보조생식술에 의한 다태임신에서의 질식 선택적 유산술에 관한 연구

김석현(SH Kim),서창석(CS Suh),최영민(YM Choi),신창재(CJ Shin),김정구(JK Kim),문신용(SY Moon),이진용(JY Lee),장윤석(YS Chang) 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.12

The number of multifetal pregnancies has increased dramatically as a result of the relatively widespread use of ovulation induction drugs and assisted reproductive technology(ART). In multifetal pregnancies, adverse outcome is directly proportional to the number of fetuses within the uterus, primarily because of an increased predisposition to premature delivery. It is extremely difficult to counsel patients about the expected outcome of pregnancies involving three or more fetuses. To increase the chances of delivering infants mature enough to survive without being irreversibly damaged by the sequelae of marked prematurity, selective fetal reduction(SFR) to the smaller number of fetuses should be considered in multifetal pregnancies. From July, 1993 to February, 1995, transvaginal selective fetal reduction in multifetal pregnancies were performed in 20 patients including 15 triplet, 4 quadruplet and 1 quientuplet pregnancies. Selective fetal resuction using intracardiac DCI injection and aspiration of amniotic fluid was carried out in 8-11 weeks of gestation. After procedure 19 patients were remained as twin pregnancies, and 1 patient as singleton pregnancy. There have been 13 sets of twin delivery including 2 stillbirths and 1 singleton delivery. Six cases were delivered after 37 weeks of gestation, 5 cases in 36-37 weeks, and 1 case in 30 weeks. Unfortunately, 2 stillbirths occurred in 20 weeks and 21 weeks of gestation, respectively, and 2 cases were aborted. As 4 losses of twin pregnancies occurred, the delaye fetal loss rate in this selective fetal reduction was 25.0%(4/16). No fetal anomaly directly related to the procedure was encountered. In conclusion, selective fetal resuction in multifetal pregnancies is a rather safe and ethically justified procedure that may improve the outcome of multiple pregnancies.

보조생식술에 의한 다태임신에서 질식 선택적 유산술

이용호(Yong Ho Lee),김선행(Sun Haeng Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.3

Objective: The prevalence of multifetal pregnancies has increased up to 30% as a result of the introduction of ovulation inducing agents for assisted reproductive teclmology(ART). An exttemely poor pognosis could be expected for viable pregnancies in multifetal gestation. So, to decrease the consequence of multiple pregnancies and prevent complications, especially premature baby irreversibly damaged, selective fetal reduction to the smaller number of fetuses should be considered in an early gestational period. Methods: From May 1994 to Apr 1998, transvaginal selective fetal reduction in 13 pati including 9 triplet, 3 quadruplet and 1 quintuplet. Of the 13 patients, 4 were obtained by controlled ovarian hyperstimulation with intrauterine insemination (COH with IUI), 6 were by IVF-ET, 2 wae by controlled ovarian hyperstimulation with natural contact and 1 was by natural conception. Selective fetal reduction using intracardiac KC1 injection and aspiration of amniotic fluid carried out in 8-11 weeks of gestation. Results: After procedures, 8 patients were remained as twin pregnancies, 5 patients as singleton pregnancies and 1 of the remaining twin embryos vanished after procedure. There have been 7 sets of twin delivery including 1 stillbirth and 3 singleton delivery. 1 cases are ongoing state. All of the singleton delivery were completed after 37 weeks of gestation. Of the twin delivery, 2 cases were delivered after 37 weeks of gestation, 2 cases in 35-37 weeks, and 3 cases before 35 weeks of gestation. Unfortunately, 1 stillbirth occurred in 20 weeks of gestation and 2 cases of singleton were aborted. As 3 losses(2 singleton, 1 twin) occurred, the delayed fetal loss rate in this selective fetal reduction was 25.0%(3/12). There was no fetal anomaly related to the procedure. Conclusion: Selective fetal reduction in multifetal pregnancies is a rather safe procedure and it may improve the outcome of multiple pregnancies.

다태임신에서 질식 선택적 유산술 후의 임신 예후에 관한 연구

김석현(Seok Hyun Kim),서상수(Sang Soo Seo),임경실(Kyung Sil Lim),지병철(Byung Chul Jee),서창석(Chang Suk Suh),최영민(Young Min Choi),김정구(Jung Gu Kim),문신용(Shin Yong Moon),이진용(Jin Yong Lee) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.2

