新女性医学大系 30 胎児胎盤機能評価

出版社: 中山書店
著者:
発行日: 2002-03-31
分野: 臨床医学:外科  >  産婦人科学
ISBN: 9784521544410
電子書籍版: 2002-03-31 (第1版第1刷)
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分娩前から分娩後に至るまで、児の健康状態の評価・管理を適切に行うことは、児のインタクトサバイバル(障害なき生存)獲得のために最も重要である。本書は、現在臨床で用いられている胎児・新生児評価法と、その適用の実際、さらには現時点での問題まで詳述した、周産期医療従事者に必須の一冊である。

目次

  • 表紙
  • 執筆者一覧
  • 目次
  • I 胎児胎盤機能評価概説
  • 1. 胎児胎盤機能不全
  • 2. 臨床で用いられる生理学的用語とその概念
  • 3. 臨床的に用いられている胎児検査法
  • 4. 胎児仮死という用語に関して
  • a. 現在までの用語の定義の歴史
  • b. "fetal distress―胎児仮死" という用語に対する誤解と混乱
  • c. "胎児仮死" と脳性麻痺に関して
  • d. 諸外国における "fetal distress" という用語に関する動き
  • e. 日本における "胎児仮死" という用語に関する動き
  • II 分娩前胎児評価と管理
  • A. 胎児心拍数モニター
  • i. 胎児心拍数の基礎
  • 1. 胎児心拍数モニタリングの歴史
  • 2. 心拍数制御の生理学
  • a. 心臓の神経支配
  • b. 血管の神経支配
  • c. 血管運動中枢と血管収縮神経系の調節
  • d. 圧受容体反射
  • e. 化学受容体反射
  • f. 心拍数調節に対する心房反射 (Bainbridge反射)
  • g. 心血管系に影響を与える液性因子
  • 3. 胎児の生理学的特徴
  • a. ヒト胎児における心臓の発達
  • b. 胎児の心血管系の反応
  • c. 胎児心拍数の間接的な調節
  • 4. 胎児心拍数パターンの臨床分類と生理学的意義
  • a. 基本的胎児心拍数パターン
  • b. 胎児心拍数基線
  • c. 胎児心拍数基線細変動
  • d. 周期性変動
  • e. 低酸素刺激と胎児心拍数制御機構
  • f. 胎児心拍数パターン研究の今後
  • ii. 胎児心拍数の臨床
  • 1. 胎児心拍数図の記述法と意義
  • a. 胎児心拍数図を読むうえでの原則
  • b. 胎児心拍数図を読むうえでの注意点
  • c. 波形の用語と定義
  • d. 胎児心拍数図上に出現する波形の意味
  • 2. ノンストレステスト (NST)
  • a. 一過性頻脈出現の意義
  • b. 適応と実施法
  • c. 判定基準
  • d. 音響振動刺激テスト
  • e. NST中に出現する一過性徐脈
  • f. NSTの診断価値と限界
  • 3. コントラクションストレステスト (CST)
  • a. 実施法
  • b. 乳頭刺激
  • c. 禁忌
  • d. 判定基準
  • e. CSTの判定と管理
  • f. CSTの評価
  • B. biophysical profile (BPP)
  • 1. BPPの各項目の生理的・病理的意義
  • a. 胎児心拍数 (FHR)
  • b. 胎児呼吸様運動 (FBM)
  • c. 胎動 (FM)
  • d. 胎児筋緊張 (FT)
  • e. 羊水量 (AFV)
  • f. fetal activityに対するsleep cycleの影響
  • 2. BPP
  • a. 判定基準およびBPPによる診療指針
  • b. BPPの臨床的意義
  • 3. modified BPP
  • C. 超音波形態評価
  • 1. 妊娠中期における胎児付属物のスクリーニング
  • 2. 妊娠後期~分娩直前の付属物異常症例に対する産科的対処
  • 3. 分娩中の超音波画像評価と産科処置
