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자궁벽 내 병합임신 제거술 후 정상 만삭분만에 성공한 1예
배진곤 ( Jin Gon Bae ),박준철 ( Joon Cheol Park ),이정호 ( Jeong Ho Rhee ),김종인 ( Jong In Kim ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.10
병합임신이란 두 개의 수정란이 자궁강 내와 자궁강 외의 장소에 동시에 착상되어 임신 되는 것을 말하며 임상적으로 매우 드물게 발견되나, 최근 불임률의 증가에 따라 체외수정술 등의 보조 생식술의 기회가 증가되고 자궁내막증, 골반내 염증, 난관수술의 유병률이 증가되면서 점차 그 발생 빈도가 높아지고 있다. 대부분의 병합임신은 난관과 자궁강에 발생되거나 난소나 자궁경부, 자궁각 또는 복강에서도 발생될 수 있으나 자궁벽 내에 병합임신이 발생하는 경우는 매우 드물며, 그런 경우 자궁벽 내 임신의 제거 후 자궁강 내의 정상 임신은 자궁파열의 위험성을 가지므로 만삭까지 유지시키기 매우 어렵다. 본 저자들은 시험관 아기 시술에 의해 자궁벽과 자궁강 내에 병합임신이 된 임신부에서 자궁벽 내 임신을 수술적으로 제거한 후, 만삭까지 유지하여 성공적인 분만을 한 1예를 경험하여 간단한 문헌고찰과 함께 보고하는 바이다. Heterotypic pregnancy occurs when there coexist intrauterine and extrauterine (or ectopic) pregnancy and it is very rare. But the incidence of heterotypic pregnancy has been increased due to the rise in pelvic endometriosis, pelvic inflammatory disease (PID), surgery of fallopian tubes and assisted reproductive technologies (ART), such as in vitro fertilization and embryo transfer (IVF-ET). In heterotypic pregnancy, extrauterine gestations are usually implanted in a fallopian tube, ovary, uterine cervix, uterine cornus or peritoneum but rarely in muscle layer of uterus (intramural pregnancy). It is difficult to preserve intrauterine pregnancy because of the risk of uterine rupture after excision of intramural pregnancy. We have experienced a heterotypic intramural pregnancy after IVF-ET which was successfully treated by excision of intramural pregnancy while maintaining the viability of the intrauterine pregnancy. So, we report this case with brief review of literatures.
차선화,박종택,김해숙,송현정,강은희,송현진,강인수,Cha, Sun-Hwa,Park, Chong-Taik,Kim, Hae-Suk,Song, Hyun-Jung,Kang, Eun-Hee,Song, Hyun-Jin,Kang, Inn-Soo 대한생식의학회 2004 Clinical and Experimental Reproductive Medicine Vol.31 No.4
Intramural pregnancy is an unusual ectopic gestation located within the uterine wall, completely surrounded by myometrium and separate from the uterine cavity, fallopian tube, or round ligament. It is known to be difficult to diagnose, and associated with a high rate of uterine rupture. We report a case of intramural pregnancy in which early diagnosis was made and successful treatment was done by dilatation and curettage. Diagnostic laparoscopy confirmed the absence of uterine rupture during the procedure. Therefore, conservation of fertility can be possible with early diagnosis of intramural pregnancy. To our knowledge, this is the first case report of intramural pregnancy following IVF-ET in Korea.
하정식 ( Ha Jeong Sig ),정인배 ( Jeong In Bae ),조주형 ( Jo Ju Hyeong ),이향아 ( Lee Hyang A ),엄민섭 ( Eom Min Seob ),박광화 ( Park Gwang Hwa ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.11
Intramural pregnancy is one of the rarest forms of ectopic pregnancy. The pathologic diagnosis of the intramural ectopic pregnancy requires that the myometrium surrounds the products of conception separated from the endometrial cavity or fallopian tubes.