Objective: To evaluate the maternal and fetal outcomes after transvaginal selective fetal reduction(SFR) in multifetal pregnancy. Materials and Methods: Transvaginal SFR using fetal intracardiac puncture with KCl injection and aspiration of amniotic fluid was performed in 58 multifetal pregnancies achieved after assisted reproductive technology(ART). After transvaginal SFR, 55 twin and 3 singleton pregnancies were evaluated and analyzed retrospectively with the medical records of mothers and babies. Results: Of 58 cases, abortion within 4 weeks after SFR occurred in 1 case(1.7%). Miscarriage of all fetuses occurred in 8 cases(13.8%) from 4 weeks after SFR until 24 weeks of gestation. Perinatal death occurred in 8 newborns from 5 mothers due to extreme prematurity in 7 cases and anencephaly in 1 case. Take-home baby rate, that is, discharge with at least 1 healthy baby, was 77.6%(45/58). Conclusion: Transvaginal SFR is an acceptable and effective management option in the cases of excessive multifetal pregnancy after infertility treatment. The ultimate successful outcomes of reduced multifetal pregnancy may be enhanced by more extensive experience with SFR.

다태임신에서의 선택적 유산술시 복식 천자와 질식 천자의 비교 연구

김석현,문신용,이진용,Kim, S.H.,Moon, S.Y.,Lee, J.Y. 대한생식의학회 1996 Clinical and Experimental Reproductive Medicine Vol.23 No.1

The number of multifetal pregnancies has increased dramatically as a result of the widespread clinical use of ovulation induction and assisted reproductive technology(ART) in infertile patients. In multifetal pregnancies, the adverse outcome is directly proportional to the number of fetuses within the uterus, primarily because of an increased predisposition to premature delivery. It is extremely difficult to counsel patients about the expected outcome of pregnancies involving three or more fetuses. To increase the chances of delivering infants mature enough to survive without being irreversibly damaged by the sequelae of marked prematurity, selective fetal reduction(SFR) to the smaller number of fetuses should be considered in multifetal pregnancies. From January, 1991 to December, 1992, transabdominal SFR in multifetal pregnancies was performed in 22 patients including 13 triplet, 7 quadruplet, 1 quintuplet and 1 heptuplet pregnancies. Transabdominal SFR using intracardiac KCI injection and aspiration of amniotic fluid was carried out in 8-13 weeks of gestation. After procedure, 20 patients were remained as twin pregnancies, and 2 patients as triplet pregnancies. There have been 11 sets of twin delivery including 2 stillbirths, 2 sets of triplet delivery including 1 stillbirth, and 1 singleton delivery. Six cases were delivered after 37 weeks of gestation, 4 cases in 33 - 37 weeks, and 1 case in 30 weeks. Unfortunately, 3 stillbirths occurred in 20-24 weeks of gestation, and 4 cases were aborted. As 7 losses of pregnanancy including 1 case of septic abortion occurred, the delayed fetal loss rate was 38.9%(7/18) in transabdominal SFR. All babies born after 30 weeks of gestation were healthy, and no fetal anomaly directly related to the procedure was encountered. From July, 1993 to February, 1995, transvaginal SFR was performed in 20 patients including 15 triplet, 4 quadruplet and 1 quintuplet pregnancies. Transvaginal SFR using the same method as transabdominal SFR was carried out in 8-11 weeks of gestation. After procedure, 19 patients were remained as twin pregnancies, and 1 patient as singleton pregnancy. There have been 13 sets of twin delivery including 2 stillbirths, and 1 singleton delivery. Six cases were delivered after 37 weeks of gestation, 5 cases in 36-37 weeks, and 1 case in 30 weeks. Unfortunately, 2 still-births occurred in 20 weeks and 21 weeks of gestation, respectively, and 2 cases were aborted. As 4 losses of pregnancy including 1 case of septic abortion occurred, the delayed fetal loss rate was 25.0%(4/16) in transvaginal SFR. No fetal anomaly directly related to the procedure was encountered. It is suggested that transvaginal SFR could be performed more easily and earlier with the lower fetal loss rate as compared with transabdominal SFR. In conclusion, SFR is a rather safe and ethically justified procedure that may improve the outcome of multifetal pregnancies.

선택적 유산술에 의한 쌍태임신의 예후에 관한 연구

서성석,조미영,김미란,황경주,김영아,유희석,Seo, Seong-Seog,Jo, Mi-Yeong,Kim, Mi-Ran,Hwang, Kyung-Joo,Kim, Young-Ah,Ryu, Hee-Sug 대한생식의학회 2003 Clinical and Experimental Reproductive Medicine Vol.30 No.1

