심한 양수과다증을 동반한 무심장 쌍둥이 임신에서복부내 제대동맥의 알코올 절제술 (alcohol ablation) 및양수감압술의 성공적인 자궁내 치료 1예
Successful Management with Intra-abdominal Alcohol Ablationof Acardiac Twin and Amniodrainage in Twin Reversed ArterialPerfusion Sequence with Severe Polyhydramnios
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초록
무심장쌍둥이 임신은 정상공급태아가 무심장태아의 혈액을 공급하는 단일 융모막 다태아 임신의 독특한 합병증이다. 무심장태아에 혈액을 공급해야 하는 정상 공급태아는 심혈관계에 과다한 부하로 말미암아 심부전 및 양수과다가 초래되어 50% 이상의 높은 사망률이 보고되고 있다. 저자들은 임신 25주에 심한 양수과다증을 동반한 무심장쌍둥이 임신에서 초음파 유도하에 무심장태아의 복부 내 제대동맥에 100% 알코올 1.5 cc를 주사하여 무심장태아의 혈액순환을 차단시키는데 성공하였다. 연속적인 초음파검사에서 정상 공급 태아 측은 정상적인 성장 및 정상적인 양수량을 보인 반면 무심장 태아 측은 대퇴골길이의 성장 멈춤과 양수량의 감소를 보였다. 임신 16주에 최초 진단 후 임신 384주가 되기까지 정상 공급태아가 건강한 상태로 임신기간을 지속 할 수 있어 성공적인 출산을 이루었던 1예를 간단한 문헌 고찰과 함께 보고하는 바이다.
Abstract
Twin reversed arterial perfusion (TRAP) sequence is a unique complication of monochorionic twinning, in which normal pump or donor twin paradoxically perfuses the recipient or acardiac twin through arterial- arterial anastomoses. This results in reversed flow of poorly oxygenated blood through the recipient twin and is usually associated with partial or complete lack of heart development. The pump twin has a mortality rate of 50% as a result of high-output heart failure, preterm labor, and polyhydramnios. We present here a case of twin reversed arterial perfusion (TRAP) sequence complicated by severe polyhydramnios during the second trimester. The blood supply to acardiac twin was interrupted successfully at 25 weeks of gestation by injecting 1.5 mL of absolute alcohol into the intra-abdominal portion of the single umbilical artery, under ultrasound guidance. Serial ultrasound showed normal growth and normal amniotic fluid volume in normal pump twin, but arrest of growth in femur length and decrease in amniotic fluid volume in acardiac twin. The normal pump twin was delivered at 384 weeks of gestation and had uneventful neonatal course.
참고문헌 (19)
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