多田 伸

In recent years, improvements in diagnostic technology have enabled the early detection of ectopic pregnancy, and the opportunities for preserving the oviduct have increased, particularly as laparoscopic surgery has become the first-line choice for treatment of ectopic pregnancy in an increasing number of institutions. At our institution we use laparoscopic techniques to attempt oviduct preservation in patients with ectopic pregnancy who wish to become pregnant again. In this report, we examined the rates of persistent ectopic pregnancy and repeat ectopic pregnancy over a ten year period in patients who were treated laparoscopically with oviduct preservation. When compared with other treatments, we found a lower rate of persistent and recurrent ectopic pregnancy in women who were treated with oviduct-persevering laparoscopy. We conclude that laparoscopic surgery with oviduct preservation should be the therapy of choice for ectopic pregnancy when the patient still desires to get pregnant. However, a thoroughly informed consent detailing the risks of persistent and recurrent ectopic pregnancies must be a priority because of the high emotional toll of these complications.

妊娠高血圧症候群(PIH)管理ガイドラインに則って診断した妊娠22週0日〜39週0日の妊娠高血圧腎症(PE群)12例、正常妊娠(NP群)19例を対象に、母体血流としての腎動脈と頸動脈について検討した。また、PIH管理ガイドラインに則って診断した妊娠24週0日〜34週0日のPIH群10例、子宮内胎児発育不全(FGR群)5例、NP群13例を対象に、胎児胎盤血流としての胎盤内血流を検討した。PE群、NP群の検討ではNP群に比べPE群の平均年齢とBMIが高かった。PE群の検査所見では尿蛋白定量所見が平均3.5g/日であったが他の血液検査では明らかな腎機能障害を示唆する所見はなかった。胎児中大脳動脈のRI、PI値はNP群に比べPE群で低かった。またPIH群、FGR群、NP群の検討では胎盤内血流のvolume histogramの結果、PIH群ではNP群に比べVI、FI、VFIが有意に低く、FGR群ではNP群に比べ平均値は低いものの有意差はなかった。PIHでは母体、胎児、胎児付属物の血管に機能的・器質的変化が出現し、これらが各臓器内血流の超音波ドプラ所見に影響を与えている可能性があった。