장시영 ( Jang Si Yeong ),서경 ( Seo Gyeong ),채두병 ( Chae Du Byeong ),조시현 ( Jo Si Hyeon ),이상희 ( Lee Sang Hui ),김보욱 ( Kim Bo Ug ),이현준 ( Lee Hyeon Jun ),구자승 ( Gu Ja Seung ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.11
Intramural pregnancy is among the rarest forms of ectopic pregnancy. Since it has been first reported by Doederlein in 1913, 37 cases were reported in worldwide literatures. The pathologic criteria required for intramural pregnancy is that the product of
손성권(Seong Kweon Son),신해수(Hae Su Shin),양영민(Young Min Yang),신원식(Won Sik Shin) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.7
Intramural implantation is among the rarest forms of ectopic pregnancy.Since the first description by Perli, 21 cases were reported in worldwide literatures.The pathologic criteria required for intramural pregnancy is that the product of conception is completely surrounded by uterine musculature and is separated from the uterine cavity and the fallopian tube or round ligament.The previous history of uterine injury or adenomyosis is known as possible etiology of intramural implantation. Because the early diagnosis is very difficult, most cases is found after onset of complication such as a uterine rupture or hemoperitoneum. We have recently experienced a case of intramural pregnancy diagnosed and treated by laparoscopy in a 9 weeks gestation nulliparous woman without previous history of uterine injury or disease, and report with a brief review of literatures.
이동헌 ( Lee Dong Heon ),조준식 ( Jo Jun Sig ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.5
목적 : 자궁벽내임신은 조기 진단이 어려우며 치료가 지연되는 경우 자궁적출술을 시행해야 하는 등 합병증이 큰 질환이나 현재까지 이 질환에 관한 전반적인 고찰은 찾아보기 어려운 실정이다. 이에 문헌 고찰을 통하여 이 질환의 임상적 특성을 분석하고자 하였다. 연구 방법 : 인터넷을 이용하여 MEDLINE과 EMBASE 데이터베이스 및 대한산부인과학회에서 제공하는 논문 검색 엔진으로 문헌 검색을 시행하였다. 총 40예의 중례 보고를 검색하였으며 이 중 임상 자료가 부족한 4예는 연구 대상에서 제외하고 36예를 대상으로 분석을 시도하였다. 결과 : 자궁벽내임신 36예의 발생 평균 연령은 31.2세였으며 평균 진단 주수는 10.8주였다. 36예 중 17예의 환자가 자궁소파술 기왕력이 있어 가장 중요한 위험인자로 나타났다. 36예 중 27예를 개복술을 통해 자궁벽내임신을 확진하였으며 치료 방법은 자궁적출술이 가장 많이 시행되었다. 결론 : 자궁벽내임신은 위험 인자를 숙지하고 최근 발달된 영상 진단 기기를 적절히 이용하면 상당수에서 조기 진단과 내과적 치료가 가능하여 임신력을 보전할 수 있을 것으로 판단된다. Objective : The goal of this article is to analyze the clinical characteristics of intramural pregnancy through the review of currently available 36 case reports. Methods : A comprehensive computer literature search was performed in MEDLINE and EMBASE database from 1966 to 2003. And domestic literature search was preformed in KSOG database. After data collection, we reviewed and analyzed meaningful clinical variables of each case report. Results : 36 articles were included. The age at diagnosis ranged from 20 to 41 years old, and the mean age was 31.2 years (S.D∴5.6). The gestational period at diagnosis ranged from 6^th to 30^th weeks, more than half of the cases occurred from 6^th to 10^th week (58.3%). Significant risk factors were history of dilatation and curettage (47.2%) and history of cesarean section (25.0%). Common clinical symptoms and signs were vague abdominal pain (58.3%) and vaginal bleeding (54.2%) in unruptured case, and sudden onset of severe abdominal pain (100%) and muscle guarding (75.0%) in ruptured case. The preoperative diagnostic accuracy was 0% before introduction of ultrasonography into the clinical practice, 48.2% after ultrasonography was available. Of 36 patients, 27 patients (75.0%) were treated with laparotomy, and 5 patients (13.8%) were treated with methotrexate. Survival outcome of fetus was very poor. Only in 1 case, the pregnancy persisted beyond the 30^th week, and the fetus survived after cesarean hysterectomy. Conclusion : With the advanced diagnostic tools and close monitoring of patients, we can improve the diagnostic accuracy and clinical outcome of intramural pregnancy.
