臨床婦人科産科77巻4号

2023年04月発行

増刊号 ―豊富な所見で診断の進め方がわかる―産婦人科 画像診断アトラス

周産期 画像診断の進め方：基礎編

経会陰超音波法

著者： 中山敏男¹²

所属機関： ¹山王病院女性医療センター産科・婦人科 ²国際医療福祉大学臨床医学研究センター

ページ範囲：P.27 - P.36

文献概要

●経会陰超音波は内診を補完しながら，より正確で客観的な分娩進行評価が可能になる方法である．

●多くのパラメータによる評価が報告されているが，画像描出や計測が困難である場合に経会陰超音波導入の妨げになることがある．最も簡便で分娩進行とよく相関するAoPを，自動計測機能を用いることで誰でも簡単に計測できるようになった．

●無痛分娩管理でより増加する医療介入のタイミングや安全性が向上する可能性がある．

参考文献

1）Akmal S, et al : Comparison of transvaginal digital examination with intrapartum sonography to determine fetal head position before instrumental delivery. Ultrasound Obstet Gynecol 21 : 437-440, 2003

2）Tutschek B, et al : A study of progress of labour using intrapartum translabial ultrasound, assessing head station, direction, and angle of descent. BJOG 118 : 62-69, 2011

3）Kalache KD,et al : Transperineal ultrasound imaging in prolonged second stage of labor with occipitoanterior presenting fetuses : how well does the ‘angle of progression’ predict the mode of delivery? Ultrasound Obstet Gynecol 33 : 326-330, 2009

4）Molina FS, et al : What is the most reliable ultrasound parameter for assessment of fetal head descent? Ultrasound Obstet Gynecol 36 : 493-499, 2010

5）Eggebø TM, et al : Sonographic prediction of vaginal delivery in prolonged labor : a two-center study. Ultrasound Obstet Gynecol 43 : 195-201, 2014

6）Henrich W, et al : Intrapartum translabial ultrasound（ITU）: sonographic landmarks and correlation with successful vacuum extraction. Ultrasound Obstet Gynecol 28 : 753-760, 2006

7）Dietz HP,et al : Measuring engagement of the fetal head : validity and reproducibility of a new ultrasound technique. Ultrasound Obstet Gynecol 25 : 165-168, 2005

8）Youssef A, et al : Fetal head-symphysis distance : a simple and reliable ultrasound index of fetal head station in labor. Ultrasound Obstet Gynecol 41 : 419-424, 2013

9）Tutschek B,et al : Comparison between ultrasound parameters and clinical examination to assess fetal head station in labor. Ultrasound Obstet Gynecol 41 : 425-429, 2013

10）Ghi T, et al : Diagnosis of station and rotation of the fetal head in the second stage of labor with intrapartum translabial ultrasound. Ultrasound Obstet Gynecol 33 : 331-336, 2009

11）Eggebø TM, et al : Prediction of labor and delivery by transperineal ultrasound in pregnancies with prelabor rupture of membranes at term. Ultrasound Obstet Gynecol 27 : 387-391, 2006

12）Kahrs BH,et al : Sonographic prediction of outcome of vacuum deliveries : a multicenter, prospective cohort study. Am J Obstet Gynecol 217 : 69.e1-69.e10, 2017

13）Youssef A, et al : Automated measurement of the angle of progression in labor : a feasibility and reliability study. Fetal Diagn Ther 41 : 293-299, 2017

14）Ghi T, et al : ISUOG Practice Guidelines : intrapartum ultrasound. Ultrasound Obstet Gynecol 52 : 128-139, 2018

15）Youssef A, et al : Ultrasound in labor : a caregiver's perspective. Ultrasound Obstet Gynecol 41 : 469-470, 2013

16）Youssef A, et al : Ultrasound in labor : is it time for a more simplified approach? Ultrasound Obstet Gynecol 41 : 710-711, 2013

17）Bultez T, et al : Angle of fetal head progression measured using transperineal ultrasound as a predictive factor of vacuum extraction failure. Ultrasound Obstet Gynecol 48 : 86-91, 2016

18）Sainz JA, et al : Intrapartum transperineal ultrasound used to predict cases of complicated operative（vacuum and forceps）deliveries in nulliparous women. Acta Obstet Gynecol Scand 96 : 1490-1497, 2017

19）Kahrs BH, et al : Sonographic prediction of outcome of vacuum deliveries : a multicenter, prospective cohort study. Am J Obstet Gynecol 217 : 69.e1-69.e10, 2017

20）Yano E, et al : The head direction to the angle of progression ratio : a quantitative parameter for intrapartum evaluation of cephalic malposition. Am J Obstet Gynecol MFM 5 : 100755, 2023