臨床婦人科産科73巻6号

2019年06月発行

今月の臨床 多胎管理のここがポイント―TTTSとその周辺 TTTS類縁疾患の診断と管理

selective IUGR

著者： 和田誠司¹ 室本仁¹ 杉林里佳¹ 小澤克典¹ 左合治彦¹

所属機関： ¹国立成育医療研究センター周産期・母性診療センター胎児診療科

ページ範囲：P.540 - P.546

●sIUGRの重症度は臍帯動脈血流により評価される．TypeⅠは正常波形，TypeⅡは拡張期の逆流または途絶，TypeⅢは正常波形から拡張期の逆流まで周期的に変化する状態である．

●分娩時期の決定は，超音波ドプラ所見，胎児発育，biophysical profile，胎児心拍数図で総合的に決定する．

●TypeⅡ, TypeⅢでは胎児治療の実施が考慮され，わが国で可能な治療は胎児鏡下胎盤吻合血管レーザー凝固術（FLP）である．

参考文献

1）Gratacos E, et al : A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery Doppler flow in the smaller twin. Ultrasound Obstet Gynecol 30 : 28-34, 2007

2）Khalil A, et al : Consensus definition and essential reporting parameters of selective fetal growth restriction in twin pregnancy : a Delphi procedure. Ultrasound Obstet Gynecol 53 : 47-54, 2019

3）Sago H, et al : Fetoscopic laser photocoagulation for twin-twin transfusion syndrome. J Obstet Gynaecol Res 44 : 831-839, 2018

4）Khalil A, et al : ISUOG Practice Guidelines : role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol 47 : 247-263, 2016

5）Buca D, et al : Outcome of monochorionic twin pregnancy with selective intrauterine growth restriction according to umbilical artery Doppler flow pattern of smaller twin : systematic review and meta-analysis. Ultrasound Obstet Gynecol 50 : 559-568, 2017

6）Townsend R, et al : Perinatal outcome of monochorionic twin pregnancy complicated by selective fetal growth restriction according to management : systematic review and meta-analysis. Ultrasound Obstet Gynecol 53 : 36-46, 2019

7）Quintero RA, et al : Selective photocoagulation of communicating vessels in the treatment of monochorionic twins with selective growth retardation. Am J Obstet Gynecol 185 : 689-696, 2001

8）Gratacos E, et al : Monochorionic twins with selective intrauterine growth restriction and intermittent absent or reversed end-diastolic flow（TypeIII） : feasibility and perinatal outcome of fetoscopic placental laser coagulation. Ultrasound Obstet Gynecol 31 : 669-675, 2008

9）Chalouhi GE, et al : Active management of selective intrauterine growth restriction with abnormal Doppler in monochorionic diamniotic twin pregnancies diagnosed in the second trimester of pregnancy. Prenat Diagn 33 : 109-115, 2013

10）Peeva G, et al : Endoscopic placental laser coagulation in monochorionic diamniotic twins with Typeii selective fetal growth restriction. Fetal Diagn Ther 38 : 86-93, 2015

11）Ishii K, et al : Perinatal outcome of monochorionic twins with selective intrauterine growth restriction and different types of umbilical artery Doppler under expectant management. Fetal Diagn Ther 26 : 157-161, 2009

12）Ishii K, et al : Ultrasound predictors of mortality in monochorionic twins with selective intrauterine growth restriction. Ultrasound Obstet Gynecol 37 : 22-26, 2011

13）Ishii K, et al : Feasibility and preliminary outcomes of fetoscopic laser photocoagulation for monochorionic twin gestation with selective intrauterine growth restriction accompanied by severe oligohydramnios. J Obstet Gynaecol Res 41 : 1732-1737, 2015

14）Ishii K, et al : Survival rate without brain abnormalities on postnatal ultrasonography among monochorionic twins after fetoscopic laser photocoagulation for selective intrauterine growth restriction with concomitant oligohydramnios. Fetal Diagn Ther 45 : 21-27, 2019