병합 임신 7예에서의 임상적 경험
Clinical Experiences of 7 Cases of Heterotopic Pregnancy
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목적: 병합 임신은 드문 질환이지만 자궁외 임신이나 골반염, 자궁내 장치, 배란 유도, 체외수정 시술의 증가로 그 빈도가 증가 추세에 있다. 이에 병합 임신으로 진단 받은 7명의 환자의 임상적 특징을 알아보고자 하였다. 연구 방법: 병합 임신으로 진단 받은 7명의 환자를 대상으로 임산부의 나이, 증상, 혈청 β-HCG 수치, 진단시 재태 연령, 산과력, 과거 수술력, 자궁외 임신 위치, 체외수정 시술 사용, 다태 유무, 태아 분만 방법을 연구하였다. 결과: 환자의 평균연령은 29.1세이고 주증상은 복통이었다. 5명의 환자에서 개복술을 시행하였으며 두 명의 환자에서 복강경을 시행하였다. 7명 중 4명은 임신을 계속 유지하였고 쌍태아 2예 단태아 2예로 6명의 태아를 분만하였다. 결론: 병합 임신에서 자궁내 임신이 확인되었다고 해서 동반된 자궁외 임신을 진단하지 못하면 환자와 태아의 예후에 중요한 영향을 끼치므로 초기 진단, 신중한 관찰이 필요하며 자궁외 임신은 제거하고 자궁내 임신을 유지하여야 한다.
Abstract
Objective: Although heterotopic pregnancy is a rare disorder, it is on an increasing tendency due to frequent use of intrauterine device, pelvic inflammatory disease, ovulation induction, assisted reproductive technology. This study was performed the clinical experiences of seven patients with heterotopic pregnancy. Methods: Seven patients diagnosed as heterotopic pregnancy were analyzed by various factors such as age, symptoms, β-hCG levels, gestational age at the time of diagnosis, postoperative course, sites of ectopic pregnancy, use of assisted reproductive technology, multiple pregnancy, and mode of surgery. Results: The mean age of patients was 29.1 years, and chief complaint was abdominal pain. Laparotomy was done in 5 patients, and laparoscopy was done in 2 patients. Four of seven patients delivered at term, two were twins, two singletones. Conclusion: In heterotopic pregnancy, identification of intrauterine pregnancy without confirmation of ectopic pregnancy is associated with poor prognosis for both mother and fetus, and hence early dignosis and careful examination are need. Ectopic pregnancy should be removed and intrauterine pregnancy should be maintained.
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