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

稀な多胎妊娠

supertwinの管理

著者： 川口晴菜¹

所属機関： ¹大阪母子医療センター産科

ページ範囲：P.574 - P.579

文献概要

●品胎妊娠のみを理由とした予防的頸管縫縮術は施行すべきではない．

●品胎妊娠において，子宮収縮は多くの症例で認めるが，子宮収縮抑制薬の投与は，母体肺水腫などのリスクから慎重に検討すべきである．

●一絨毛膜部分を含む品胎では，FFTSの発症リスクがあることを念頭に管理すべきである．

参考文献

1）Kawaguchi H, et al : Perinatal Research Network Group in Japan : Perinatal death of triplet pregnancies by chorionicity. Am J Obstet Gynecol 209 : 36. e1-e7, 2013

2）Committee on Practice Bulletins-Obstetrics, et al : Practice Bulletin No. 169 : Multifetal gestations : twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol 128 : e131-146, 2016

3）Crowther CA, et al : Hospitalisation and bed rest for multiple pregnancy. Cochrane Database Syst Rev （7） : Cd000110, 2010

4）Caritis SN, et al : Prevention of preterm birth in triplets using 17 alpha-hydroxyprogesterone caproate : a randomized controlled trial. Obstet Gynecol 113 : 285-292, 2009

5）Combs CA, et al : Failure of 17-hydroxyprogesterone to reduce neonatal morbidity or prolong triplet pregnancy : a double-blind, randomized clinical trial. Am J Obstet Gynecol 203 : 248.e1-e9, 2010

6）American College of Obstetricians and Gynecologists' Committee on Obstetric Practice, et al : Committee Opinion No.677 : Antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol 128 : e187-e194, 2016

7）Melamed N, et al : The role of antenatal corticosteroids in twin pregnancies complicated by preterm birth. Am J Obstet Gynecol 215 : 482.e1-e9, 2016

8）Day MC, et al : The effect of fetal number on the development of hypertensive conditions of pregnancy. Obstet Gynecol 106 : 927-931, 2005

9）Martin JA, et al : Births : final data for 2015. Nat Vital Stat Rep 66 : 1, 2017

10）Lappen JR, et al : Maternal and neonatal outcomes of attempted vaginal compared with planned cesarean delivery in triplet gestations. Am J Obstet Gynecol 215 : 493.e1-e6, 2016

11）Sato Y, et al : Incidences of feto-fetal transfusion syndrome and perinatal outcomes in triplet gestations with monochorionic placentation. Fetal Diagn Ther 40 : 181-186, 2016

12）Ishii K, et al : Perinatal outcome after laser surgery for triplet gestations with feto-fetal transfusion syndrome. Prenat Diagn 34 : 734-738, 2014

13）D'Antonio F, et al : Perinatal outcome after fetoscopic laser surgery for twin-to-twin transfusion syndrome in triplet pregnancies. BJOG 123 : 328-336, 2016

14）Garite TJ, et al : Twins and triplets : the effect of plurality and growth on neonatal outcome compared with singleton infants. Am J Obstet Gynecol 191 : 700-707, 2004

15）Curado J, et al : Perinatal mortality and morbidity in triplet pregnancies according to chorionicity : a systematic review and meta-analysis. Ultrasound Obstet Gynecol, 2018［Epub ahead of print］