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 ［胎児の発育とwell-beingの評価］

2．胎児行動とbiophysical profile score

著者： 青木昭和¹

所属機関： ¹島根大学医学部産婦人科

ページ範囲：P.656 - P.661

文献概要

　現在行われている胎児well-being評価法の主なものには，非侵襲的なものとしてNST，CST，VASなどの胎児心拍数モニタリングや，胎児ドプラ血流計測，biophysical profile score（BPS），羊水量測定といった超音波診断法などがある．また侵襲的な方法としては，胎児・臍帯穿刺採血，頭皮電極法などがある．精度に関しては侵襲的手法のほうが優れているが，リスクを考えると非侵襲的で再現性，簡便性に優れた方法が現実的である．胎児ドプラ血流計測や胎児・臍帯穿刺採血は専門的な知識や高度なテクニックを要する場合もあるため，臨床の第一線で誰でも正確に行えるわけではない．これに対し，比較的容易に行うことができ診断精度の高い方法としてBPSが挙げられる．BPSはcombined fetal biophysical testingの1つとしてManningら^1）により提唱された胎児well-being評価法であり，過期妊娠を含めたハイリスク妊娠における周産期有害事象の予測法として発表された．胎児アシドーシス，分娩中の胎児ジストレス，5分後Apgar指数および周産期死亡などの予測を目的に検討され，さらにそれをもとに分娩時期の決定も含めた管理方法として今日に至っている．

　ただし，最大30分という検査時間のため日常診察内で妊婦全員に行う胎児スクリーニングとしては困難である．よって，一般にはハイリスク妊娠，fetal growth restriction（FGR）を対象に，そのなかでwell-beingを評価する方法として用いられることが多い．ちなみに略語としては，米国ではBPSよりBPP（biophysical profile）を用いている場合が多い．本稿ではBPSの各観察項目と，それを用いた妊娠・分娩管理法について述べる．また，BPSに関連したほかの胎児評価法，特に超音波ドプラ法による胎児血流計測の最近の知見も紹介したい．

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