  • D. 血流計測
  • i. 動脈系
  • 1. 血流計測の方法
  • 2. 血流速度波形指数とその意義
  • 3. 血流計測の産科臨床における意義
  • a. 妊娠中毒症の発症予知
  • b. 子宮内発育遅延の予知・診断
  • c. 胎児well-beingの診断
  • ii. 静脈系
  • 1. 胎児静脈系の解剖とその特殊性
  • 2. 臍帯静脈血流
  • a. 正常胎児における臍帯静脈血流
  • b. 臍帯静脈血流速度波形の定義と分類
  • 3. 臍帯静脈pulsationの病的意義
  • a. 心原性の臍帯静脈pulsation
  • b. 臍帯原性の臍帯静脈pulsation
  • c. 臍帯静脈pulsation陽性例の臨床的取り扱い
  • 4. 胎児下大静脈血流
  • a. 胎児下大静脈血流速度波形の評価方法
  • b. 下大静脈血流による胎児不整脈の診断
  • c. 下大静脈血流速度波形異常の臨床的取り扱い
  • 5. 胎児静脈管血流
  • E. 胎児採血
  • 1. 胎児における血液ガスと酸塩基平衡測定の基礎
  • a. 血液ガスおよびpHの解釈
  • b. 胎児血液の特性
  • 2. PUBSの実際
  • a. PUBSの一般的適応
  • b. PUBSの操作に伴う危険性
  • 3. PUBSによる胎児well-being評価
  • a. 臍帯静脈における血液ガス, pHの基準値
  • b. IUGRに対するPUBSの試み
  • c. IUGR児の血液ガス, pH所見
  • d. IUGR児の乳酸値とグルコース値
  • 4. PUBSと従来からの非侵襲的胎児評価法の比較
  • a. ノンストレステスト (NST)
  • b. biophysical profile (BPP)
  • c. 超音波Doppler血流速度波形計測
  • 5. PUBSによる胎児評価の適応と限界
  • a. 適応
  • b. 問題点
  • F. 生化学的検査
  • 1. 妊娠とエストロゲン
  • 2. エストリオールによる胎児評価
  • 3. hPLによる胎児評価
  • III 分娩前胎児評価法と管理の実際
  • A. IUGR
  • 1. 形態評価からみたIUGRの検査法
  • a. 妊娠週数の補正
  • b. 胎児発育の評価
  • c. 胎児形態異常
  • 2. 機能評価からみたIUGRの検査法
  • a. ノンストレステスト (NST)
  • b. コントラクションストレステスト (CST)
  • c. 羊水量
  • d. BPP
  • e. Doppler血流評価
  • f. 尿産生能
  • g. 胎児血酸塩基平衡
  • h. 多指標による集学的胎児評価
  • B. 過期妊娠
  • 1. 定義, 頻度, 疫学
  • 2. 病因
  • 3. 診断
  • 4. 妊娠・分娩中の管理
  • a. ACOGの管理指針
  • b. 胎児評価の開始時期
  • c. 過期妊娠・分娩における合併症
  • d. 分娩誘発か待機的管理か
  • e. 羊水過少と羊水混濁
  • f. 巨大児と肩甲難産
  • g. 卵膜剥離と人工破膜
  • h. 過期妊娠と胎児血流評価
  • C. 妊娠中毒症
  • 1. 子宮胎盤循環の評価
  • a. 子宮動脈の血流速度波形
  • b. 子宮動脈血流計測の実際
  • c. 妊娠中毒症と子宮動脈血流速度波形の変化
  • 2. 胎児発育の評価
  • 3. 胎児well-beingの評価
  • a. 胎児発育状態
  • b. 羊水量
  • c. 胎児胎盤血流計測
  • d. 胎児心拍数モニタリング
  • 4. 妊娠中毒症に対する治療およびその児に対する影響
  • 5. 総合的な胎児well-beingの評価の実際
  • D. 糖尿病
  • 1. 分娩前胎児評価法
  • a. 胎児well-beingの評価
  • b. 胎児発育の評価
  • 2. 胎児管理法の実際
  • E. 常位胎盤早期剥離
