2. The costs of appeal are assessed against the Plaintiffs.

The following facts are no dispute between the parties, Gap evidence 1 through 8, Gap evidence 14, Gap evidence 15-1 through 7, Gap evidence 16-1 through 4, Gap evidence 17-18, 19, Gap20-1, Gap evidence 21-2, Gap evidence 222, Gap evidence 23-1 through 4, Gap evidence 25-1 through 6, Gap evidence 26-1 through 3, Gap evidence 27-1 through 13, Gap evidence 28-1 through 7, Gap evidence 29, Gap evidence 30-1, Gap evidence 32-1, Gap evidence 333, Gap evidence 1 to 36-13, Gap evidence 1-1, Eul evidence 1 to 36-13, Eul evidence 1-1, Eul evidence 1 to 5-13, Eul evidence 1-1, and the results of the fact inquiry by the court, Eul evidence 2-1 to 361-13, Eul evidence 14, and other evidence.

A. Status of the parties

On November 26, 1998, Plaintiff 2 was the second medical institution operated by Defendant 1 medical corporation, and was given birth to Plaintiff 1 at ○○ Hospital, a general hospital (hereinafter “Defendant hospital”). Defendants 2 and 3 were the employees of Defendant 1 medical corporation, who were affiliated with the Defendant hospital at the time of the Plaintiff 1’s childbirth.

B. The plaintiff 2's diagnosis before the end of the period

(1) On June 4, 1998, Plaintiff 2 (date of birth omitted) was diagnosed to have been pregnant with her mother at the Defendant hospital (the 11th day of pregnancy). Thereafter, at the Defendant hospital, the Defendant hospital was regularly under the pre-delivery examination by Nonparty 8, a medical specialist of her father and child. Until November 11, 1998 (the 33th day of pregnancy), both Plaintiff 2 and both her mother, who was the mother, did not seem to have any special abnormal check, and the scheduled date of delivery was December 25, 1998.

(2) However, around November 25, 1998, the 6th sixth day of pregnancy, as a result of the Defendant Hospital’s regular pre-industrial medical examination conducted by Defendant 2 at the Defendant Hospital around November 25, 1998, the body of the fetus on the part of the two births was not reduced and died.

(3) Accordingly, Defendant 2 recommended the Plaintiff 2 to be hospitalized for the purpose of continuously observing the condition of the death of the fetus on the ground that the death of the fetus on the part of the day is likely to affect the survival of the fetus. On the same day from 11:36 to 13:40 on the same day, Defendant 2 had the outcome of showing the reaction by conducting a non-divating examination by using a non-divating device between 11:36 to 13:40 on two occasions.

C. The plaintiff 2's hospitalization and the progress before childbirth

(1) After undergoing a non-dating test, Plaintiff 2 completed a surgery prior to the operation (blood test, urine test, heart test, chest filming, etc.) according to Defendant 2’s instruction in preparation for the occurrence of an emergency situation requiring prompt operation of the surviving fetus, and was returned to the preparation for hospitalization, and was hospitalized in a delivery room with a fetus heart supervision device at around 17:00 on the same day, and was hospitalized in the delivery room. Until that time, Defendant 2 retired from the time of the above Plaintiff’s hospitalization, Defendant 3, a doctor on duty, transferred medical records, etc. on the said Plaintiff, and was in charge of the said Plaintiff.

(2) Meanwhile, at the time of Plaintiff 2’s hospitalization, Nonparty 1, a midwife of the Defendant hospital, delivered by Defendant 2 the scheduled date of delivery and the above Plaintiff’s early childbirth, along with the fact that the said Plaintiff was the early childbirth of the said Plaintiff, and the fact that the said Plaintiff was the early childbirth, was hospitalized to observe the survival of the fetus due to the death of the fetus on the part of the mother during the pregnancy of a pair of fetuses, again carried out a non-party 1, a midwife from 17:13 to 17:45 on the same day immediately after the above Plaintiff’s hospitalization. As a result of the inspection, there was no self-satisfa, and the heart b

(4) At the time of Plaintiff 2’s hospitalization, Defendant 3’s review of the medical records, including the records of the above Defendant’s records transferred by Defendant 2, based on the determination that the result of the above non-party 1’s examination conducted after hospitalization was not in a state of prompt needing to be confirmed, i.e., for the above Plaintiff’s normal meals. Nonparty 1, hospitalized in the delivery room of the above Plaintiff, provided the above Plaintiff with normal meals, provided 5% liter and 1 liter for each 30 minutes, check the heart of the fetus’s heart, and instruct Nonparty 1 to prepare two-waves of the above Plaintiff’s red blood cells in preparation for an over-burine clock in preparation for an over-burine clock, and instruct Nonparty 1 to observe the status of the above Plaintiff and the fetus by using the fetus surveillance device in case there is any abnormal contact with Nonparty 1 by telephone on the same day.

