는 감소하였다. 하지만, 다변인 로지스틱 회귀분석에서는 난관 요인만이 자궁외임신에 대한 독립적인 예측인자로서 통계적으로 유의한 차이를 보였다. 결론: 난관 불임요인이 신선 비공여 IVF-ET후에 발생하는 자궁외임신의 주요한 위험요인이다. Objective: To find risk factors for ectopic pregnancy among women who conceived after fresh non-donor in vitro fertilization and embryo transfer (IVF-ET). Methods: A total of 2,326 cycles conceived after fresh non-donor IVF-ET between January 2002 and December 2005 were studied with regard to patient factors, and factors related to the ART procedures through review of their medical chart. Risk factors in ectopic pregnancy were assessed by using chi-square test and multivariate logistic regression analysis. Results: Of 2,326 pregnancies of fresh non-donor IVF-ET cycles, 135 (5.8%) were ectopic pregnancies. Most of ectopic pregnancies were tubal type (79 cases, 58.5%) and combined type (40 cases, 29.6%). Most of ectopic pregnancies (87.4%) were treated by laparoscopic surgery. In comparison with clinical pregnancy group, estradiol level checked on human chorionic gonadotrophin (hCG) injection day for final follicular maturation and mean number of oocytes retrived were higher in ectopic group. respectively, (2,228.9 vs. 1,906.9 pg/ml, p=0.022; 13.8 vs. 11.6, p=0.001). In univariate analysis, the risk for ectopic pregnancy was increased among women with tubal factor infertility (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.20-2.35) and, decreased among women with male factor infertility (OR 0.7, 95% CI 0.47-0.94) and use of intracytoplasmic sperm injection (ICSI) (OR 0.7, 95% CI 0.50-0.98). However, in multivariate logistic regression analysis, only tubal factor was an independent predictor for ectopic pregnancy. Conclusions: Tubal factor infertility is the main risk factor for ectopic pregnancy following fresh non-donor IVF-ET.

난관 불임술에 따른 자궁외 임신 및 자궁내 임신 18예

유혜승(HS Yoo),안영준(YJ Ahn),이상태(ST Lee),장문기(MK Chang),김창이(CY Kim) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.3

저자들은 가톨릭 의대 보속 성 바오로 병원에서 1979년 1월부터 1981년 12월까지 3년간 발생한 난관붙임술기왕력이 있는 환자에서 17예의 자궁외임신과 1예의정상 자궁내 쌍태임신을 경험하였기에 문헌고찰과 함께 보고하는 바이며 최근 인구증가의 대응책으로 권장되고 있는 난관붙임술이 자궁의임신을 일으킬 수 있는원인이 된다는 점을 고려하여 이러한 난관붙임술은 반드시 숙련된 전문가에 의해 시술되어야 하며 또한 어떠한 방법을 사용하더라도 실패의 위험성이 내포되므로 시술 후 최소한 2년간의 관찰이 필요함을 주지해야할 것으로 여겨진다. In a consecutive study of 139 women of ectopic pregnancy confirmed by histologic examination from Jan.1,1979 to Dec. 31, 1981, at the Dept. of Obst. and Gynec., St Paul Hospital, Catholic Medical College,17 women were found to have had pre- ⅵous history of tubal sterilization, and intrauterine twin pregnancy occured in one patient. We had reⅵewed the failure cases of tubal sterilization surgery and the results were as follows: 1. In 14 cases of these failure cases the type of tubal sterilization was laparos- copic eletrical coagulation of the tube, in 3cases, was by Falope ring, and one case by Pomeroy procedure. 2. ln our series 7 out of 18 cases could be considered as the failure resulting from recanalization of the tube. The cause of sterilization failure were in order of frequency, recanalization(7 cases), technical error(6 cases),fistula formation(5 ca- ses). ln one intrauterine twin pregnant woman who were delivered by abdomen, the type of sterilization was laparoscopic one and recanalization of the tube was confirmed histologically. 3. Pregnancy after tubal sterilization occured in half of the patients(50%) within 2 years, with the shortest interval beimg 3 month and the longest 69 months. 4. ln all of the cases, the site of tubal sterilization was isthmic portion of the tube and it is significant that in 13 out of 17 ectopic pregnancy was located in the distal tubal segment. The location of ectoplc pregnancy were in order of frequency, 12 patients in the ampullar, 3 patients in the cornual,1 patient in the isthmic por- tion and another patient in the fimbrial portion of the tube. 5. The marked increase in the incidence of ectopic pregancy occuring after a previous sterilization procedure is of particular significance and the percentage of ectopic pregnancy in our study was 12.2%, This suggests that the increasing impor- tance of previous sterilization as an etiologic factor in ectopic pregnancy.

