臨床婦人科産科64巻4号

2010年04月発行

今月の臨床 これを読めばすべてわかる―最新の産婦人科超音波診断 IV　産科における超音波診断─妊娠中・後期 ［胎児の正常超音波像と形態異常］

10．3次元超音波の応用

著者： 秦利之¹

所属機関： ¹香川大学医学部母子科学講座周産期学婦人科学

ページ範囲：P.636 - P.648

胎児皮下脂肪の評価

　従来より痩せた胎児（子宮内胎児発育遅延）あるいは肥満胎児（巨大児）の2次元超音波法による診断において，正常胎児との鑑別に苦慮する症例が多数認められた．これらを解決するために，従来の2次元超音波法を用いた胎児の軟部組織や筋肉量を評価する試みが行われてきた^1）．一方，3次元超音波法の進歩により，子宮内の胎児をまるで新生児を見るかのように立体的でリアルな像として描出することができるようになってきた^{2, 3）}（図1）．そこで，新生児の皮下組織量を定性的に評価できるNutrition Score ^4）をヒントとして，われわれは3次元超音波法を用いた胎児軟部組織を定性的に評価するFetal Nutrition Scoreを考案した^5）（図2）．その結果，出生前1週間以内のFetal Nutrition Scoreは出生直後の新生児の栄養状態とよく相関していることが明らかとなった．3次元超音波法を用いたFetal Nutrition Scoreは子宮内胎児の栄養状態を評価する新しい方法であり，胎児発育異常（子宮内胎児発育遅延と巨大児）を予測するのに有用となる可能性があり，今後胎児発育評価の新しいパラメーターとしてさらに検討していく必要がある．

　また，3次元超音波法を用い上腕あるいは大腿の体積を計測し，胎児発育と栄養状態の評価に応用しようとする試みも最近報告されている^{6, 7）}．

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