쌍태임신에 관한 임상적 고찰

박광웅,박성관 인제대학교 1980 仁濟醫學 Vol.1 No.2

산과 영역에서 쌍태임신은 고위험임신으로서 조산, 높은 주산기 이환율 및 사망율과 모체에 여러 종류의 합병증을 초래하므로 산과적으로 쌍태 임신은 중요하여 지난 3년간의 쌍태 임산부 및 쌍태아에 대해 임상적 견지에서 조사하여 봤다. The thirty-nine twin deliveries at the Paik Hospital for 3 years front Jan. 1, 1977 to Dec. 31, 1979 were studied retrospectively. Twin delivers carries a considerable fetal & neonatal risk but the maternal mortality is not increased. 1.The frequency of twin delivery was one in 126 births. 2.The mean age was 28. The youngest was 20 years of age. The oldest was 35 years of age. 3.Primiparas were 22/39, 56.4% and multiparas were 17/39, 43.6%. 4.The mean durations of twin pregnancy was 38.9 weeks. 5.The diagnostic accuracy with physical examination & radiological examination before delivery of the twins was 92.3%. 6.The mean numbers of the antenatal care of twin pregnant woman was over 5. 7.The presentation; Head-Head 17/39, 43.6% Head-Breech 15/39, 38.4%. Breech-Breech 6/39, 25.4%. 8.The common maternal complication were anemia (69.23%). Toxemia (43.6%) post-partum Hemorrhage (38.5%). 9.The maternal morbiditiesy of postpartum women were hemorrhoids (12/39, 30.7%). G-I trouble (5/39, 12.8%) & wound abscess (5/39, 12.8%). 10.The methods of twin delivery were C/S (11/39, 28.2%) & vaginal deviveries (28/39, 71.8%). 11.The spontaneous vaginal delivery of placenta after twin birth was 25/28, 89.2% & manual delivery of placenta at vaginal twin birth was 3/28, 7.7%. 12.The mean duration of labor at vaginal delivery was 10 hour 30min 13.The mean interval of first & second birth at vaginal delivery was 5∼10min. 14.The mean birth weight of twin delivery was 2,408Gm. 15.The APGAR score at 1min. over 7 was shown in 32/38, 78.9% of the first twin & 23/38, 89.9% of the second twin. 16.There were both males 18/39, 46.15% & both females 13/39, 33.3% & opposite sex 8/39, 20.5%. 17.The placenta with monochorionic & diamnionic membrane were seen abou thalf of twin. 18.Fetal risk was defined in term of the increased rates of prematurity, stillbirth, & congenital anomalies (craniodidymus twin, cleftlip & palate, & fetal transfusion syndrom). 19. The perinatal mortality in the twin was 9/77, 11.7%.

성장불일치를 초래하는 쌍태아에서 태반의 난막성, 태반무게, 제대부착부위에 따른 도플러혈류의 변화

김석영 ( Kim Seog Yeong ),김광준 ( Kim Gwang Jun ),윤성준 ( Yun Seong Jun ),이순표 ( Lee Sun Pyo ),이지성 ( Lee Ji Seong ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.2

Objective : To evaluate hemodynamic change in growth discordant twins using a ratio of middle cerebral artery/umbilical artery resistance index and to assess the relationship between Doppler hemodynamic and the influence of placental chorionisity and umbilical cord insertion. Methods : 118 live born twin pairs whose birthweight discordance below or above 20% between March 2000 and March 2002 were included in our study. And we divided the two groups in which above 20% of growth discordance (GD) group was GD and below 20% of GD group was control. Chorionisity and umbilical cord insertion in all study subjects within 24 hours after delivery were investigated. And then we classified to monochorionic (MONO), and dichorionic (DI) placenta and the type of insertion of umbilical cord were also classified central, marginal and velamentous type. 56 of twin pairs were performed 153 Doppler flow velocimetry between smaller and larger fetus prenatally. Resistance index (RI) of middle cerebral artery and umbilical artery in each fetus were measured and standardized as a ratio of middle cerebral artery/umbilical artery (MCA/UmA). ANOVA, Mann-Whitney U test, and chi-square test, were performed and p<0.05 was considered as statistically significant. Results : Mean birthweight in monochorionic twins had lighter than those of dichorionic twins (p<0.01). The mean growth discordant ratios were 14.1% in monochorionic twin and 12.1% in dichorionic twins. In monochorionic twin, the smaller fetus in GD group showed lower value of MCA/UmA RI ratio than those of the larger fetus, significantly (1.09 vs. 1.28 p<0.05). And in monochorionic twins, the smaller fetus in GD group showed lower value of MCA/UmA RI ratio than the smaller fetus in control group, significantly (1.09 vs. 1.27 p<0.05). The placental weight in dichorionic twin was correlated the birthweight in infants in GD group, positively. Monochorionic twins in GD group had a significantly higher incidence of peripheral cord insertion than those of dichorionic twins in GD group (50.0% vs. 35.7% p<0.01). But dichorionic twins had a significantly higher incidence of central cord insertion than those of monochorionic twins in control group (69.2 vs. 57.4 p<0.05). Conclusion : The higher middle cerebral artery blood flows in smaller fetuses of monochorionic twins proved to be circulatory redistribution of the fetus in inadequate intrauterine condition. And these change of middle cerebral blood flow might be understood the part of mechanisms fetal growth and adaptation. Placental weight, number and umbilical cord insertion were also important factors which affected to develop the growth discordance of twin pregnancy.

