羊水過少症に対する人工羊水注入の検討
【目的】第2三半期までの未破水の羊水過少症に対する経腹的羊水注入の治療的意義の報告は少ない．羊水過少症に対して経腹的羊水注入を行った症例について，妊娠期間の延長および肺低形成の予防に関する効果を検討した．【方法】2007年から2016年までに当院で未破水の羊水過少症の診断を行い経腹的羊水注入を行った7例を対象とし，妊娠分娩および出生後の経過を後方視的に検討した．【結果】臍帯胎盤因子が5例，胎児腎尿路奇形が2例であった．羊水過少症の診断の週数は中央値24週，分娩週数は中央値35週，診断から分娩までの期間は中央値12週，羊水注入回数は臍帯胎盤因子では中央値4回，胎児腎尿路奇形では11回と21回であ...
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| Published in | 日本周産期・新生児医学会雑誌 Vol. 59; no. 1; pp. 38 - 44 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本周産期・新生児医学会
2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1348-964X 2435-4996 |
| DOI | 10.34456/jjspnm.59.1_38 |
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| Abstract | 【目的】第2三半期までの未破水の羊水過少症に対する経腹的羊水注入の治療的意義の報告は少ない．羊水過少症に対して経腹的羊水注入を行った症例について，妊娠期間の延長および肺低形成の予防に関する効果を検討した．【方法】2007年から2016年までに当院で未破水の羊水過少症の診断を行い経腹的羊水注入を行った7例を対象とし，妊娠分娩および出生後の経過を後方視的に検討した．【結果】臍帯胎盤因子が5例，胎児腎尿路奇形が2例であった．羊水過少症の診断の週数は中央値24週，分娩週数は中央値35週，診断から分娩までの期間は中央値12週，羊水注入回数は臍帯胎盤因子では中央値4回，胎児腎尿路奇形では11回と21回であった．児は全例生存，退院時に人工呼吸器の症例は認めなかった．胎児腎尿路奇形は腎移植となった．【結論】未破水の経腹的羊水注入は，胎児腎尿路奇形だけでなく，臍帯胎盤因子においても羊水注入による効果を示唆されたことから，治療選択肢になりうる． |
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| AbstractList | 【目的】第2三半期までの未破水の羊水過少症に対する経腹的羊水注入の治療的意義の報告は少ない．羊水過少症に対して経腹的羊水注入を行った症例について，妊娠期間の延長および肺低形成の予防に関する効果を検討した．【方法】2007年から2016年までに当院で未破水の羊水過少症の診断を行い経腹的羊水注入を行った7例を対象とし，妊娠分娩および出生後の経過を後方視的に検討した．【結果】臍帯胎盤因子が5例，胎児腎尿路奇形が2例であった．羊水過少症の診断の週数は中央値24週，分娩週数は中央値35週，診断から分娩までの期間は中央値12週，羊水注入回数は臍帯胎盤因子では中央値4回，胎児腎尿路奇形では11回と21回であった．児は全例生存，退院時に人工呼吸器の症例は認めなかった．胎児腎尿路奇形は腎移植となった．【結論】未破水の経腹的羊水注入は，胎児腎尿路奇形だけでなく，臍帯胎盤因子においても羊水注入による効果を示唆されたことから，治療選択肢になりうる． |
| Author | 谷口, 博子 三浦, 美沙 戸田, 薫 前田, 隆嗣 切原, 奈美 上塘, 正人 |
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| References | 19) van den Wijingaard JA, Pijpers L, Reuss A, et al.：Effect of amnioinfusion on the umbilical Doppler flow velocity wavefprm: a case report. Fetal Ther 1987；2：27-30 2) Rutherford SE, Phelan JP, Smith CV, et al.：The four quadrant assessment of amniotic fluid volume: An adjunct to antepartum fetal heart rate testing. Obstetrics Gynecology 1987；70：353-6 10) Gramellini D, Fieni S, Kaihura C, et al.：Transabdominal antepartum amnioinfusion. International Journal of Gynecology & Obstetrics 2003；83：171-8 15) Brace RA, Cheung CY, Anderson DF：Regulation of amniotic fluid volume: insights derived from amniotic fluid volume function curves. Am J Physiol Regul Integr Comp Physiol 2018；315：777-89 23) Haeri S, Simon DH, Pillutla K：Serial amnioinfusions for fetal pulmonary palliation in fetuses with renal failure. J Matern Fetal Neonatal Med 2017；30：174-6 7) Van Teeffelen S, Pajkrt E, Willekes C, et al.：Transabdominal amnioinfusion for improving fetal outcomes after oligohydramnios secondary to preterm prelabour rupture of membranes before 26 weeks. Cochrane Database Syst Rev 2013；doi:10.1002/14651858.CD009952.pub2.［Epub ahead of print］ 17) Brace RA, Cheung CY：Pre-delivery changes in amniotic fluid volume and composition in sheep. J Soc Gynecol Investig 2005；12：396-401 21) Iwagaki S, Takahashi Y, Chiaki R, et al.：Hypercoiled cord can cause a reversible abnormal Doppler in ductus venosus in cases of fetal growth restriction. J Obstet Gynaecol Res 2018；44：1922-1928 4) Oyelese Y：Placenta, Umbilical Cord and Amniotic Fluid: The Not-less-important Accessories. Clinical Obstetrics and Gynecology 2012；55：307-23 6) Rotschild A, Ling EW, Puterman ML, et al.