(5) From 19:50 to 19:50 on the same day after the Defendant 3’s direction, Nonparty 1 continued to observe the condition of the Plaintiff and the fetus by continuously attaching the embryo heart surveillance device to the part of the body of Plaintiff 2, from 20:45 on the same day, determined that the change of the condition of the Plaintiff and the fetus occurred from 20:45 on the same day (the heart heart of the fetus was 160 times per minute, and the number of the fetus was 160 times per minute, and 1:10 on the same day). On the same day, Nonparty 1 contacted Defendant 3 by telephone at around 21:10 on the same day. On the other hand, the above Defendant provided the said Plaintiff with the oxygen, and ordered Nonparty 1 to provide the said Plaintiff with the oxygen oxygen, and supplied the said Plaintiff with the oxygen, thereby increasing the change of the heart of the fetus.

(6) At around 22:00 on the same day, Nonparty 1, a midwife, was in shifts with Nonparty 2, and Nonparty 2 observed Plaintiff 2. On the same day, Nonparty 2 observed Plaintiff 2. At around 23:00 on the same day, he did not feel but did not feel. Nonparty 1’s heart was 138 times per minute.

(7) From around 00:00 on November 26, 1998, Plaintiff 2 appealed from 00:00, and observed several times, the fetus heart surveillance device’s finite. Nonparty 2 confirmed that the finite body of the above Plaintiff was still closed, and contacted Defendant 3 at around 00:20 on the same day. Defendant 3 delivered the above Plaintiff’s status by Nonparty 2 to the above finine for early unification, the finine for the purpose of suppressing the finine and continuing to observe the finine for the purpose of suppressing the finine unification, and the finine for the purpose of controlling the finine unification continued to be finine and the finine finine finine finine finine finine fat at night. Nonparty 2 instructed the above Plaintiff to have the guardian of the above Plaintiff undergo an operation even at night, and Nonparty 2 was waiting at the time of the above finite.

(8) At around 01:00 on the same day, Plaintiff 2 was unable to feel. However, the heart food of a fetus was 148 times per minute, and Nonparty 2 continued monitoring of an embryo heart food monitoring device at around 03:00 on the same day, and continued monitoring of an embryo heart food monitoring device at around 05:00 on the same day, but resumed supplying oxygen at around 05:0 on the same day.

(9) At around 06:00 on the same day, Plaintiff 2 saw a simple progress, and observed four times as a monitor of an embryo heart food monitoring device, but the heart of the fetus was 138 times per minute. While continuing monitoring, Nonparty 2 discontinued the supply of an oxygen at around 07:0 on the same day, and then transferred it to Nonparty 3 and Nonparty 4 of the nurse.

(d) The process of childbirth and the state of a newborn baby;

(1) Although Defendant 3’s attendance at around 09:00 on the same day and did not seem to have an opinion to observe Plaintiff 2’s condition and presume the difficulty of the fetus, Defendant 3 determined that, from around 08:30 on the same day of the heart of the fetus, it was relatively low to observe the scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic.

(2) From around 09:40 on the same day, Defendant 3 performed an king surgery under a general anesthesia and performed it on the same day at around 09:57 on the same day, the fetus already died within the her mother (mama, 2,200g in body), and Plaintiff 1, the surviving fetus (mama, 2,300g in body) at around 09:58 on the same day, was delivered to each other, and there was no error between Plaintiff 2’s her mother and her mother’s head.

(3) Meanwhile, according to the medical record of the Defendant hospital, the part of the protocol prepared after the above operation (Evidence No. 23-2) stated to the effect that the cardiopulmonary resuscitation was written in the column of “No,” and that the cardiopulmonary resuscitation was not implemented. However, the records of the operation (Evidence No. 23-3) prepared by Defendant 3 were written in the non-party 9, a medical specialist of the Defendant hospital (hereinafter “Ruscitated Docit Doced Doced Doced Doced Doced Doced Doced Doced Doced Doced Doced Doced Doced Doced Doced Doced Doced Doced Doced Doced Doced Doced Doced Doctrid Domin was written in the first operation report and diagnosis after the operation.

(4) 원고 1의 1분 아프가 점수는 6점, 5분 아프가 점수는 8점이었고, 분만 시부터 기면상태로서 몸통 부분이 심하게 창백하였으며, 제대로 울지 못하고 활동성이 떨어져 전신 허약감을 보이고, 끙끙거리는 호흡음을 내고 있었으며, 다만 활력징후는 안정적이었고, 거친 호흡음에도 불구하고 심박동은 잡음없이 규칙적이었으며, 몸통 청색증 양상을 보이지는 아니하였다. 피고 병원의 소아과 의료진은 원고 1의 상태를 미숙아로서 쌍태아간 수혈증후군 의증으로 판단하여 분만 직후 위 원고를 소아과 신생아 중환자실에 입원시켰는데, 같은 날 15:00경 원고 1은 여전히 기면상태로 끙끙거림이 나타났다가 사라지기를 반복하면서 전신의 기운이 저조한 상태로서, 활력징후는 안정적이나 빈호흡의 양상을 보였고(호흡수 분당 76회), 피고 병원의 의료진은 같은 날 15:10경부터 4시간에 걸쳐 원고 1에게 농축 적혈구 25시시(cc)를 수혈하는 등 그 무렵부터 인큐베이터에서 집중관찰하면서 보존적 치료를 시작하였다.

