下大静脈血流波形による胎児循環動態の評価(2 胎児wellbeingの臨床的評価法 : その精度と限界)

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Objective: In the fetal hydrops hypoxemia or acidemia are not always present, but the fetal jeopardy resulting in the death actually exists. This is the reason why the assessment of fetal circulation is imperative to evaluate the fetal wellbeing. In the fetus cardiac impairment seems to be manifested by right heart failure, thus the investigation of venous circulation is particularly important. The purpose of this study is to elucidate the usefulness of inferior vena caval (IVC) blood flow measurement for the evaluation of the fetal wellbeing and to confirm the pathophysiology which influence the blood flow of IVC using animal model. Methods: The new index named preload index (PLI) was defined to evaluate the reverse flow of the IVC. Among several fetal diseases including IUGR, the PLI values were compared. In the chronically prepared pregnant sheep animal mode, the effect of the transfusion to the fetus was studied. Results: The mean of PLI is almost constant after 24 gestational weeks and the cut off value is set at 0.4 throughout this period. The PLI value was high in the case of endometrial fibroelastosis of the heart with hydrops, which represents the typical fetal heart failure. In the IUGR the elevation of PLI indicated the poor neonatal outcome. In the animal model, the correlation between the fetal central venous pressure and the blood flow pattern was confirmed. Conclusion : The usefulness of the IVC blood flow analysis for the assessment of the fetal condition was confirmed.
社団法人日本産科婦人科学会の論文
2002-08-01

下大静脈血流波形による胎児循環動態の評価(2 胎児wellbeingの臨床的評価法 : その精度と限界)

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