大口 昭英

妊婦10069例を対象に多重ロジスティックモデルを用いて解析し,高年出産において分娩後出血が増加するか,輸血が増加するかについて検討した.経腟分娩における過多出血の90パーセンタイル値は615mlで,従来異常出血の定義とされていた500mlより多かった.初産経腟分娩での分娩後過多出血の最大危険因子は低位胎盤であり,経産経腟分娩での最大危険因子は既往帝王切開であった.年齢の影響は低位胎盤,既往帝王切開と比較すると小さかったが,分娩後過多出血の独立危険因子であった.帝王切開分娩では,前置胎盤,次いで子宮筋腫が分娩後過多出血の大きな危険因子であった.年齢の影響は前置胎盤,子宮筋腫と比較すると小さかったが,初産においては分娩後過多出血の独立危険因子であった.しかし高年出産は輸血の実施とは関連性が認められなかった

26歳女.妊娠7〜10週の間切迫流産で入院した.妊娠28週3日,軽度の呼吸苦,咽吐,急激な体重増加,著明な全身浮腫を認め,腹緊の出現が頻回になった.妊娠中毒症,切迫早産の診断で入院となった.著明なAT-III活性低下を伴うDICを合併したHELLP症候群疑いの診断で緊急母体搬送となった.DICの改善を目的としてFOYを開始した.減少した凝固因子の補充と,出血性ショックの改善のためFFPとMAPを輸血した.FDPは急速に改善した.肝機能異常,FDP値は急速に改善したが,AT-III活性の改善は遷延した.DIC治療後の経過は順調で,術後浮腫,高血圧等なく術後14日目に退院となった

無作為に選択した妊婦において,妊娠中期の子宮動脈血流速度波形を用いたスクリーニングにより,pre-eclampsiaの発生が予知し得るかどうかを検討し,子宮動脈の血管抵抗の指標としてresistance index(RI),最大収縮期/拡張早期血流速度比(A/C比),notchの有無及びnotch depth index(NDI)のいずれがpre-の発生予知に有用かを比較した.288例中9例がpre-eclampsiaを発症した.全ての指標が統計学的に有意な予知力を有していた.感度,特異度,陽性予測値及び相対危険率はRIでは78%,87%,16%,9.7,A/C比では67%,85%,12%,19.2,NDIでは67%,92%,22%,19.2であった.NDIが小さい,即ちnotchが小さい波形を有した妊婦はpre-eclampsiaになりにくいことが示唆された

妊娠中の収縮期血圧30mmHg以上の上昇或いは拡張期血圧15mmHg以上の上昇(△BP上昇)の臨床的意義を検討した.妊娠後期正常血圧かつ△BP上昇群は,妊娠後期正常血圧かつ△BP非上昇群と比較して,尿蛋白出現及びIUGRの発生に差を認めなかった.妊娠後期高血圧の影響を補正すると,△BP上昇は尿蛋白出現,IUGRのリスクを高めないことが判明した.妊娠初期血圧が低い群からは妊娠中毒症の発症率が低いにも関わらず,妊娠初期血圧が低い群では妊娠後期の血圧上昇幅が大きく,更に,妊娠初期血圧が低い群ほど△BP上昇の発生率が高いことを明らかにした

PROBLEM: The fractions of Th1 cells and Tc1 cells may be increased in preeclamptic women compared with healthy pregnant women. METHOD OF STUDY: Eleven healthy non-pregnant women, nine healthy pregnant women (34.1 +/- 3.1 weeks of gestation), and 10 women with preeclampsia (32.0 +/- 5.4 weeks) were studied. The fractions of Th1 cells, Th2 cells, Tc1 cells, and Tc2 cells in the peripheral blood mononuclear cells were determined using a three-color flow cytometric technique. The concentrations of plasma plasminogen activator inhibitor-2 (PAI-2) were simultaneously determined. RESULTS: The fraction of Th1 cells was significantly larger in women with preeclampsia (18.7 +/- 5.2%) than in normal pregnant women (11.0 +/- 5.7%), and it increased with a decrease in the PAI-2 level (r = - 0.706, P = 0.002), which was significantly lower in preeclamptic women (83.4 +/- 46.8 ng/mL) than in normal pregnant women (225.3 +/- 82.0 ng/mL). The fraction of Tc1 cells increased with increases in the fraction of Th1 cells (r = 0.657, P < 0.001) and the ratio of Th1-to-Th2 cells (r = 0.535, P = 0.002). The ratio of Tc1-to-Tc2 cells also increased with an increase in the ratio of Th1-to-Th2 cells (r = 0.394, P = 0.031). CONCLUSIONS: The fraction of Th1 cells appears to be expanded in women with preeclampsia compared with healthy pregnant women.