(5) 분만 직후 원고 1에 대한 피고 병원 진단방사선과의 흉부 검사 결과 위 원고의 심장은 정상 소견을 보였고, 뇌초음파 검사 결과 역시 특별한 이상 소견을 보이지 아니하였으나, 임상병리과의 혈액 검사 결과 위 원고의 혈색소(헤모글로빈)의 수치는 정상아의 1/3 정도에 불과한 주5) 6.3g/㎗ 로 빈혈 상태였고, 망상적혈구의 비율이 12%에 주6) 이르렀다.

(6) After the Plaintiff 1’s blood transfusion, the Defendant hospital’s medical personnel observed the above Plaintiff’s condition and suspended human care around 15:00 on December 10, 1998 at the end of the treatment, and thereafter, the Plaintiff was discharged on December 16, 1998 from the hospital’s father on December 16, 198. Meanwhile, Plaintiff 2 discharged the Defendant hospital’s father and father on December 2, 1998.

(7) The address of the place of discharge (A30 No. 1, 2) of the above plaintiff prepared by the medical personnel of the defendant hospital at the time of the discharge of the plaintiff 1 is indicated as "preficur", and each final diagnosis column is indicated as "1. mountain and 2............."

E. The diagnosis of cerebral Bribery against the Plaintiff 1

After that, the plaintiff 1 was diagnosed by brain salutism, the brain salutism test conducted at the East Asian University Hospital on February 22, 2000, after the plaintiff 1 was found to have been under the diagnosis of brain salutism, the left-hand salutism salutism, the right-hand salutism, and the brain salutism salutism. On November 6, 2000, the plaintiff 1 was within the Magsan Hospital and was diagnosed by brain salutism due to low salutism salutism in which the opinion on brain salutism salutism was shown to be serious on the side of the brain.

(f) Relevant medical knowledge;

(1) Unborn surveillance, treatment, etc.

㈎ 태아 심음의 정상범위(분당 횟수)는 임신 제삼분기(약 29주에서 42주 사이)의 경우 120회에서 160회 사이로, 그보다 낮은 경우는 서맥(bradycardia)이라고 하고, 그보다 빠른 경우는 빈맥(tachycardia)이라고 하나 정상범위의 하한에 대해서는 논란이 있어, 분당 110회를 정상범위의 하한으로 정의하는 경우도 있다. 분당 100회에서 119회 사이의 경도의 태아서맥이 다른 태아심박동 변화들과 함께 나타나지 않는다면 태아의 상태가 나쁘다고 할 수 없다. 즉 태아심박동 감소가 나쁘게 나타나더라도 그 지속시간이 짧고, 간헐적으로 나타나는 때에는 태아에 의미 있는 영향을 미치지 않는다.

㈏ 태아 심음의 변동성(beat-to-beat variability)은 태아의 심폐기능을 반영하는 중요한 지표로서 자율 신경계에 의해서 지배를 받는다. 이는 태아심음그래프 상의 파형으로 나타나며 각 심장 박동시에 나타나는 단기간의 변동성(short term variability)과 1분 동안에 기록되는 파의 모양을 보는 장기간의 변동성(long term variability)으로 나눌 수 있고, 각각의 정상 범위는 1분 동안 단기간의 변동성은 6에서 25회, 장기간의 변동성은 2회 이상으로 정의하고 있다. 이에 대해 영향을 줄 수 있는 요소로는 태아의 호흡, 운동, 재태연령 등이 있으며, 심음의 다양성이 저하된 경우에는 태아의 산혈증, 산모의 산혈증, 산모에게 중추신경 억제제 등의 약물을 투여한 경우 등이 있다.

㈐ 태아심음감시장치에 의한 태아심음그래프에서 볼 수 있는 자궁의 수축과 관련한 태아심장박동의 저하는 조기(early), 변이(variable), 만기(late) 심박동감소로 나뉠 수 있다. 이 중 만기심박동감소는 자궁수축의 절정시, 혹은 그 이후에 심박동감소가 시작되어서 자궁수축이 끝난 후에야 다시 기저 태아 심박수로 돌아오는 점진적이고 대칭적인 형태의 심박동 감소를 말하는데, 이는 일반적으로 자궁 태반부전을 의미한다.

㈑ 반복적인 만기심박동감소 상태가 되면 환자의 체위를 측와위로 바꾸고, 정맥으로 수액을 충분히 공급하며, 산모의 저혈압을 유발할 수 있는 요소들을 제거하고, 자궁 수축제를 투여하고 있었다면 이를 멈추며, 이러한 모든 방법 후에도 태아의 심박동이 계속적으로 만기 심박동 감소를 보인다면 곧바로 제왕절개술로 태아를 분만하는 것이 일반적이다.

㈒ 미국 산부인과 학회의 권고 사항에 따르면, 지속적 태아심음감시장치와 같은 효과를 보려면, 분만 중 간헐적 태아심음청취는 고위험군의 경우 분만 제1기에는 15분 간격, 분만 제2기에는 5분 간격으로 하여야 한다.

(2)Influence of embryos and influence of primary acids;

㈎ 가사란 호흡 및 순환부전을 주요 소견으로 하는 증후군으로, 출생 전, 출생 과정, 또는 출생 후에 동반되는 다양한 원인들에 의하여 태아 또는 신생아에 산소 공급 부족으로 저산소증, 여러 장기에 혈액 관류의 부족으로 허혈증이 발생하여 초래되는 일련의 장애 현상을 말하는데, 대사성 산증과 환기가 잘 되지 않는 경우는 고탄산혈증이 동반된다. 태아기 가사를 태아곤란증(fetal distress)이라고 하고, 출생 후 가사를 신생아 가사라 하며, 이 모두를 주산기 가사라고 한다.