  • 1. 診断
  • a. 臨床症状
  • b. 理学所見
  • c. 血液検査
  • d. 超音波診断
  • e. 胎児心拍数モニタリング
  • 2. 管理方針
  • a. 分娩様式の選択
  • b. 治療の要点
  • F. 胎児病
  • 1. 胎児不整脈
  • a. 期外収縮
  • b. 徐脈性不整脈
  • c. 頻脈性不整脈
  • 2. 中枢神経異常
  • G. 多胎
  • 1. 多胎における胎児機能評価法
  • a. 羊水量
  • b. ノンストレステスト (NST)
  • c. biophysical profile (BPP)
  • d. 胎児血流計測 (超音波Doppler法)
  • e. 多胎妊娠における胎児機能評価の実際
  • 2. 多胎妊娠に特徴的な病態における胎児機能評価
  • a. 一絨毛膜双胎
  • b. discordant twins
  • c. 慢性双胎間輸血症候群 (cTTTS)
  • d. 双胎一児胎内死亡
  • H. 外傷
  • 1. 鈍的外傷
  • a. 胎盤早期剥離
  • b. 子宮破裂
  • c. 母児間輸血
  • d. 切迫早産
  • e. 胎児外傷
  • f. 横隔膜ヘルニア
  • 2. 穿通性外傷
  • 3. 熱傷
  • IV 分娩中胎児評価と管理
  • A. 胎児心拍数モニター
  • 1. 分娩中胎児心拍数モニタリングの位置づけ
  • 2. わが国における胎児心拍数モニターに関する定義
  • 3. nonreassuring fetal statusとは
  • 4. 胎児asphyxiaとその取り扱い
  • 5. 分娩時 (中) 胎児心拍数モニターの実施
  • 6. 正常分娩時胎児心拍数モニター所見
  • 7. nonreassuring FHR pattern
  • 8. 胎児心拍数図の異常とその管理方法
  • B. 児頭採血, パルスオキシメータ
  • 1. 児頭採血
  • a. 児頭採血の歴史
  • b. 児頭採血の実際
  • c. 児頭採血による分娩時胎児モニタリング
  • 2. パルスオキシメータ
  • a. パルスオキシメータの歴史
  • b. パルスオキシメータの基礎
  • c. 胎児用反射型パルスオキシメータプローブの開発
  • d. 反射型パルスオキシメータによる分娩時胎児モニタリング
  • e. 分娩中の胎児動脈血酸素飽和度
  • f. パルスオキシメータの今後の展望
  • 3. near-infrared spectroscopy (ニロスコープ)
  • V 分娩中胎児評価法と管理の実際
  • A. 人工羊水注入
  • 1. 定義, 概念
  • 2. 歴史
  • 3. 適応
  • a. 変動一過性徐脈と羊水注入
  • b. 羊水混濁
  • c. 羊水過少に対する予防的注入
  • 4. 手技
  • 5. 副作用
  • B. VBAC
  • 1. VBACの禁忌
  • 2. VBACの適応
  • 3. VBACの成功率
  • 4. VBACの管理
  • a. 外回転術
  • b. 硬膜外麻酔
  • c. 子宮収縮薬の使用
  • d. 分娩中の管理
  • e. 分娩
  • 5. 帝王切開
  • 6. 合併症
  • C. 早産
  • 1. 胎児心拍数制御機構の発達過程
  • 2. 胎児心拍数モニタリングの妊娠週数に伴う推移
  • a. 胎児心拍数基線
  • b. 胎児心拍数基線細変動
  • c. 一過性頻脈
  • d. 変動一過性徐脈 / 遅発一過性徐脈
  • 3. 早産児の胎児心拍数モニタリングを修飾する因子
  • a. 感染, 炎症
  • b. 薬剤
  • 4. 早産児の胎児心拍数モニター異常に伴う病態と予後
  • a. アシドーシス
  • b. 中枢神経系の障害
  • c. 壊死性腸炎 (NEC)
  • 5. 管理の実際
  • D. 双胎第2子
  • 1. 双胎の分娩様式
  • 2. 双胎第2子分娩時のリスク
