체외수정시술로 임신된 쌍태 임신과 정상 쌍태 임신의 예후 비교

강은희(Eun Hee Kang),박은주(Eun Joo Park),채희동(Hee Dong Chae),김성훈(Sung Hoon Kim),김정훈(Chung Hoon Kim),강병문(bYUNG mOON kANG),장윤석(Yoon Seok Chang) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.9

Objective : To compare pregnancy outcome of in vitro fertilization (IVF) twin pregnancies with that of normally conceived twin pregnancies Materials and Method : From October 1995 to October 1998, total 100 twin pregnancies were included in this study. The pregnancies were grouped into the IVF twin pregnancy group (n = 60) and normal twin pregnancy group (n = 40). Twin pregnancies resulting from multifetal pregnancy reduction (MFPR) were excluded in this study. The obstetric and perinatal outcomes were compared between the two groups. Statistical analysis was performed using Student's t-test, Fisher's exact test, and χ2 test as appropriate. Statistical significance was defined as p < 0.05. Results : There were no significant differences in mean gestational age and distribution of gestational age between the two groups. We did not find any significant differences in birthweight, weight discordancy, presentation of fetuses, and frequency of cesarean section between the two groups. There were also no differences in obstetric and perinatal outcomes between the IVF twin and normal twin pregnancy groups. Conclusion : This study suggests the pregnancy outcome of twin pregnancies resulting from IVF-ET is comparable with that of normally conceived twin pregnancies.

단태아와 쌍태아 모체의 임신 분기별 지방산 섭취와 혈청 인지질 지방산 조성 비교

권슬기,임수정,신중식,장성희,안홍석 대한지역사회영양학회 2008 대한지역사회영양학회지 Vol.13 No.4

Essential fatty acids are important essential nutrients during pregnancy. The objective of this study was to compare fatty acid composition of serum phospholipids and essential fatty acid intakes between Korean pregnant women with a single baby and Korean pregnant women with twins. A total of 116 pregnant women who had maintained their health without any symptoms of pregnancy complications participated in the study. The subjects consisted of 57 women of singleton pregnancy and 58 women of twin pregnancy at the 1st, 2nd, or 3rd trimester of pregnancy. A 24-hour dietary recall was administered to each subject to obtain dietary information. The mean ages of the singleton pregnancy group and the twin pregnancy group were 31.44 years and 32.27 years, respectively, and the mean height values were 161.86 ㎝ and 160.64 ㎝, respectively. The mean daily energy intakes in the singleton pregnancy group were 1639.95 ㎉, 1904.71 ㎉, and 1882.82 ㎉ for the 1st, 2nd, and 3rd trimester group, respectively. The mean daily energy intakes in the twin pregnancy group were 1745.99 ㎉, 2203.46 ㎉, and 2092.26 ㎉ for the 1st, 2nd, and 3rd trimester group, respectively. There were no significant differences in the mean fatty acid intakes by the type of pregnancy (i.e., singleton vs. twins) and the stage of pregnancy (i.e., 1st vs. 2nd vs. 3rd trimester). However, the mean total fatty acid intake of those at the 1st trimester among the singleton pregnancy group tended to be higher than that of those at the 1st trimester among the twin pregnancy group. Such a trend seemed to be retro-versed. That is, the mean total fatty acid intakes of the twin pregnancy group were higher compared to the singleton pregnancy group for the 2nd and 3rd trimester group. The LA and total n6 concentrations of serum phospholipids of the singleton pregnancy group were significantly higher as the gestational age increased (p < 0.05). The α-LNA (p < 0.05), EPA (p < 0.05), and total n3 (p < 0.001) concentrations of serum phospholipids of the twin pregnancy group were significantly lower as the gestational age increased. The α-LNA concentrations of serum phospholipids in the singleton pregnancy group at the 3rd trimester were significantly higher than that in the twin pregnancy group at the same trimester (p < 0.05). The serum phospholipids levels of AA and DHA of the twin pregnancy group were generally higher compared to those of the singleton pregnancy group. Particularly the differences reached at the level of statistical significance for those at the 1st trimester (p < 0.01). It is concluded that the study findings imply that fatty acid metabolism may meaningfully differ by the type and stage of pregnancy. Future research needs to be conducted to more elucidate grounding etiology and possible roles of dietary fatty acid intake levels in relation to the study findings.