㈏ 태아곤란증은 자궁 내의 태아의 상태를 나타내는 광범위한 용어로서, 태아가 자궁 내에서 저산소증에 의한 산혈증 등의 스트레스를 보상할 수 없을 정도로 상태가 나빠져 있다는 것을 말하는데, 대개의 산부인과적 진료에서는 태아심음감시장치에 의한 심박동감소(예 : 만기심박동감소, 심한 변이심박동감소)로 정의하고 있다. 진정한 태아곤란증은 박동대 박동 변동성이 거의 없으며 중증 태아 심박동 감소와 동반되거나, 지속적인 기초 태아 심박동수의 변화를 말한다. 심각하고 진정한 태아곤란증이 회복 없이 지속된다면 태아 뇌손상이나 사망에까지 이를 수 있다.

㈐ 분만전 태아 상태를 정확히 판단하는 것은 현대 의학으로는 한계가 있다. 태아곤란증을 정확히 정의하기는 곤란하지만 태아심박동수만으로 판단할 경우 일반적으로 다음의 사항이 나타날 경우 인정받고 있다. 첫째, 기저 변동성이 없어지고(감소가 아닌 소실) 반복적인 만기심박동감소 혹은 변이성 심박동감소, 둘째, 기저 변동성이 없어지고 태아심박동의 서맥이 있는 경우 등이다. 원인으로는 만기심박동감소 소견을 보이는 경우는 산모의 저혈압, 과도한 자궁수축, 태반기능부전 등이 있고, 변이성 태아심박동감소는 제대압박 등이 있다.

(3) Apgar Score

㈎ 아프가 점수는 심박동수, 호흡하려는 노력, 근 긴장도, 반사성 흥분 및 피부색깔 등 5가지 요소로 구성되며 이에 대하여 각각 0, 1, 또는 2점을 주어 합산하여 얻어진다.

㈏ 신생아소생술의 필요성을 평가하기 위한 수단으로 생후 1분과 5분에 실시하는 아프가 점수를 들 수 있다. 1분 아프가 점수는 출생시 응급소생술의 필요성을 판단하는데 사용된다. 아프가 점수가 7점 이상인 활발한 아기는 일반적으로 기도 청소와 함께 안면 마스크로 산소를 잠깐 불어 주는 것 외에는 소생술을 시행하지 않는다. 아프가 점수가 4~6점에 해당하는 신생아는 호흡기능이 감소하고, 무기력하며, 창백하거나, 청색증을 띄게 되나, 심박동수와 자극에 대한 반사는 좋은 편인데, 이 경우에는 호흡 개시를 위한 자극이 필요하고 안면 마스크를 통하여 산소를 투여해 주어야 한다. 아프가 점수가 1~3점인 경우 대부분 기관 삽관과 폐의 팽창이 필요하다.

㈐ 1분 아프가 점수는 신생아가 특별한 주의를 요하는가를 나타내는 지표로 사용될 수 있으나 1분 아프가 점수가 낮더라도 향후 예후와 연관지을 수는 없다. 5분 아프가 점수 7~10점은 정상으로 여겨지며, 4~6점은 중등도로서 추후 신경학적 기능이상이 생길 고위험의 지표는 아니다. 5분 아프가 점수가 0~3점이고 이것이 저산소증에 의한 것이라도 문제의 심각성을 나타내는 데는 한계가 있으며 향후의 신경학적 예후와도 상관관계가 불분명하다.

㈑ 10분, 15분 그리고 20분 점수가 0~3점일 때 아프가 점수와 향후 신경학적 예후와의 상관관계가 높아진다. 뇌성마비를 일으킬만한 뇌의 저산소증은 ① 제대동맥혈액검사에서 대사성 또는 혼합성 산혈증(pH 〈 7.0)이 나타날 때, ② 5분 이상에서 아프가 점수가 0~3점인 경우, ③ 신생아의 신경학적 이상(예 : 경련, 혼수, 저긴장증)이 있는 경우, ④ 여러 장기의 이상(예 : 심혈관계, 위장관계, 혈액학적 이상, 폐, 신장 등) 중 세 가지 조건을 만족시킬 경우 추정될 수 있다.

(4) The death of a fetus in the Tin-to-to-tin syndrome and a single-day fetus

㈎ 단일 융모막 태반에서 태반의 표면이나 심부에 존재하는 동맥-정맥간 혈관 문합을 통하여 공혈아인 한 쪽 태아로부터 수혈아인 다른 쪽 태아로의 일반적인 혈류 유입이 일어나서 공혈아는 빈혈, 발육 지연, 양수과소증을 초래하고, 수혈아는 다혈, 심장확대, 피하부종, 양수과다증을 유발하는 것을 쌍태아 수혈증후군이라 한다. 이에 동반되어 태아곤란증 등이 유발될 수도 있으며, 공혈아는 빈혈, 저혈압으로 인한 뇌 허혈로, 수혈아는 혈압 불안정과 같은 심각한 저혈압으로 인한 뇌 허혈 및 뇌 경색으로 출생 후 중증 뇌성마비가 초래될 수 있다.