쌍태 임신에서 일측 태아의 자궁내 사망이 산모와 생존아에 미치는 영향

김소연,정해율,백희조,최익선,조창이,최영륜 대한소아과학회 2002 小兒科 Vol.45 No.12

국내 유우(Holstein)의 쌍태임신율 및 분만에 관한 조사

조진행,김명철,정성목,이재연,신상태,신범준 한국임상수의학회 2012 한국임상수의학회지 Vol.29 No.1

This study was performed to evaluate the rate of twin pregnancy and parturition in dairy cows. Calving records of Holstein dairy cows from 1998 to 2009 comprising Goyang and Paju cities herd with 20,990 calving events representing 820 twin births were used to evaluate twinning rate, calf sex ratio, periods of pregnancy and complication after parturition in single and twin births. Overall, the reported twinning rate was 3.9% in Holstein dairy cows. Rate of bicornual pregnancy (75%) was larger than that of unicornual pregnancy (25%) among cows having twin. Regardless of parity, the greatest twinning rate was observed in fall season from September to November. Calf sex ratios (male,M; female, F) were 48.0% FM, 28.9% MM, 21.5% FF and 0.9% mummifications for twin calves. Parturition type among cows having twins included normal (4.7%), premature (66.9%), delayed (9.2%), abortion (18.4%) and mummification (0.8%). The period of pregnancy in twin pregnancy (mean 272.6 days) was shorter than single pregnancy (mean 278.1 days). The retained placenta after parturition was over fourth times such as twin parturition (34.8%) higher than single parturition (8.5%) and the abomasal displacement was over two times such as twin parturition (10.2%)higher than single parturition (4.9%). The distribution of twin pregnancy with parities was high rate during the 2~3parities. The prevalence of complication such as retained placenta and abomasal displacement with twin parturition revealed higher than single parturition.

무심장 쌍둥이 임신에서 고주파 융해술 후 정상 태아 생존 출생한

장지현 ( Ji Hyon Jang ),문명진 ( Myoung Jin Moon ),박혜리 ( Hea Ree Park ),안은희 ( Eun Hee Ahn ),정상희 ( Sang Hee Jung ),이유미 ( Yu Mi Lee ),김은아 ( Eun A Kim ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.5

Acardiac twin is a rare anomaly that occurs 1% in monochorionic twins and 1 in 35,000 pregnancies overall. Acardiac twin, also known as twin-reversed arterial perfusion (TRAP) sequence, involves a “pump” or donor twin perfusing a recipient or “acardiac” twin through vascular (usually arterial-arterial and venous-venous) anastomoses. Perinatal mortality rate for the pump twin has been reported to be 50~75%, mainly as a result of polyhydramnios, preterm labor, and congestive heart failure. Therefore, occlusion of the circulation to the acardiac twin has been recommended to improve perinatal outcome of the pump twin. Radiofrequency ablation of the acardiac twin effectively protects the pump twin from high-output cardiac failure and death. We report our experience in the treatment of patients with TRAP sequence using radio frequency ablation to stop perfusion to the acardiac twin.

