체외수정시술 후 이배체성 부분포상기태와 동반된 쌍태임신 1예
Twin pregnancy with diploid partial hydatidiform mole and coexisting fetuses following in vitro fertilization and embryo transfer: A case report
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24세 미분만부가 체외수정에 의해 임신이 된 후 임신 14주에 시행한 산전 초음파 검사에서 포상기태와 동반된 쌍태임신으로 의심되어 본원으로 전원되었다. 임신 14주 3일에 시행한 초음파 검사에서 쌍태아 1의 양두정경과 대퇴골 길이는 임신주수와 합당하였고 태아 심박동도 정상 범위였다. 태반, 양수 그리고 태아에 특이사항은 없었다. 쌍태아 2의 양두정경과 대퇴골 길이는 임신 13주 정도의 크기였고 태아 심박동은 없었다. 자궁의 앞쪽 벽에 포상기태 변화가 있는 태반이 확인되었다. 임신부와 남편은 임신 유지를 원하여 임신 16~17주경에 태아 염색체 핵형검사를 위해 양수천자술을 시행하기로 하였다. 그러나 임신 14주 4일에 심한 질출혈과 자궁수축으로 자연 만출이 되었다. 쌍태아 1과 쌍태아 2의 태반조직을 배양한 결과는 각각 46,XY, 46,XX였다. 임산부는 현재 12개월째 추적검사에서 지속성 임신성 융모종양의 근거는 없다. 저저들은 최근 체외수정시술 후 이배체성 부분포상기태와 동반된 쌍태임신을 경험하였기에 간단한 문헌고찰과 함께 이를 보고하는 바이다.
Abstract
A 24-year-old woman, gravida 1, para 0, was referred to our hospital at 14 weeks of gestation due to suspected twin pregnancy with hydatidiform mole and coexisting fetuses. The present pregnancy was achieved following in vitro fertilization and embryo transfer (IVF-ET). Ultrasound examinations at 14 weeks 3 days of gestation revealed a live fetus appropriate for assigned gestational age with a normal-looking placenta and a dead fetus with an additional echogenic mass resembling molar placenta. The patient was planned to take amniocentesis for chromosomal analysis. However, regular uterine contraction was developed and spontaneous expulsion was occurred at 14 weeks 4 days of gestation. Chromosomal analysis of twin pregnancy using normal and molar placental tissues revealed normal karyotype with 46,XY, 46,XX, respectively. Follow-up showed no progression to persistent gestational trophoblastic disease. We present a twin pregnancy with diploid partial hydatidiform mole and coexisting fetuses that occurred following IVF-ET, which was aborted spontaneously.
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