㈏ 원인은 명확하게 알려져 있지 않으나 제대 변연 부착, 난막 부착, 와르톤 젤리 감소, 제대 과염전, 제대 지름의 감소 등과 같은 제대 이상이나 선천적인 태반 자체의 미세혈관 발생장애, 갑작스러운 한 태아의 사망에 따른 급속한 혈류 이동 등이 알려져 있다.

㈐ 쌍태아간 수혈증후군을 분만 중 확진하는 검사법은 없고, 일측 태아가 사망한 경우 쌍태아간 수혈증후군의 발생 여부를 사전에 알 수는 없다. 산전에 공혈자 쌍태아인 경우 빈혈이 심해 정현 곡선 태아 심박동율을 보일 수도 있고, 초음파 상 양수과다증 및 과소증, 쌍태아간 성장차이 등이 나타날 수 있으나, 이것만으로 진단하기는 어렵다.

㈑ 일반적으로 쌍태아 임신에서 한 태아가 자궁내 사망 순간에 즉각적인 분만이 이루어진다 하여도 쌍태아간 수혈이나 남아 있는 태아에 동반될 수 있는 저혈압은 남아 있는 태아 뇌에 이미 불가역적인 손상을 줄 수 있다고 알려져 있다.

㈒ 쌍태임신에서 일측 태아가 사망한 경우 생존 태아에서의 뇌병변은 일측 태아가 사망한 시점의 급성 저혈압에 의하여 발생할 가능성이 매우 높은 것으로 알려져 있다. 가능성은 낮지만 사망 태아에서 유래한 혈전생성 물질의 색전에 의하여 발생할 수도 있다. Fusi 등(1990., 1991.)은 일측 태아가 사망한 시점에서 혈압이 높은 상태의 살아 있는 태아에서 혈압이 낮은 사망한 태아로 급격한 태아간 수혈이 일어나 생존 태아에서 혈액의 양이 감소하고 허혈성 산전 뇌손상이 일어난다는 것을 관찰하였다. Pharoah와 Adi(2000.)는 쌍태아 중 일측 태아가 자궁내에서 사망했지만 다른 태아가 생존했던 348례를 조사하여 뇌성마비의 빈도가 1000명당 83명으로 약 40배의 위험이 증가했음을 보고하였다.

㈓ 일측 태아가 사망한 후 태아간 수혈과 이후에 발생하는 저혈압이 급격히 발생하기 때문에 생존 태아에 대한 성공적인 처치는 불가능하다. 태아가 사망한 것을 안 뒤 즉각적으로 분만을 시킨다고 하더라도 태아가 사망한 시점에 발생하는 저혈압은 이미 비가역적인 손상을 초래하였기 때문이다.

㈔ 일측 태아에 대한 사망 진단 이후에는 다태임신의 유지와 관련된 위험보다는 조산의 위험이 더 크고, 생존 태아를 보존적 치료하는 것이 바람직하다고 알려져 있다.

(5) Tysitic and low-living infants;

In the World Health Organization, the birth period of less than 37 weeks or not more than 259 days from the last day of the month of the birth was determined as the baby or the baby of her early birth. When the body of the birth period is less than 2,500g, it is called the baby of her early birth in a broad sense.

(6) Bribe;

㈎ 뇌성마비는 미성숙한 뇌에 대한 비진행성 병변 혹은 손상으로 인하여 생기는 운동과 자세의 장애를 보이는 임상증후군으로 일반적으로 정의된다. 뇌성마비의 발생빈도는 전체 인구 중 0.15~0.2% 정도로 1500명 출생당 7명 또는 연간 10만명 인구당 7명의 비율로 새로 발생한다고 하며 특히 조산아의 경우 100명 출생당 약 5명의 발생빈도를 보여 만삭아에 비하여 높은 빈도를 보인다.

㈏ 뇌성마비의 원인은 구체적으로 밝혀지지 않았지만 최근의 임상적, 역학적 연구에 의하면 신생아기에 뇌초음파에서 뇌백질의 이상이 발견되는 것이 추후 뇌성마비가 생길 수 있는 가장 중요한 위험인자로 생각되고 있다.

㈐ 조산에 의한 미성숙(prematurity)은 뇌성마비의 주요 위험인자로 생각되고 있는데, 1,500g 미만 생존한 조산아의 뇌성마비 발생빈도는 5~15%로 보고되며 이는 3,500g의 만삭아와 비교할 때 30배나 높은 발생율이다. 또한 전체 뇌성마비 환아의 1/3이 2,500g 이하의 저출생 체중아임을 고려할 때, 뇌성마비는 만삭아의 성숙한 뇌보다 미성숙 발달과정의 조산아 뇌에서 발생하기 쉽고 신생아 집중치료와 관련이 있다.