조선누층군 풍촌석회암 방해석 쌍정에서 유추된 고응력장

강성승,장보안 대한지질공학회 2022 지질공학 Vol.32 No.1

Calcite twins were analyzed in six oriented samples of the Pungchon limestone, Joseon Supergroup, to reconstruct the paleostress field. The orientations of c-axis of calcite and e twin plane were measured along with the average thickness and numbers of twins, and the widths of calcite grains. Twin strain, mean width, and intensity of twinning, and the relative magnitude and orientations of principal stresses were calculated using Calcite Strain Gauge program. Twin strain, mean width, and intensity of twinning showed ranges of 1.09-15.36%, 0.53-3.72 μm and 21.0-53.1 twim/mm, respectively. Metamorphic temperatures calculated from the twins were 170-200°C, indicating that the twins developed after the Pungchon limestone was uplifted to at least half of the maximum burial depth. Results for five of the samples indicate that the calcite twins formed during two events with principal stress axes of different orientations, while the remaining sample recorded only one event that produced calcite twins. The axis of maximum compressive stress was oriented mainly WNW-ESE to ENE-WSW, and to a lesser degree NW-SE and NE-SW. Comparison of paleostress orientations measured here and in other studies indicates that most twins were produced during the Songrim orogeny. However, the Daebo orogeny and the Bulguksa orogeny also produced calcite twins in the Punchon limestone. 본 연구는 방해석 내 쌍정을 이용하여 조선누층군 풍촌석회암층의 고응력장을 규명하기 위함이다. 이를 위해 조선누층군 두위봉형의 풍촌석회암에서 6개의 시료를 채취하여 방해석 c-축의 방향 및 경사, e 쌍정면의 방향 및 경사, 쌍정의 평균 두께 및 갯수, 방해석 입자의 크기 등을 측정하였다. 측정된 자료들은 Calcite Strain Gauge 프로그램에 입력되어 쌍정의 변형률, 평균 두께, 치밀도 및 고응력장의 상대적 크기 및 방향 등을 계산하였다. 쌍정의 변형률은 1.09~15.36%, 평균 두께는 0.53~3.72 μm, 치밀도는 21.0~53.1 twin/mm의 범위를 보인다. 쌍정의 변형률, 치밀도 및 두께에 의한 변성온도 계산결과 대부분의 시료에서 170~200°C 이하를 보여, 풍촌층의 상부층인 직운산층의 변성온도에 비교할 때 최대 심도의 절반 이상 상승한 후에 쌍정이 생성된 것으로 판단된다. 응력장의 방향은 5개의 시료에서 2방향을 보이는 반면, 단지 1개의 시료에서만 한 방향을 보여 대부분의 시료에서 압축응력이 2번 이상 작용하였음을 보여준다. 압축응력은 WNW-ESE~ENE-WSW의 방향성이 가장 우세하고 NW-SE와 NE-SW의 방향성도 보인다. 본 연구에서 측정된 고응력장과 연구지역 인근에서 지질구조나 다른 방법에 의하여 규명된 고응력장과 비교할 때 E-W 방향의 고응력장은 트라이아스기 말에서 쥬라기 초에 발생한 송림조산운동에 가장 큰 압축응력이 작용하였고 쥬라기에 발생한 대보조산운동과 불국사 변동에 의해서도 쌍정이 생성된 것으로 판단된다.

FlexSim 모형 간 연동을 통한 공정 디지털 트윈 개념 설계 및 평가

김정수,박진오,김준우 한국지식정보기술학회 2023 한국지식정보기술학회 논문지 Vol.18 No.6

Digital twin is one of the integral components of advanced smart factory. However, digital twin applications are typically difficult to design and develop, since digital twin is implemented through integration of various software and hardware components. In order to mitigate these burdens, this paper proposes a novel approach called synchronization of FlexSim models for conceptual design and evaluation of process digital twin. The proposed approach is based on the virtual digital twin environment, where digital twin model interacts with virtual physical twin model instead of real hardware equipments. The virtual digital twin environment can be conveniently established by utilizing simulation models with appropriate structures and functions, which can be used as the virtual physical twin and digital twin models. Consequently, the proposed approach helps to reduce the time and cost of developing digital twin applications. FlexSim software is a commercial discrete event simulation tool suitable for building the virtual physical twin and the digital twin models, since it provides rich 3D visualization, flexible logic builder and external data connectivity. In addition, the evaluation method for digital twin model within the virtual digital twin environment is also discussed in this paper. The proposed approach is applied to develop a simple prototype of a digital twin for a manufacturing facility, and the experiment result demonstrate the usefulness of synchronization of FlexSim models in developing digital twin applications.