증례: 자기공명영상에 의해 진단된 자궁벽내 임신의 내과적 치료 2예
고현선 ( Hyun Sun Ko ),이영 ( Young Lee ),이희중 ( Hee Joong Lee ),박인양 ( In Yang Park ),정대영 ( Dae Young Chung ),김수평 ( Soo Pyung Kim ),박태철 ( Tai Churl Park ),신종철 ( Jong Chul Shin ) 대한주산의학회 2005 Perinatology Vol.16 No.3
자궁벽내 임신은 자궁외 임신의 1% 미만에서 발생하는 드문 질환으로, 과거에는 수술적 치료가 이루어 졌으나, 최근 자궁에 대한 보존적 치료가 시도되고 있다. 저자들은 임신낭이 파열된 이후 초음파로 진단이 불명확한 경우 자기공명영상을 이용하여 자궁벽내 임신을 진단하고, methotrexate를 통한 내과적 치료를 통해 성공적으로 치료된 자궁벽내 임신 2예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Intramural pregnancy is one of the rare forms of ectopic pregnancy and the optimal treatment is unknown. We describe two cases of intramural pregnancy treated with systemic methotrexate, which were diagnosed by pelvic MRI. Medical treatment with methotrexate may be a conservative treatment alternative for intramural pregnancies.
오상엽 ( O Sang Yeob ),박준철 ( Park Jun Cheol ),이정호 ( Lee Jeong Ho ),김종인 ( Kim Jong In ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.10
Implantation of a gestational sac within a previous cesarean scar is the rarest form of ectopic pregnancy. A delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, and significant maternal morbidity due to severe hemorrhage. As
제왕절개 반흔 부위에 착상한 자궁벽내임신의 보존적 치료
김희진 ( Hee Jin Kim ),이경순 ( Kyoung Soon Lee ),한미영 ( Mee Young Han ),이은희 ( Eun Hee Lee ),최원영 ( Won Young Choi ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.9
목적 : 제왕절개 반흔에 착상한 자궁벽내임신의 보존적 치료에 대한 효과와 안정성을 알아보고자 하였다. 연구 방법 : 2001년 1월부터 2003년 12월까지 일신기독병원 산부인과에서 제왕절개 반흔 임신으로 진단된 환자 10명을 대상으로 하였다. 치료법은 양막강내 Methotrexate를 직접 주입하는 방법과 전신적인 Methotrexate/Folinic acid 투여 후 소파술을 시행하는 방법, 양막강내 Methotrexate를 직접 주입한 후 소파술을 Objective : To evaluate of safety and effectiveness of conservative treatment of previous cesarean section scar pregnancy. Methods : Ten patients with previous cesarean section scar pregnancy were treated systemic methotrexate or intra-amnionic methotrexa
제왕절개 반흔 부위에서 발생한 자궁근층내 임신의 보존적 치료
길민경 ( Min Kyung Gil ),강영미 ( Young Mi Kang ),김성용 ( Sung Yong Kim ),정수전 ( Su Jeon Jeong ),김영남 ( Young Nam Kim ),정대훈 ( Dae Hoon Jeong ),이경복 ( Kyung Bok Lee ),성문수 ( Moon Su Sung ),김기태 ( Ki Tae Kim ) 대한주산의학회 2005 Perinatology Vol.16 No.4
Intramural pregnancy, implanted in the previous cesarean section scar, is one of the rare and dangerous forms of ectopic pregnancies, because a delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, or significant maternal morbidity, due to severe hemorrhaging. With the development of transvaginal ultrasound and MRI, early diagnosis and conservative treatment of intramural pregnancy is possible. For young patients who wish to maintain their fertility, an earlier diagnosis and more conservative treatment are desirable. We experienced a case of intramural pregnancy, developed in the previous cesarean section scar and successfully treated it with conservative management. So we report this case with a brief review of literature.