Objective : To evaluate the safety and efficacy of selective fetal reduction (SFR) and compare the outcome of twin pregnancy after SFR in multiple pregnancy induced by assisted reproductive technology (ART) with that of natural twin pregnancy. Methods : From September 1995 to March 2002 in Ajou University Hospital, SFR was performed in 79 patients whose gestational sacs were more than 3. Of these 79 patients, 47 patents resulted in twin pregnancy after SFR. SFR was performed using transvaginal intracardiac KCl injection at gestational age of $6{\sim}9$ weeks. Control group was composed of 264 patients with natural twin pregnancy, who delivered after intrauterine pregnancy at 24 weeks, from June 1994 through December 2002. We compared Obstetric and perinatal outcomes between SFR group and natural twin group. Results: Among 47 patients with twin pregnancy after SFR, 2 spontaneous abortion were occurred at intrauterine pregnancy at 8 and 19 weeks. Obstetrical and perinatal outcomes were available in 43 patients. Single intrauterine fetal death was occurred in 1 of 43 (2.3%) patients in SFR group. Incidence of preterm labor, premature rupture of membrane, preeclampsia and placenta previa were similar, but gestational diabetes mellitus (GDM) was occurred more frequently in SFR group (3 (7.0%) vs 4 (1.5%), p=0.02). Mean gestational age, mean birth weight, incidence of discordancy, use of intubation and ventilation, incidence of fetal anomaly, low (<7) Apgar score and intrauterine growth restriction were similar in both groups. Conclusion: Twin pregnancy after SFR has the increased incidence for GDM but other obstetric and perinatal outcome was similar compared with natural twin pregnancy. So SFR is a safe and effective procedure, so we suggest SFR is needed in multifetal pregnancy more than triplet.

다태임신에서 복식선택적 유산술 6례

전정희 日新基督病院 1996 日新基督病院論文集 Vol.11 No.-

복식 선택적 유산술에 관한 임상연구

문정주(JJ Moon),이남희(NH Lee),정미은(ME Jung),조지영(JY Cho),전정희(JH Jeun) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.8

Over the past 30 years , there has been an increase in the incidence of multifetal pregna-ncies , primarily because of the introduction of ovarian stimulants for ovulation induction and assisted reproductive technology ( ART ) in infertile patients. It is well established that multifetal pregnancies are associated with an increased frequency of the maternal complications and gre-ater perinatal morbidity and mortyality. The adverse outcome of multifetal pregnancies is dire-ctly proportional to the number of fetuses , primarily as an consequence of prterm delivery. Re-duction in the number of fetuses in multifetal pregnancies has been proposed as a way to impr-ove the perinatal outcome in this situation. Therefore , selective fetal reduction ( SFR ) is sugges-ted as a therapeutic option for continuation of pregnancy with fetuses mature enough to survi-ve. In this paper , we report our infertility clinic experiences with 6 patients who carried mult- ifetal pregnancies including 1 quintuplet , 1 quadruplet, and 4 triplets. from January, 1991 to May, 1996, transabdominal SFR was accomplished by fetal intrathoracic KCl injection at 9∼10 weeks of gestation. After the prcedure , 4 patients remained as twin pregnancies, and 2 patients as single pregnancy. There have been 3 sets of twin deliveries and the 2 sets of single delivery. One case was aborted. Two patients were delivered after 37 weeks of gestation , 2 patients were at 35 weeks , and 1 patient at 24 weeks. All babies have been healthy after birth in patients after 35 weeks gestation. There was no fetal anomaly related to the procedure in the 6 cases.< BR> We concluded that transabdominal SFR is a rather safe and useful procedure that may improve the outcome of multifetal pregnancies.

선택적 태아감수술을 이용하여 성공적으로 만삭분만에 이른 자궁각 임신을 동반한 병합임신

이지영 ( Lee Ji Yeong ),오지영 ( O Ji Yeong ),홍승화 ( Hong Seung Hwa ),권혜은 ( Kwon Hye Eun ),김성훈 ( Kim Seong Hun ),채희동 ( Chae Hui Dong ),김정훈 ( Kim Jeong Hun ),강병문 ( Kang Byeong Mun ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.9

Heterotopic pregnancy refers to the simultaneous occurrence of an ectopic gestation with an intrauterine one. The incidence of heterotopic pregnancy in the general population is about 1 to 30,000 pregnancies, but it has been increased due to the rise in p

자궁각 병합임신 환자에서 KCL 주입을 통한 선택적 태아감축술 시행 후 성공적으로 만삭분만에 이른

김미선 ( Mi Seon Kim ),이지원 ( Ji Won Lee ),정명철 ( Myung Chul Jung ),최희정 ( Hee Jeong Choi ),김용봉 ( Yong Bong Kim ),문명진 ( Myoung Jin Moon ),박병규 ( Byung Kyoo Park ),노지현 ( Ji Hyun Noh ) 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.12

Heterotopic pregnancy is defined as simultaneous intrauterine and ectopic pregnancy. Natural occurrence rate is very low occuring 1/30,000. However, with the use of assisted reproductive technology (ART), the risk increases up to 1/7,000. It is important to continuously monitor the patient using ultrasonography after ART for early detection of heterotopic pregnancy. Treatment options include surgical and medical interventions for the maintenance of intrauterine pregnancy. This is a case of full-term birth following selective fetal reduction using potassium chloride in a heterotopic pregnancy along with relevant literature review.