：Neonatal outcome after prolonged preterm rupture of the membranes. Am J Obstet Gynecol 1990；162：45-52 14) Ulkumen BA, Pala HG, Baytur YB, et al.：Outcomes and management strategies in pregnancies with early onset oligohydramnios. Clin Exp Obstet Gynecol 2015；42：355-7 11) Gramellini D, Fieni S, Kaihura C, et al.：Antepartum amnioinfusion: a review. The Journal of Maternal-Fetal and Neonatal Medicine 2003；14：291-296 18) Vanderheyden T, Kumar S, Fisk NM：Fetal renal impairment. Seminars in Neonatology 2003；8：279-289 5) Wu CS, Chen CM, Chou HC：Pulmonary Hypoplasia Induced by Oligohydramnios: Findings from Animal Models and a Population-Based Study. Pediatr Neonatol 2017；58：3-7 20) Sarno AP, Polzin WJ, Feinstein SJ, et al.：Transabdominal amnioinfusion in preterm pregnancies complicated by fetal growth restriction, oligohydramnios and umbilical cord compression. Fetal Diagn Ther 1995 Nov-Dec；10：408-14 22) Takahashi Y, Iwagaki S, Chiaki R, et al.：Amnioinfusion before 26 weeks’ gestation for severe fetal growth restriction with oligohydramnios: Preliminary pilot study. J Obstet Gynaecol Res 2014；40：677-685 3) Daniel SS, Yeh MN, Bowe ET, et al.：Renal response of the lamb fetus to partial occlusion of the umbilical cord. J Pediatr 1975；87：788-94 24) Athalye-Jape G, Lim M, Nathan E, et al.：Outcomes in extremely low birth weight（≤500 g）preterm infants: A Western Australian experience. Early Human Development 2022；167：105553. doi:10.1016/j.earlhumdev.2022.105553 1) 宮川康司，山本樹生：羊水過少．周産期医学 2001；31：1047-49 8) Spinillo A, Cesari S, Bariselli S, et al.：Placental lesions associated with oligohydramnios in fetal growth restricted（FGR）pregnancies. Placenta 2015；36：538-44 16) Kamitomo M, Alonso JG, Okai T, et al.：Effects of long-term, high-altitude hypoxemia on ovine fetal cardiac output and blood flow distribution. Am J Obstet Gynecol 1993；169：701-7 9) Turhan NO, Atacan N：Antepartum prophylactic transabdominal amnioinfusion in preterm pregnancies complicated by oligohydramnios. International Journal of Gynecology & Obstetrics 2002；76：15-21 12) Nicksa GA, Yu DC, Kalish BT, et al.：Serial amnioinfusions prevent fetal pulmonary hypoplasia in a large animal model of oligohydramnios. J Pediatr Surg 2011；46：67-71 13) Shipp TD, Bromley B, Pauker S, et al.：Outcome of singleton pregnancies with severe oligohydramnios in the second and third trimesters. Ultrasound Obstet Gynecol 1996；7：108-13 |
| References_xml | – reference: 12) Nicksa GA, Yu DC, Kalish BT, et al.：Serial amnioinfusions prevent fetal pulmonary hypoplasia in a large animal model of oligohydramnios. J Pediatr Surg 2011；46：67-71 – reference: 13) Shipp TD, Bromley B, Pauker S, et al.：Outcome of singleton pregnancies with severe oligohydramnios in the second and third trimesters. Ultrasound Obstet Gynecol 1996；7：108-13 – reference: 1) 宮川康司，山本樹生：羊水過少．周産期医学 2001；31：1047-49 – reference: 19) van den Wijingaard JA, Pijpers L, Reuss A, et al.：Effect of amnioinfusion on the umbilical Doppler flow velocity wavefprm: a case report. Fetal Ther 1987；2：27-30 – reference: 5) Wu CS, Chen CM, Chou HC：Pulmonary Hypoplasia Induced by Oligohydramnios: Findings from Animal Models and a Population-Based Study. Pediatr Neonatol 2017；58：3-7 – reference: 17) Brace RA, Cheung CY：Pre-delivery changes in amniotic fluid volume and composition in sheep. J Soc Gynecol Investig 2005；12：396-401 – reference: 14) Ulkumen BA, Pala HG, Baytur YB, et al.：Outcomes and management strategies in pregnancies with early onset oligohydramnios. Clin Exp Obstet Gynecol 2015；42：355-7 – reference: 24) Athalye-Jape G, Lim M, Nathan E, et al.