2. The plaintiffs' assertion

A. Medical malpractice claim

As long as Defendant 2 and 3 knew of the fact that Plaintiff 2’s fetus was dead on November 25, 1998 and the cardiopulmonary diversity of the surviving fetus has decreased, Defendant 2 and 3 did not follow the assessment of the fetus at intervals of 15 minutes for the first time for the first time for the delivery, and at intervals of 5 minutes for the second time for the first time for the delivery. From around 08:50 on November 26, 1998 to around 09:50, the Plaintiff 2 was negligent in performing the assessment of the health of the fetus, such as failing to conduct an examination of cardiopulmonary resuscitation-suction of the fetus, and Defendant 3 and other medical personnel at the hospital including Defendant 2 were negligent in performing the assessment of the health of the fetus at an early stage until the end of 00:00 to 100,000,000 before the end of 19:5,000 square meters from the end of 19 to the end of 198.

B. Grounds for violation of duty of explanation

In addition, Defendant 2 and 3 did not explain that Plaintiff 2 died of a single fetus at the time of hospitalization at the Defendant hospital, and in such a case, the Plaintiffs asserted that Plaintiff 2 violated Plaintiff 2’s right to self-determination by failing to explain the possibility that the fetus during the delivery might cause a strekea or a pair of birth symptoms to the surviving fetus during the delivery due to the high-risk group, and that the exposure to the fetus is likely to cause a low oxygen brain injury if the fetus is exposed to the strekea, and that Plaintiff 2’s right to self-determination may be infringed on by failing to explain the streaka, and even when the implementation of the strepathical surgery on the following day after the date of hospitalization, Defendant 2 and 3 violated the duty to explain by implementing the streakthal surgery without any explanation about the streaka and the streaka

3. Determination

A. Determination on medical negligence

(1) Determination on the assertion that the fetus was negligent in monitoring (Article 2-1(a)(i)

According to the medical record appraisal request from the court of first instance as of Sep. 2, 2004, with respect to the statement 1 to 13 of evidence A27 and the president of the Korean Medical Association of the court of first instance as of Sep. 2, 2004, as in the case of Plaintiff 2, delivery in the case of Plaintiff 2 where the fetus was already dead in the part of a day during the pregnancy of both birth was classified by high-risk group only. The time is not continuous from the date printed on the records of the fetus heart back from November 25, 1998 to 19:49 of the same day, from 20:05 to 20:44 of the same day, from 0:0 to 0:35 of Nov. 26, 1998, to 05:300 to 05:35 of the same day, Plaintiff 2 had not output the fetus during the time period from 00 to 05:35 of the same day.

However, Defendant 2’s diagnosis and examination of the body of the Plaintiff 2 and soliciting the Plaintiff 2 to be hospitalized for the purpose of observing the fetus’s survival. Meanwhile, considering that the Plaintiff 2’s medical record was not recorded at the time of birth of the Plaintiff 1, it is difficult to find that the Plaintiff 2’s medical record was kept at the time of birth of the Plaintiff 2, and that the Plaintiff 1’s medical record was not recorded at the time of birth of the Plaintiff 2, and it is difficult to find that the Plaintiff 1’s medical record was recorded at the time of birth of the Plaintiff 1, and that the Plaintiff 2’s medical record was not recorded at the time of birth of the Plaintiff 1, as it was recorded at the time of birth of the Plaintiff 2, it is difficult to find that the Plaintiff 1’s medical record was recorded at the time of birth of the Plaintiff 2, as well as at least 08:50 on the day immediately after the Plaintiff 2 was hospitalized, and that the Plaintiff 1 and Nonparty 2, a midwife of the Plaintiff 2, still decreased.

Furthermore, even if there was negligence on the part of the medical personnel of the Defendant hospital in neglecting the surveillance of the fetus, it is difficult to view that the occurrence of a fetus difficult, such as the Plaintiffs’ assertion, has occurred or aggravated.

Therefore, the plaintiffs' above assertion is without merit.

(2) Determination as to the assertion that a fetus has been overworked and did not reach an early portion (as defined in Section 2(a)(2)

First of all, it is examined whether there is a difficult reason to find whether the fetus has occurred before the plaintiff 2 delivered the plaintiff 1.