Study on the Interoperability of Digital Twin Systems

공준익 국제문화기술진흥원 2022 International Journal of Advanced Culture Technolo Vol.10 No.3

The world is paying a lot of attention to digital twins to preoccupy future technological competitiveness. Digital twins can be used in various fields such as manufacturing, medical care, and cities. Various market research institutes predict that the market size of digital twins will gradually expand. Korea has also selected digital twin as one of the representative tasks of the Korean version of the New Deal and is promoting related policies. However, a common platform or standard for building digital twins is not enough. Interoperability is a very important characteristic for the purpose of creating new value through interconnection between digital twins rather than independently developing and utilizing digital twins. The Digital Twin Consortium is an international council for the effective development and utilization of digital twins, and is working to solve the problem of digital twin interoperability. The Digital Twin Consortium recently published the 'Digital Twin System Interoperability Framework', and this paper analyzes the digital twin interoperability based on it.

쌍생아 임신의 융모막과 주산기 결과

최은진,윤현진,허재원,홍수영 대한신생아학회 2008 Neonatal medicine Vol.15 No.1

Purpose : The purpose of this study was to assess the natural history and perinatal outcomes of twin gestations according to chorionicity. Methods : We retrospectively reviewed the medical records of 99 monochorionic (MC) and 206 dichorionic (DC) twin gestations delivered at Il Sin Christian Hospital in Busan between January 2002 and December 2007. The incidences of twin-to-twin transfusion syndrome (TTS) and selective intrauterine growth restriction (sIUGR), as well as perinatal morbidity and mortality, were evaluated. Results : MC twins had a lower gestational age (35.7 vs. 36.6 weeks, P=0.03) at birth and a higher incidence of intrauterine fetal loss (10% vs. 1.5%, P<0.001) than DC twins. The incidence of intrauterine fetal loss was higher in MC sIUGR than in DC sIUGR (19% vs. 2.5%, P=0.025) twins. The number of admissions to the neonatal intensive care unit (NICU; 31% vs. 16%, P=0.042), and the incidence of periventricular leukomalacia (7% vs. 0%, P=0.031), and respiratory distress syndrome with surfactant treatment (27% vs. 11%, P=0.049) were higher in MC than DC twins. The incidences of sIUGR and TTS were 21 and 9% among the MC twins. The incidences of intrauterine fetal loss were higher in MC twins with TTS [6 of 9 (67%)] or sIUGR [4 of 21 (19%)] than uncomplicated MC twins (P<0.001). The frequency of admission to the NICU (P=0.001), the length of hospital stay (P=0.033), the prevalence of periventricular leukomalacia (P=0.011), and intraventricular hemorrhage (P=0.007) were also higher in MC with TTS or sIUGR than in uncomplicated MC twins. Conclusion : The incidence of neonatal complications was higher in MC twins, especially those gestations complicated by TTS or sIUGR.

Acardiac Twin-Twin Reversed Arterial Perfusion Sequence

Sun-Gyoeng Kim,Hui-Gyeong Seo,Yun-Sook Kim 순천향대학교 순천향의학연구소 2016 Journal of Soonchunhyang Medical Science Vol.22 No.1

In general, twin pregnancy represents a high-risk pregnancy. The monozygous twin of all twin pregnancy is a real challenge for the obstetrician due to the severe complications that may arise during its development. An extremely uncommon, severe complication of monozygous twin pregnancy, which we recently experienced in Soonchunhyang University Cheonan Hospital, was a monochorionic diamniotic twin pregnancy with acardiac twin-twin reversed arterial perfusion sequence. An acardiac twin presented no heart, underdeveloped inferior part of the body, being transfused by the other fetus (pumping twin) by umbilical vessels. We report a 33-year-old pregnant woman, with a history of in vitro fertilization-embryo transfer in the second pregnancy, who presented with generalized edema, abdominal discomfort, and high blood pressure at 33 weeks’ gestation. By ultrasonography, one of the babies is normally developed but in the other baby, head, upper extremities, and cardiac activity cannot be detected. The pumping twin was cardiomegaly, polyhydramnios, absent diastolic wave on the umbilical artery, and small for gestational age. We decided to terminate the pregnancy by primary cesarean section after administration of corticosteroids. The comprehension of this case is compulsory in order to provide maximum survival opportunity to the viable baby.