Options for the treatment of thoracoabdominally conjoined twins are dependent on the anatomy of the cardiovascular system. It is important to increase the accuracy of diagnosis of conjoined twins with a fused heart. Color Doppler imaging performed in a 23-year-old nulliparous Japanese woman at 12 weeks of gestation revealed synchronized blood flow in 2 aortic arches arising from a single heart. The patient underwent a therapeutic abortion, and the diagnosis of conjoined twins with a fused heart was confirmed. Thus, color Doppler imaging is useful for investigating the cardiovascular anatomy in conjoined twins suspected of having a fused heart, even in an early gestational age.

Objectives To develop a new quantitative index, the notch depth index (NDI), to evaluate its association with the risk of pre-eclampsia and a small-for-gestational-age (SGA) infant and to compare its clinical usefulness with that of the uterine artery resistance index (RI) and the peak systolic to early diastolic velocity (A/C) ratio. Methods Uterine artery color Doppler ultrasound was performed in 288 consecutive healthy pregnant women at 20.2 +/- 2.0 (range 16.0-23.9) weeks of gestation. The NDI represents the depth of the early diastolic notch divided by the maximal diastolic velocity. Results Nine (3.1%) of the 288 women developed pre eclampsia and 18 women (6.3%) delivered an SGA infant. The NDI was associated with subsequent onset of pre-eclampsia. The optimal cutoff value for the NDI in predicting pre-eclampsia was 0.14, giving a sensitivity specificity and a positive predictive value (PPV) of 67, 92, and 22%, respectively The PPV of the NDI was the largest of the three indices evaluated (12% for the RI and 26% for the A/C ratio). The relative risk for pre-eclampsia in women with values equal to or greater than the optimal cutoff values of the RI, A/C ratio and the NDI was 9.7 (95% confidence interval, 2.5-3.7), 19.2 (4.2-91), and 19.2 (5.1-71), respectively. The NDI of 0.14 improved the PPV of 18% determined by the presence of notches in bilateral uterine arteries. The optimal cutoff value of 0.14 for the NDI in predicting an SGA infant yielded a higher PPV (22%) than those for the RI (9%) and AIC ratio Conclusions The NDI value in the second trimester is associated with the later onset of pre-eclampsia, and is clinically more useful In predicting pre-eclampsia than the two conventional indices.

子宮内胎児発育遅延(IUGR)を合併した典型的な抗リン脂質抗体症候群を2症例経験した.1例では,子宮動脈血流速度波形の異常はIUGRの発症に先行していた.もう1例では,抗カルジオリピンβ2GPI抗体異常の高値のため,ステロイド+低用量アスピリン療法に加えて免疫吸着療法を併用した

妊娠30週以降死産となった単胎妊娠77例の死産原因について検討した.無脳児11例を含む21例は重篤な奇形を有していた.外表奇形のなかった56例中2例に顕著な胎児水腫を認めた.残り54例中21例では妊娠中毒症が胎児死亡に先行しており9例は胎盤早期剥離も合併していた.妊娠中毒症のなかった33例中15例では死産原因を特定できなかったが,残り18例の原因は胎盤早期剥離(9例),胎盤機能不全(3例),HELLP症候群(3例),絨毛羊膜炎(2例),臍帯真結節(1例)と考えられた.このように胎盤早期剥離が外表奇形のない児の死産原因の33%を占めた.外表に異常がなかった54例中,剖検は僅かに13例に行われたのみであった

We encountered a fetus who exhibited transient (at most 30 s), repeated episodes of tachyarrhythmia (240 bpm). This female neonate was born at 36 weeks of gestation and showed a markedly prolonged QT interval and transient, repeated episodes of polymorphic ventricular tachycardia. Congenital long QT syndrome was diagnosed. Retrospective analysis of the videotape showing fetal cardiac movement revealed that atrio-ventricular dissociation was present prenatally and thus, the fetal tachyarrhythmia was due to ventricular tachycardia. To our knowledge, there are few reports of a fetus with the long QT syndrome who exhibited ventricular tachycardia in utero. In the presence of unexplained fetal tachyarrhythmia, long QT syndrome should be considered as a possible underlying cause disorder. The presence of atrio-ventricular dissociation may be useful in prenatal diagnosis of long QT syndrome. Copyright (C) 1999 John Wiley & Sons, Ltd.

神経学的後障害のリスクファクターとしては,LTVが10bpm以上及び長期の塩酸リトドリン投与が有意であった.また,有意ではなかったものの,PROM,CAM,Doppler異常,早期出生,敗血症,人工換気は神経学的後障害のリスクファクターである可能性が示唆された.また,1歳迄の新生児死亡については,CAM,アプガースコア5分値,出生週数が独立した予後因子であった