살피건대, ① 피고 3에 의하여 작성된 수술기록지(갑23호증의 3)의 수술전 진단과 수술후 진단 란에 진단 명이 태아곤란증으로 기재된 사실은 앞서 본 바와 같고, 갑16호증의 6, 갑18호증, 갑23호증의 1 내지 13, 갑24, 38호증의 각 기재와 제1심 법원의 대한의사협회장에 대한 2004. 9. 2.자 진료기록감정촉탁결과 및 같은 법원의 부산대학교병원장에 대한 사실조회결과에 의하면, ② 원고 2가 피고 병원을 내원하여 비수축검사를 받은 다음 작성된 외래기록지(갑16호증의 6)상에는 “NST ⇒ Suspicious, variability ↓"로 기재되어 있어 태아심음의 변동성이 감소된 듯한 취지로 기재된 사실, ③ 피고 병원에서 1998. 11. 27. 작성된 타과의뢰서(갑24호증)에는 원고 2가 태아곤란증으로 제왕절개술을 시술받은 환자라는 취지의 문구가 기재되어 있고, 위 원고가 피고 병원을 퇴원할 무렵 작성된 피고 병원의 퇴원요약지의 ‘최종진단(final diagnosis)’란에도 태아곤란증으로 기재된 사실, ④ 한편 부산대학교병원장은 제1심 법원의 사실조회에 대하여, 태아감시장치의 태아심음그래프 상 1998. 11. 25. 20:53경 태아심음의 다양성의 감소를 보이고, 같은 날 23:26경 자궁수축의 증거가 관찰되며, 같은 날 22:55경 자궁수축 후 동반된 태아심음의 감소 소견이 관찰된다는 취지로 회신한 사실, ⑤ 대한의사협회장은 제1심 법원의 진료기록감정촉탁에 대하여, 태아심음그래프 상 1998. 11. 25. 20:45경부터 20:55경까지 사이에 태아 심박동의 변동성 감소 소견이 있고, 같은 날 21:05경까지 사이에 1회의 태아 심박동 감소가, 같은 날 21:15경부터 22:45경까지 사이에 불규칙한 자궁수축이 각 관찰되며, 같은 날 22:50경 1회의 자궁수축과 1회의 태아 심박동 감소를 보이고(다만 태아 심박동 감소에 대하여는 기계적인 오류를 배제하지 않고 있다), 같은 날 23:26경부터 다음 날인 1998. 11. 26. 00:05경까지 사이에 이전보다 강도가 커진 불규칙한 자궁수축이, 1998. 11. 26. 05:35경부터 06:00경까지 사이에 다시 강도가 줄어든 불규칙한 자궁수축과 4회 정도의 태아 심박동 감소가 각 관찰되며, 같은 날 08:13경 불규칙한 자궁수축이 계속 관찰되는 한편 태아심음의 변동성이 감소되었으며, 태아 심박동 감소가 약 2회 관찰된다는 취지로 회신한 사실은 인정된다.

However, according to the result of the examination of the medical record of the court of first instance on the Seoul University's request for the examination of the fetus's death, the result of the examination of the change of the fetus at Busan University Hospital, the president of the Korean Medical Association, and the professor at the Law of the Seoul University, the head of the Busan University Hospital pointed out that the temporary change in the fetus's heart, as seen in the above paragraph 4, could not be seen as a result of the examination of the medical record of the defendant hospital's medical record at the time of delivery or the delivery of the medical record at the time of the above plaintiff's medical record, or that there could not be any evidence to suspect that there was a lack of risk of exposure to the fetus at the time of delivery at the time of the above plaintiff's medical record or its delivery, the head of the Korean Medical Association cannot be seen to have determined that there was no serious decrease in the exposure of the fetus at the time of the defendant hospital's request for the examination on the remaining death of the fetus at the end of the second instance medical record.

6) The above facts are as follows: (a) even if the fetus is reduced, if the duration of the fetus remains short and intermittently, it does not affect the fetus; (b) in this case, even if the fetus seems to be operated completely, it appears that the heart food of the fetus was temporarily reduced before the implementation of the sking surgery; (c) even though the fetus was changed temporarily, it appears that the fetus was restored in accordance with the treatment of the midwife at the defendant hospital under the direction of the defendant 3, but it appears that the cerebral macy against the plaintiff 1 is more likely to have been incurred by the salutism after the salutism, rather than by the salutism, in full view of the following factors: (a) it is insufficient to confirm that the above facts alone, including the parts seen to be the salutic operation of the fetus, there is a serious and genuine lack of proof that the fetus might have a meaningful influence on the fetus; and (d) there is no other obvious evidence to prove that there is any other difficulty in finding the fetus.

In the same way, Plaintiff 2 was observed at the time of her delivery of a fetus, which cannot be entirely excluded from the possibility of her difficult pain, and the reduction of her change. However, it is difficult to conclude that Plaintiff 1 was at the time of her delivery to the extent that Plaintiff 2 was at the time of her birth, and that Plaintiff 1 was at the time of her birth and was at the time of her birth and at the time of her birth (the period of her birth is at least 36 weeks, the body of 2,300g, and the risk of her birth is greater than that of her pregnancy after her death, the above fact that Plaintiff 2 was at the time of her birth and was at the time of her birth and was at the time of her birth, and that Plaintiff 2 was at the time of her early delivery and was at the time of her birth and was at the time of her birth and was at the time of her birth and was at the time of her birth and was at the time of her birth (other, the above Plaintiff 2'sium was at the above 1000.

(3) Determination as to the assertion that fin injection and suspension of supply of oxygen have increased fetus difficulty (Article 2-A.3)

On November 26, 1998, at around 00:00 on the part of the defendant 3, the non-party 2 of the defendant hospital's midwife non-party 2 appealed to the above plaintiff at around 00:20 on the same day as the plaintiff 3's instructions, and the non-party 2 suspended the supply of a mountain suit to the above plaintiff at around 03:00 on the same day, but resumed the supply of a mountain suit at around 05:00 on the same day. In light of the record of evidence No. 41 and the medical record entrustment report of the court of first instance on February 26, 2004 to the president of the Korean Association of Medical Doctors at the court of first instance, it is recognized that the newborn may cause symptoms to the newborn baby in the event that fin and the induced body is administered to the mother body of the part of the part of the part of the mother body, and it is recognized that findine injection can restrain the pulmon of the fetus, and that may cause an embryo.