：Outcomes in extremely low birth weight（≤500 g）preterm infants: A Western Australian experience. Early Human Development 2022；167：105553. doi:10.1016/j.earlhumdev.2022.105553 – reference: 6) Rotschild A, Ling EW, Puterman ML, et al.：Neonatal outcome after prolonged preterm rupture of the membranes. Am J Obstet Gynecol 1990；162：45-52 – reference: 9) Turhan NO, Atacan N：Antepartum prophylactic transabdominal amnioinfusion in preterm pregnancies complicated by oligohydramnios. International Journal of Gynecology & Obstetrics 2002；76：15-21 – reference: 20) Sarno AP, Polzin WJ, Feinstein SJ, et al.：Transabdominal amnioinfusion in preterm pregnancies complicated by fetal growth restriction, oligohydramnios and umbilical cord compression. Fetal Diagn Ther 1995 Nov-Dec；10：408-14 – reference: 22) Takahashi Y, Iwagaki S, Chiaki R, et al.：Amnioinfusion before 26 weeks’ gestation for severe fetal growth restriction with oligohydramnios: Preliminary pilot study. J Obstet Gynaecol Res 2014；40：677-685 – reference: 8) Spinillo A, Cesari S, Bariselli S, et al.：Placental lesions associated with oligohydramnios in fetal growth restricted（FGR）pregnancies. Placenta 2015；36：538-44 – reference: 18) Vanderheyden T, Kumar S, Fisk NM：Fetal renal impairment. Seminars in Neonatology 2003；8：279-289 – reference: 21) Iwagaki S, Takahashi Y, Chiaki R, et al.：Hypercoiled cord can cause a reversible abnormal Doppler in ductus venosus in cases of fetal growth restriction. J Obstet Gynaecol Res 2018；44：1922-1928 – reference: 3) Daniel SS, Yeh MN, Bowe ET, et al.：Renal response of the lamb fetus to partial occlusion of the umbilical cord. J Pediatr 1975；87：788-94 – reference: 7) Van Teeffelen S, Pajkrt E, Willekes C, et al.：Transabdominal amnioinfusion for improving fetal outcomes after oligohydramnios secondary to preterm prelabour rupture of membranes before 26 weeks. Cochrane Database Syst Rev 2013；doi:10.1002/14651858.CD009952.pub2.［Epub ahead of print］ – reference: 2) Rutherford SE, Phelan JP, Smith CV, et al.：The four quadrant assessment of amniotic fluid volume: An adjunct to antepartum fetal heart rate testing. Obstetrics Gynecology 1987；70：353-6 – reference: 16) Kamitomo M, Alonso JG, Okai T, et al.：Effects of long-term, high-altitude hypoxemia on ovine fetal cardiac output and blood flow distribution. Am J Obstet Gynecol 1993；169：701-7 – reference: 4) Oyelese Y：Placenta, Umbilical Cord and Amniotic Fluid: The Not-less-important Accessories. Clinical Obstetrics and Gynecology 2012；55：307-23 – reference: 23) Haeri S, Simon DH, Pillutla K：Serial amnioinfusions for fetal pulmonary palliation in fetuses with renal failure. J Matern Fetal Neonatal Med 2017；30：174-6 – reference: 10) Gramellini D, Fieni S, Kaihura C, et al.：Transabdominal antepartum amnioinfusion. International Journal of Gynecology & Obstetrics 2003；83：171-8 – reference: 11) Gramellini D, Fieni S, Kaihura C, et al.：Antepartum amnioinfusion: a review. The Journal of Maternal-Fetal and Neonatal Medicine 2003；14：291-296 – reference: 15) Brace RA, Cheung CY, Anderson DF：Regulation of amniotic fluid volume: insights derived from amniotic fluid volume function curves. Am J Physiol Regul Integr Comp Physiol 2018；315：777-89 |
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| Title | 羊水過少症に対する人工羊水注入の検討 |
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