여성의 재생산건강권 보장에 관한 소고 : 보조생식술에서의 배아이식 문제를 중심으로

김은애 이화여자대학교 젠더법학연구소 2010 이화젠더법학 Vol.1 No.1

여성의 재생산건강권은 여성이 재생산의 기능 및 과정과 관계되는 모든 문제들에 있어 신체적, 정신적, 사회적으로 완전한 안녕 상태에 있을 수 있도록 보장받을 권리로서 인권에 해당하는 권리임이 국제적 논의를 통해 확인되었다. 이에 채취된 난자와 정자를 이용하여 체외에서 생성된 배아를 자궁 내로 이식 받는 방식의 보조생식술을 통해 임신을 시도하는 여성은 임신·출산을 위해 생명의료과학기술 내지 보건의료서비스를 이용하는 자로서 그 시행의 전 과정에서 재생산건강권을 보장받을 수 있어야 한다. 현재 우리나라에서는 모성 보호를 규정하고 있는「헌법」등에 의해 여성의 재생산건강권이 보장되고 있으나, 보조생식술의 시행에 관한 세부적인 규정을 포함하고 있는「생명윤리 및 안전에 관한 법률」을 비롯한 그 어느 법률에도 배아이식술에 관한 직접적인 규정이 마련되어 있지 않다. 그러므로 우리나라에서는 이식되는 배아의 수를 사실상 배아생성의료기관이나 시술을 직접 담당하는 의료인이 자율적으로 판단할 수 있도록 되어 있다. 이에 이식되는 배아의 수가 과다함으로 인해 초래되는 결과인 다태임신 때문에 임신 여성이 그에 따른 부작용으로 인한 신체적·정신적 건강상의 침해를 겪는 경우가 발생하고 있을 뿐만 아니라, 다태임신으로 인한 위험을 줄이거나 해결하기 위한 방법으로 임신된 태아의 수를 감소시키는 선택적태아감수술이 시행되는 경우 임신의 유지와 임신의 중단을 동시에 경험한다거나 결과적으로 잔여 태아도 유산되는 문제 등으로 인해 역시 건강상의 침해를 감당하여야 하는 경우까지도 발생하고 있다. 그러므로 여성에게 재생산권리의 보장은 단지 임신·출산이라는 목적의 달성을 가능하도록 하는 것만이 아니라 안전하고 건강하게 재생산능력을 이용하는 전 과정이 이루어질 수 있도록 하는 데에까지 이르러야 하는 바, 임신을 목적으로 배아이식을 받는 여성을 위해서는 임신의 성공을 기대할 수 있되 다태임신을 방지할 수 있도록 하기 위해 필요최소한도의 배아가 이식될 수 있어야 할 것이다. 앞으로 여성의 재생산건강권은 임신·출산이라는 목적 내지 결과를 위해서만이 아니라 이의 주체가 되는 자 내지 재생산능력을 이용하는 자로서의 여성이 그 존재가치를 존중받아 건강한 삶을 영위할 수 있도록 하기 위해서 살펴져야 한다. The reproductive health rights is the right to guarantee the state of complete physical, mental and social well-being in all matters relating to the reproductive system and to its functions and processes, so the reproductive health rights is the one of the human rights. The women who use the assisted eproductive technology must be able to possess and enjoy the reproductive health rights. In Korea, this right has been secured by the constitutional law and so forth. But 「Bioethics and Safety Act」that regulates the assisted reproduction and the embryo producing medical institution does not include the provision to control the embryo transfer. The multi-embryo transfer has caused the multi-fetal pregnancy, so the pregnant has the side effect like a gestosis. And the multi-fetal pregnancy has been settled by the selective fetal reduction, so the pregnant also has the side effect like a premature delivery and an abortive birth. To ensure the women’s reproductive health rights has an object to the secure the physical, mental and social health of the women in the whole process of the using the assisted reproductive technology as well as to achieve the final aim(the gestation of the fetus and the birth of the baby). Therefore, the number of the embryo that will be transferred in the uterus of women must be minimized in the necessary need not only to guarantee the reproductive health of women from the side effect of the multi-fetal pregnancy but also to expect the successional pregnancy. From this day forward, we have to respect the woman’s reproductive health rights as the human rights of the all woman to guarantee the state of complete physical, mental and social wellbeing in all matters relating to the reproductive system and to its functions and processes.