임신 중기 쌍둥이임신에서 태아 소실률과 원인

이유미 ( Yu Mi Lee ),신중식 ( Joong Sik Shin ),석준민 ( Jun Min Seok ),장지현 ( Ji Hyon Jang ),강진희 ( Jin Hee Kang ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.4

Objective: To evaluate and compare the rate and etiologies of second trimester pregnancy loss in monochorionic (MC) or dichorionic (DC) twins, and natural or assisted reproductive technology (ART) twins. Methods: Between January 1997 and December 2008, there were 146 cases of second trimester twin pregnancy losses (between 12 and 24 weeks gestation) from 2,467 twin pregnancies. They were divided into four groups according to chorionicity and fertilization. Chorionicity was established by ultrasound at early gestation and confirmed by histologic examination after delivery. From a total of 2,467 twin deliveries, 392 MC, 2058 DC, and 17 unknown chorionicity were observed. Fertilization methods were classified as 736 natural, 1,590 ART, and 141 unknown conceptions. The pregnancy loss rate and possible mechanisms were compared in each group. Results: During the study period, there were 43 MC, 86 DC, and 17 unknown chorionicities and 45 natural, 78 ART, and 23 unknown fertilizations. Total twin pregnancy loss rate was 5.9% (146/2,467), with 11.0% (43/392) and 4.2% (86/2,058) for MC twin group and DC twin group, respectively. Likewise, it was 6.1% (45/736) and 4.9% (78/1,590) for natural twin group and ART twin group. The most common cause was intrauterine fetal death (IUFD) in 22 (51.2%) in MC twin group and preterm premature rupture of membranes (PPROM) in 40 (46.5%) in DC twin group, followed by preterm labor (PTL) in 37 (43%). In natural pregnancy, IUFD was the most common etiology in 20 (44.5%) and for ART twin group, it was PTL in 35 (44.9%). Conclusion: Twin pregnancy loss rate was higher in MC twin group compared with DC twin group in the second trimester. MC twin group had a higher incidence of IUFD as a cause of second trimester pregnancy loss. The etiologies in DC twin group were PPROM and PTL. It is suggested that antenatal care in twin pregnancy should be explored for preventing fetal loss and promoting neonatal well-being.

체외수정시술 후 발생한 쌍태임신의 주산기 예후: 선택적 유산술 시행 여부에 따른 비교 연구

김명희(MH Kim),김석현(SH Kim),지병철(BC Jee),서창석(CS Suh),최영민(YM Choi),신창재(CJ Shin),김정구(JK Kim),문신용(SY Moon),이진용(JY Lee) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.8

Multifetal pregnancy reduction(MFPR) has been suggested to improve pregnancy outc-ome in multifetal pregnancies with three or more fetuses after assisted reproductive techn-ology(ART) such as IVF-ET program, and now it seems to be a rather safe and effective mothod to reduce perinatal loss associated with multifetal pregnancies. To investigate the effectiveness of MFPR, the perinatal outcome of twin pregnancies in IVF-ET patients was analyzed in 3 groups:Group Ⅰ-12 infertile patients who had conceived more than quadru-plet pregnancy and underwent MFPR to twin pregnancy, Group Ⅱ-29 patients who had conceived triplet pregnancy and underwent MFPR to twin pregnancy, and Group Ⅲ-30 pat-ients who had conceived twin pregancy initially and served as control group. Among 3 gr-oups, fetal loss rate before 24 weeks of gestation, pregnancy non-reduced, complications, gestational age at delivery, and birth weight were compared. Fetal loss rate after MFPR was significantly higher in Groups Ⅰ(41.7%) and Group Ⅱ(17.2%) compared with Group Ⅲ(3.3%), and positively correlated with the number of fetuses before MFPR in Groups Ⅰ and Ⅱ. However, pregnancy complication rate was not significantly different among 3 groups(41.7%, 48.3%, and 36.7%). After exclusion of fetal loss cases before 24 weeks, mean gestational age at twin delivery and mean birth weight were not significantly different among 3 groups(36.2 weeks, 36.6 weeks, and 36.1 weeks; 2.37 kg, 2.45 kg and 2.47kg).In conclusion, MFPR in multifetal pregnancies is an ethically justified procedure that may improve perinatal outcome in cases of multifetal pregnancies.

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.

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.