  • a. 臍帯脱出
  • b. 胎位異常 (足位, 顔位, 上肢先進など)
  • c. 胎児徐脈
  • d. 懸鉤
  • e. 胎盤剥離
  • f. 胎盤嵌頓
  • g. 第2子娩出遅延
  • 3. 双胎の分娩時評価の実際
  • 4. 双胎経腟分娩管理の実際
  • a. 先進児の分娩
  • b. 後続児の分娩
  • 5. 対処法の実際
  • a. 緊急帝王切開
  • b. 外回転術
  • c. 内回転術
  • d. 迅速子宮収縮抑制
  • VI 分娩直後の児の評価
  • A. 臍帯血液ガス所見
  • 1. 臍帯血液ガス分析の目的とその意義
  • 2. 血液ガス所見の生理
  • 3. 臍帯血液ガス分析の実際
  • 4. 臍帯静脈と臍帯動脈
  • 5. 正常値と異常値
  • 6. アシドーシスの発生とその分類
  • 7. アシドーシスと神経学的後遺症
  • B. Apgarスコア
  • 1. 歴史
  • 2. 問題点
  • 3. 他の評価法との関連性
  • 4. 予後との関連性
  • 5. 改良の試み
  • VII 胎児・新生児低酸素性臓器障害
  • A. 胎児
  • 1. 病態解明の歴史―Myersらの実験
  • 2. 用語の定義
  • 3. アスフィキシア性脳障害の発生時期
  • 4. 胎児の低酸素に対する反応
  • a. 酸素運搬にかかわる反応
  • b. 代謝性反応
  • 5. 胎児アスフィキシアと臓器障害
  • 6. 細胞・分子レベルからみた神経障害メカニズム
  • 7. 低酸素虚血による脳障害の修飾因子
  • a. 胎児の成熟度
  • b. ストレスの強度とパターン
  • c. 子宮内感染症
  • d. 先天奇形
  • 8. 脳以外の臓器障害
  • 9. 胎児脳障害の診断
  • a. 分娩時におけるアスフィキシア性脳障害の診断
  • b. 胎児脳障害を評価すべき例
  • c. 胎児脳障害の診断法
  • d. ヒツジ胎仔アスフィキシア後の観察から演繹した診断法
  • e. 脳波所見
  • f. 胎児心拍数モニタリング
  • g. 胎児呼吸様運動
  • 10. 胎児脳障害の予防と治療
  • a. 胎児脳障害と胎児心拍数モニタリング
  • b. アスフィキシアによる胎児脳障害の治療
  • B. 新生児
  • 1. 新生児仮死蘇生法
  • a. 体温管理 (保温と保湿)
  • b. モニタリング
  • c. 仮死蘇生のための状態の評価
  • d. 気道吸引および呼吸確立の補助
  • e. 新生児仮死に対する処置
  • 2. 新生児仮死児の一般的管理
  • a. 体温管理
  • b. 呼吸管理
  • c. 循環管理
  • d. 中枢神経障害の予防, 治療
  • 3. 中枢神経細胞障害のメカニズムに関する最近の考え方
  • a. 脳循環異常
  • b. HIEにおける中枢神経細胞障害のメカニズム
  • 4. HIE治療の今後の展開
  • C. 胎盤の病理
  • 1. 母体の低酸素と胎盤病理所見
  • 2. 胎児胎盤系の急性低酸素障害
  • a. 急性低酸素障害と胎盤病理所見
  • b. 胎盤後血腫, 辺縁出血
  • c. 臍帯血栓症
  • d. 臍帯巻絡, 過捻転など
  • 3. 胎児胎盤系の慢性低酸素障害
  • a. 慢性低酸素障害と胎盤肉眼病理所見
  • b. 慢性低酸素障害と胎盤組織病理所見
  • c. 慢性胎盤循環障害 (妊娠中毒症など)
  • d. Breues' mole (巨大絨毛膜下血腫) と絨毛膜下フィブリン
  • e. Rohr's fibrinと母体面梗塞
  • f. 胎盤の腫瘍と絨毛膜外性胎盤
  • g. 臍帯の付着異常・異常拡張
  • 4. 双胎と低酸素障害
  • a. 双胎の胎盤検査法
  • b. 双胎間輸血症候群と低酸素障害
  • c. 双胎一児死亡と低酸素障害
  • d. 双胎の予後と胎盤所見
  • Glossary
  • 索引
  • 和文索引
  • 欧文索引
  • 奥付