The Risk Factors and Pregnancy Outcomes of 48 Cases of Heterotopic Pregnancy from a Single Center

전지현,황유임,신임희,박찬우,양광문,김혜옥 대한의학회 2016 Journal of Korean medical science Vol.31 No.7

The purpose of this study was to investigate risk factors that are associated with heterotopic pregnancy (HP) following in vitro fertilization (IVF)-embryo transfer (ET) and to demonstrate the outcomes of HP after the surgical treatment of ectopic pregnancies. Forty-eight patients from a single center, who were diagnosed with HP between 1998 and 2012 were included. All of the patients had received infertility treatments, such as Clomid with timed coitus (n = 1, 2.1%), superovulation with intrauterine insemination (n = 7, 14.6%), fresh non-donor IVF-ET (n = 33, 68.8%), and frozen-thawed cycles (n = 7, 14.6%). Eighty-four additional patients were randomly selected as controls from the IVF registry database. HP was diagnosed at 7.5 ± 1.2 weeks (range 5.4-10.3) gestational age. In six cases (12.5%), the diagnosis was made three weeks after the patients underwent treatment for abortion. There were significant differences in the history of ectopic pregnancy (22.5% vs. 3.6%, P = 0.002). There were no significant differences in either group between the rates of first trimester intrauterine fetal loss (15.0% vs. 13.1%) or live birth (80.0% vs. 84.1%) after the surgical treatment for ectopic pregnancy. The risk factors for HP include a history of ectopic pregnancy (OR 7.191 [1.591-32.513], P = 0.010), abortion (OR 3.948 [1.574- 9.902], P = 0.003), and ovarian hyperstimulation syndrome (OHSS) (OR 10.773 [2.415- 48.060], P = 0.002). In patients undergoing IVF-ET, history of ectopic pregnancy, abortion, and OHSS may be risk factors for HP as compared to the control group of other IVF patients. The surgical treatment of HP does not appear to affect the rates of first trimester fetal loss or live birth.

폐쇄와(obturator fossa)에 착상된 후복막임신

유지연 ( Ji Yeon You ),이예리 ( Ye Ri Lee ),옥순애 ( Soon Ae Oak ),박종훈 ( Jong Hoon Park ),이은희 ( Eun Hee Lee ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.12

Ectopic pregnancy occurs in approximately 1.5 to 2.0% of pregnancies and accounts for 6% of all maternal deaths. Nearly all ectopic pregnancies are implanted in the fallopian tube. However, they may rarely occur within the retroperitoneal area in 1.3% of the ectopic pregnancy. Early diagnosis is difficult because it is not easy to differentiate symptoms of ectopic pregnancy in obturator fossa with in fallopian tube. Treatment is the removal of ectopic tissue through laparotomy or laparoscopy. A 26-year-old woman was diagnosed with left ectopic pregnancy and amenorrhea for 9+0 weeks and visited our hospital. A diagnosis of ectopic pregnancy in obturator fossa was made by laparoscopy, ectopic conceptus removal and the ligation of left hypogastric artery was performed. We report this case with a brief review of the literatures.

자궁외 난관임신에 동반된 난관의 병리조직학적 소견 및 혈청 β-HCG 수치와 난관 근층 침범과의 상관관계

박혜진,김호정,구혜수,성순희,한운섭 대한병리학회 1999 Journal of Pathology and Translational Medicine Vol.33 No.7

자궁근층 침윤을 동반한 일차성 자궁장막임신

강민정 ( Min Jung Kang ),주정경 ( Jung Kyung Joo ),강지현 ( Ji Hyun Kang ),주인숙 ( In Sook Joo ),박양순 ( Yang Soon Park ),서경용 ( Kyoung Young Seo ) 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.3

Ectopic pregnancy is reported to be 1.5%-2% of all pregnancies. Ectopic pregnancy varies with the site of implantation; abdominal pregnancy has been reported to occur in approximately 1% of patients with ectopic pregnancy. Especially, uterine serosal pregnancy is an extremely rare form of abdominal pregnancy. Although variable diagnostic imaging methods have been developed, accurate diagnosis of the abdominal pregnancy using noninvasive imaging study is still diffi cult. Delayed diagnosis leads to high maternal morbidity and mortality in relation to massive bleeding. Therefore, diagnostic laparoscopy or laparotomy is generally considered to patients with uncertain diagnosis of the abdominal pregnancy. We experienced a case of primary uterine serosal pregnancy that had a rupture of gestational sac with myometrial invasion. We finally confirmed a definite site of the ectopic pregnancy through laparoscopic exploration. That precise location could be not found by pelvic ultrasonography and magnetic resonance imaging. The patient underwent a subtotal hysterectomy.