However, as seen earlier, there is no evidence to deem that the fetus was difficult even after Non-party 2's transfer of Finine and its administration or the suspension of the supply of oxygen, as well as that there was no evidence to deem that the fetus was difficult, and according to the result of the medical record appraisal on September 2, 2004 on the president of the Korean Medical Association of the court of first instance, it can be administered on the ground of the reduction of pain, and the fetus may have a temporary action, but it is recognized that the fetus was not difficult to prove the degree that the fetus was difficult, except in the case where the fetus was administered immediately before the delivery. In light of the fact that Non-party 2 might not be deemed to have been immediately preceding the part of the plaintiff's womb at the time of its administration to the plaintiff 2, it is difficult to view that the fetus was destroyed or aggravated by the finine's administration.

Therefore, the plaintiffs' above assertion seems to be a mother or without merit.

(4) Additional Judgment - The causal relationship between the Defendants’ negligence and the Plaintiff 1’s cerebral cerebral macy

Even if a fetus was damaged by medical negligence as alleged by the Plaintiffs, as seen earlier, the Plaintiff 2 had already died of one side of the two children at the time when the Defendant hospital was established. According to the result of each medical record appraisal entrustment to the president of the Korean Medical Association of the first instance court and the fact inquiry to the president of the Busan National University Hospital, according to each fact inquiry to the director of the Busan National University University Hospital, the Head of the Korean Medical Association, and the Head of the Law of the Seoul National University, each of the above institutions was unable to prove the causal relationship between the Plaintiff 1 and the Plaintiff 1’s cerebral sis from the death of the two births rather than the difficulty of proving the fetus. Thus, it is difficult for the Plaintiff 1 to prove that the causal relationship between the Plaintiff 1 and the Plaintiff 2’s her mother-child’s her mother-child her mother-child her mother-child her mother-child her mother-child her mother-child her mother-child her mother-child her mother-child her mother-child her mother.

Therefore, in this respect, the plaintiffs' above assertion cannot be accepted.

B. Determination on the assertion of violation of the duty to explain

The doctor's duty to explain to the patient is not limited to the time of surgery, and it takes place at all stages of medical treatment, such as examination, diagnosis, and treatment. However, if a doctor fails to explain the patient properly and the patient suffers from unexpected significant results by performing the surgery, etc., the doctor is required to choose whether the patient would receive the medical treatment by exercising his/her right to self-determination even though the patient would have been able to avoid serious results by choosing whether the patient would receive the medical treatment by exercising his/her right to self-determination. In this sense, the doctor's explanation is not subject to all medical procedures, but subject to the whole medical procedure, and it is necessary for the doctor to select the patient as a result of a medical act with possibility of adverse results such as surgery, diagnosis, and treatment, or medical act with anticipated adverse results, such as death, and it is not necessary for the patient to select the patient by his/her own decision, and therefore, it is not subject to the duty of self-determination 94 or 15.

Based on these legal principles, the act of the medical personnel of the defendant hospital, including the health unit and the defendant 2, soliciting the plaintiff 2 to be hospitalized in order to observe the condition of the surviving fetus itself cannot be deemed as a medical act that is likely to cause an invasion such as surgery, or an adverse result. Thus, it is difficult to view the act of soliciting hospitalization itself as a medical act that is subject to the duty to explain. Meanwhile, prior to the execution of the king surgery, the defendant 3 explained the necessity and side effects of surgery to the plaintiff 2 and the non-party 7, who is its machine, and explained that the death of the fetus may not affect the fetus's survival, and as seen earlier, the defendant 3 fulfilled the duty to explain. Accordingly, it is reasonable to view that the defendant 3 fulfilled the duty to explain if the fetus died in the day, it is difficult to predict whether the two-way disease occurred in the aftermath, and it is difficult to see that the defendant 3 violated the duty to explain the fetus in this case due to the lack of any specific explanation of the symptoms or symptoms of the fetus.

4. Conclusion

Therefore, the plaintiffs' claims based on the premise that the damages were incurred to the plaintiffs due to the negligence of the medical staff of the defendant hospital are dismissed without any further consideration as to the scope of damages, etc., and the judgment of the court of first instance is justified in this conclusion, and it is so decided as per Disposition.

Judges Park Jong-nam (Presiding Judge)

1) The device that detects the heart of a fetus mainly through the marctic wall of the mother and records it continuously through the marctic wall of the mother. At the same time, by applying the device that detects the degree of the heart of the fetus at the same time, the level of the heart and the marc of the womb of the fetus shall also be indicated by applying both the device detecting the degree of the heart of the fetus at the same time.

2) NST is also NST. The response to the Taedong means the method of assessing the health condition of a fetus through an examination as to whether her fetus heart is appropriately increased.

3) A manager of a pregnant woman in charge of diagnosis, management and education, delivery, and delivery of a woman in pregnancy may receive a mixed baby, and a woman in charge of a woman in childbirth and a baby may take an emergency measure, if necessary, after discovering the abnormal situation of the woman in childbirth and the baby.

Note 4) In a normal physiological state, the interval between the rest of the fetus heart is changed with a certain minor difference, and the size and direction of the fetus are changing with the strength and direction. This is a change in the depth or diversity of the fetus.

Note 5) The range of the circumstances is 11 to 17.

Note 6) Normalia is less than 1%.