(2)合併症妊娠の管理方法 : 分娩のタイミングと母児の長期予後に関する検討(<特集>第60回学術講演会シンポジウム1「ハイリスク妊娠・分娩の管理」)

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Objective: To identify prenatal events associated with preterm delivery at less than 35 weeks of gestation and long term prognosis of mother and neonate in women with congenital heart disease (group I), renal transplant (group II) and diabetes mellitus (group III). Methods: A case-control study was conducted of 599 pregnant women with group I, 53 pregnant women with group II and 219 pregnant women with group III, who were treated at a single medical center. Fetal anomaly and multiple pregnancy excluded from this study. In the prognosis of mother, maternal death was defined as within 1year after birth. The deterioration of baseline disease was defined as any of the following: the operation or re-operation in group I , graft loss in group II and retinopathy or nephropathy progression in group III. In the prognosis of neonate, primary outcome was defined as perinatal death or death. Secondary outcome was defined as yes or no of cerebral palsy (CP), borderline (BL) and mental retardation (MR). Results: Preterm delivery at less than 35 weeks of gestation occurred 38 cases (6.3%) in group I, 23 cases (43.4%) in group II and 16 cases (7.3%) in group III. The mean gestaional age at delivery was 38.1±2.4 in group I, 35.5±3.3 in group II and 37.5±2.7 in group III. In this case-control study, the deterioration of baseline disease, hypertension prior to delivery or pregnancy induced hypertension (PIH), was found to be correlated with an increase in the risk of preterm delivery at less than 35 weeks of gestation. There were no maternal deaths in three groups. The deterioration of baseline disease occurred 8 cases (1.3%) in group I, 16 cases (30.1%) in group II and 22 cases (10.0%) in group III. In the prognosis of the neonate, 592 cases (98.9%) were live births, and fetal and neonatal death complicated 3 and 4 cases, respectively in group I. CP, BL and MR occurred 1 case, respectively in group I. Although there were no neonatal death in group II, CP and MR occurred 1 case, respectively. In group III, 1 neonatal death occurred and there were no CP, BL and MR. Conclusion: In this case-control study, the deterioration of baseline disease was found to be correlated with the long term prognosis of mother. Factor that influence in the long term prognosis of neonate was found to be correlated with neonatal prematurity due to the earlyness of gestational week at delivery.
社団法人日本産科婦人科学会の論文
2008-09-01

(2)合併症妊娠の管理方法 : 分娩のタイミングと母児の長期予後に関する検討(<特集>第60回学術講演会シンポジウム1「ハイリスク妊娠・分娩の管理」)

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