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I 胎児胎盤機能評価概説

P.7 掲載の参考文献
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45) Garite TJ, Porto M, et al:The influence of elective amniotomy on fetal heart rate patterns and the course of labor in term patients:A randomized study. Am J Obstet Gynecol 1993;168:1827-1831
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20) Sameshima H, Ikenoue T, et al:Effects of longitudinal maternal glucose controt on infants of diabetic mothers. Acta Obstet Gynaecol Japonica 1991;43:779-782
21) 鮫島 浩, 松本俊彦, ほか:糖尿病妊娠におけるcontraction stress test と biophysical profile の意義. 周産期医学 1995;25:277-281
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2) 伊藤雄二, 荒木保博, ほか:24時間NST中に常位胎盤早期剥離を発症し, 救命し得た1例-発症前胎児心拍パターンと長時間持続胎児心拍モニタリングについて. 日本産科婦人科学会雑誌 2000;52:1640-1644
3) Page EW, King EB, Merrill JA:Abruptio placentae:Dangers of delay in delivery. Obstet Gynecol 1954;3:385-393
4) 真木正博:常位胎盤早期剥離. 周産期医学 1991;21(臨時増刊号):243-244
5) 前田隆嗣, 松田義雄, ほか:常位胎盤早期剥離における予後予測因子の検討. 日本産婦人科・新生児血液学会誌 2002;11(2):26-32
7) 金岡 毅, 牧野康男:子宮胎盤溢血の超音波断層像. 周産期医学 1995;25(増刊号):191-197
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9) 松田義雄, 上塘正人:胎児の生理学的, 生化学的変化. 新女性医学大系第25巻, 正常分娩(岡村州博, 編). 1998;pp138-158, 中山書店, 東京
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13) Backes C, Cordero L, et al:Sinusoidal heart rate pattern and fetal distress secondary to severe anemia. J Reprod Med 1980;24(4):167-170
14) 真木正博, 寺尾俊彦, 池ノ上 克:産科DICスコア. 産婦人科治療 1985;50:119-124
15) 日母研修ノートNo 35, 産科における救急処置. 1989;p73, 日本母性保護医協会, 東京
16) Cunningham FG, Gant NF, et al(eds):Abruptio placentae. Williams Obstetrics, 21th ed. 2001;p628, McGraw-Hill, New York
17) 真木正博:産婦人科領域の救急診療. 日本医師会雑誌 1988;100:717-723
18) 小林隆夫:常位胎盤早期剥離. 新女性医学大系第23巻, 異常妊娠(佐藤 章, 編). 1998;pp107-125, 中山書店, 東京
19) 月森清巳, 小松 一, 中野仁雄:常位胎盤早期剥離. 新女性医学大系第26巻, 異常分娩(寺尾俊彦, 編). 1999;pp233-244, 中山書店, 東京
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IV 分娩中胎児評価と管理

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20) 天野 完, 平野聡子, ほか:胎児動脈血酸素飽和度(F-SpO2)モニタリングの有用性と安全性. 日本産科婦人科学会雑誌 1998;50:389-395

V 分娩中胎児評価法と管理の実際

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14) 村越 毅, 成瀬寛夫, ほか:超未熟児における幸帽児帝王切開の工夫-セボフルレン麻酔, 子宮下部J字切開, 完全被膜児娩出. 産婦人科手術 1999;10:55-61
25) Ley SJ, Scheller J, Jones BR:Intrauterine pressure during administration of nitroglycerin for extraction of retained placenta. Anesthesiol Rev 1993;20:95-97

VI 分娩直後の児の評価

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VII 胎児・新生児低酸素性臓器障害

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