妊娠初期脱落膜の研究
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概要
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Studies were carried out on the endometrium at the early stages of gestation, especially on inflammation of the decidual membranes of pregnancy. The specimen for pathologic study consisted of the deciduae obtained from 345 cases of forced abotion and 5 cases from which the uterus had been removed surgically, together with the fetus. The following results were obtained : 1. The normal decidual membranes of pregnancy. a. Staining by Hashizume's technique is the best method for classification of the cells of the decidual membranes. b. Contrary to the observations made by Deelmann, the specific decidual reaction of the connective tissue appearing around the blood vessels was not necessarily noticed more commonly in old women than in young ones. c. There was an infiltration of the round cells, but no infiltration of the polynuclear leukocytes, in the decidua vera of normal pregnancy. There was, however, an infiltration of the polynuclear leukocytes in the decidua basalis and the decidua capsularis. d. Many of the decidual membranes from young women were thick and enlarged, while many on those from old women were thin. e. There was a tendency for the decidual membranes to be thinner in direct proportion to the number of childbirths. They varied in thickness from individual to individual. Even in the same person, they varied in thickness each time she was pregnant. 2. The morbid decidual membranes of pregnancy. a. Two cases of endometritis deciduae tubuosa are reported. The difference between, the decidual membranes of these cases and the normal ones seems to lie in the amounts of cells and glands that have proliferated as well as in the degree of congestion, having essentially no relation with infection. It is considered most likely that abnormal prolifera tion of the cells and congestion in the endometrium may cause hemorrhage and destruction of the tissue to occur, resulting in abortion. As to the etiological factors, the author is in favor of the hormone theory of Kehrer. b. Congestion characterized the decidual membranes of the retroflexed uterus. It appears to be an important factor in the occurrence of abortion in the cases of retroflexed uterus. c. In order to evaluate the significance of the cervi uteri in the development of inflammation of the decidual membranes, the incidence of appearance of a colony of more than 30 or 40 round cells in the compact and spongy layers, a symptom of inflammation of the deciduae, was investigated in cases divided into 8 groups based on the combination of the following conditions : dilatation of the cervix, uteri, erosion of the portis vaginalis, and retroflexion of the uterus. It was revealed that dilatation and erosion of the cervix tueri were closely related to the development of inflammation of the decidual membranes. d. For the purpose of investigatingthe changes occurring in the decidual membranes after the death of a fetns, the specimen was examined which was obtained 24 hours after the fetus in the 4th or 5th month had been Killed by cutting off the umbilical cord by Injima's method. Histologic changes appearing in the decidua basalis consisted primarily of congestion, hemorrhage and degeneration. On the other hand, the decidua vera was affected slightly, showing no evidence of inflammatory changes within 24 hours after the umbilical cord had been cut off. e. Marked inflammation, as well as congestion, characterized the residual portion of the decidual membranes following spontaneous abortion in the majority of cases. In the light of these observations, the author has concluded that endometritis decidualis, which has been thought to be a causative factor in abortion, is not a cause but an effect of abortion.
- 千葉大学の論文
- 1960-11-28