Cell-free DNA screening in twin pregnancies

Hye Yeon Boo,You Jung Han 대한산부인과학회 2024 Obstetrics & Gynecology Science Vol.67 No.2

Cell-free DNA (cfDNA) screening for fetal aneuploidies is clinically available and exhibits better performance than conventional serum screening tests. However, data on the clinical performance of cfDNA screening in twin pregnancies are limited. In this review, we summarized the clinical performance and evaluated the feasibility of cfDNA screening in twin pregnancies based on recent studies and recommendations. The performance of cfDNA screening for trisomy 21 in twin pregnancies is similar to that in singleton pregnancies. Specifically, cfDNA screening has a higher detection rate and lower false-positive rate compared with conventional serum screening. Consequently, recent international guidelines from several academic communities have recommended that cfDNA screening for aneuploidy in twin pregnancies could be considered. Moreover, twin pregnancies can present with specific conditions, such as different zygosities and vanishing twins; therefore, individualized counseling and management are required. Further clinical studies with more twin pregnancies are required for a more accurate analysis. Cell-free DNA (cfDNA) screening for fetal aneuploidies is clinically available and exhibits better performance than conventional serum screening tests. However, data on the clinical performance of cfDNA screening in twin pregnancies are limited. In this review, we summarized the clinical performance and evaluated the feasibility of cfDNA screening in twin pregnancies based on recent studies and recommendations. The performance of cfDNA screening for trisomy 21 in twin pregnancies is similar to that in singleton pregnancies. Specifically, cfDNA screening has a higher detection rate and lower false-positive rate compared with conventional serum screening. Consequently, recent international guidelines from several academic communities have recommended that cfDNA screening for aneuploidy in twin pregnancies could be considered. Moreover, twin pregnancies can present with specific conditions, such as different zygosities and vanishing twins; therefore, individualized counseling and management are required. Further clinical studies with more twin pregnancies are required for a more accurate analysis.

국내 유우 (Holstein)의 단태 또는 쌍태분만 후 태반정체와 제4위전위증 발생우의 수태 관련성에 대한 조사

조진행,김명철,정성목,이재연,신범준,Cho, Jin-Haeng,Kim, Myung-Cheol,Jeong, Seong-Mok,Lee, Jae-Yeon,Shin, Beom-Jun 대한수의학회 2012 大韓獸醫學會誌 Vol.52 No.2

Calving records of Holstein dairy cows from 2005 to 2010 comprising Goyang and Paju cities herd with 2,362 calving events representing 240 twin births were used to evaluate the effect of abomasal displacement and retained placenta after single or twin births on fertility. In retained placenta cows, the period of twin pregnancy (mean 270.5 days) was shorter than that of single pregnancy (mean 274.8 days), however first artificial insemination period (twin: mean 107.4 days, single: mean 92.0 days), non-pregnant period (twin: 154.8 days, single: 132.2 days), and number of insemination (twin: mean 2.00 times, single: mean 1.87 times) of twin pregnancy were increased as compared with single pregnancy. In abomasal displacement cows, first artificial insemination period (twin: mean 122.9 days, single: mean 106.0 days), non-pregnant period (twin: 172.4 days, single: 152.0 days), and number of insemination (twin: mean 2.16 times, single: mean 1.89 times) of twin pregnancy were increased as compared with single pregnancy. The prevalence of complication such as retained placenta, abomasal displacement with single or twin births increased first artificial insemination period, non-pregnant period, and number of insemination period.

일측 태아사망을 동반한 쌍태임신 1례

이태화,김성한 고신대학교 의과대학 2009 고신대학교 의과대학 학술지 Vol.24 No.2

The antepartum death of one fetus in twin pregnancy is a rare obstetric complication. One fetal demise of twin pregnancy in the second or third trimester is an unusual and difficult problem in the management of pregnancy. It can be associated with an increased risk for mortality and morbidity in the remaining fetus and with maternal DIC(Disseminated intravascular coagulation). If one fetus in twin pregnancy died in uterus remote from term and another fetus did not, the dead fetus will be compressed between the uterine wall and the membrane of living fetus, becomes a fetus compress or fetus papyraceous. Concern for the surviving fetus after death of its co-twin is balanced between the risk of preterm birth and those involving exposure to events in uterus that may threaten its well-being. Recently we experienced a case of twin pregnancy complicated by the death of one fetus. We represent a case in diamnionic monochorionic twin pregnancy with a brief review of literatures.

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