(4)臍帯異常の早期診断とハイリスク群の抽出及び管理に関する研究(<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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Objectives: To evaluate early detection and prediction of high risk pregnancies with umbilical cord abnormalities and to propose management of these cases. Methods: 1) Causations of intrauterine fetal death (IUFD), fetal growth restriction (FGR) and nonreassuring fetal status (NRFS) were retrospectively analyzed. 2) Relations among coiling index of umbilical cord, umbilical ring constriction and velocities of umbilical vein blood flow were evaluated. 3) Frequencies of variable deceleration, NRFS and emergency cesarean section in cases with abnormal cord insertion were evaluated. 4) Aspects of 8 vasa previa cases were retrospectively analyzed. 5) A prospective cohort study was conducted, in which the relationship between cord insertion sites diagnosed via a grey scale transvaginal ultrasound examination between 9 and 11 weeks of gestation, and placenta and umbilical cord abnormalities at delivery were assessed. 6) Retrospective analyses were done to investigate the relationship between cord abnormalities and intrapartum fetal heart rate paterns. Results: 1) Hyper coiled cord (HCC), especially that with umbilical ring constriction, and velamentous cord insertion (VCI) were high risk for IUFD, FGR and NRFS. 2) Ultrasonically, high coiling index of umbilical cord torsion and high umbilical vein flow velocity at the umbilical ring were high risk for perinatal complication. 3) In cases with abnormal cord insertions, especially VCI into lower third of uterine segment, frequency of emergency cesarean sections was extremely high. 4) Placenta previa in mid-gestation, unexplained FGR and lower umbilical cord insertions were risk factor for vasa previa. 5) Cases with lower umbilical cord insertions in early gestation were risk factor for placenta and/or cord abnormalities and perinatal complication. 6) Frequencies of atypical variable decelerations were higher in cases with HCC and VCI than controls. Conclusion: Cases with umbilical cord abnormalities, especially HCC, VCI and multiple or complicated cord abnormalities, should be ultrasonically diagnosed in earlier gestation. In these cases, intensive fetal heart rate monitoring should be performed at delivery. Furthermore, additional screening for the cord insertion site at 9 to 11 weeks of gestation may have clinical significance for detecting abnormalities of the cord and the placenta.
- 2008-09-01
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