異常浸潤性胎盤妊婦の予定帝王切開術における周術期管理2症例と文献的考察

異常浸潤性胎盤は, 子宮筋層に癒着または浸潤し, 基底脱落膜の部分的もしくは完全な欠如を伴うまれな妊娠である. 絨毛浸潤の程度により癒着胎盤・嵌入胎盤・穿通胎盤に分類され, 穿通胎盤は周辺臓器にまで達することがある. 妊娠中や分娩時には, 子宮破裂や致死的大量出血, 母体の重篤な合併症に対する子宮摘出術と, 将来の生殖能力を喪失するリスクが高い. 近年, 帝王切開数の増加に伴い, 異常浸潤性胎盤の発生率が増加している. しかし, この異常妊娠に対する適切な管理方法はいまだ確立されていない. われわれは, 最近経験した異常胎盤の周術期管理2症例を示し, 発生頻度や診断方法, 管理戦略などに関する...

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Published in日本臨床麻酔学会誌 Vol. 29; no. 2; pp. 204 - 213
Main Authors 坂本, 篤裕, 古市, 昌之, 岸川, 洋昭, 寺嶋, 克幸, 大江, 裕美子
Format Journal Article
LanguageJapanese
Published 日本臨床麻酔学会 2009
Subjects
リコンビナント第VII因子
大量出血
急速輸血装置
癒着胎盤
穿通胎盤
Online AccessGet full text
ISSN0285-4945
1349-9149
DOI10.2199/jjsca.29.204

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Abstract 異常浸潤性胎盤は, 子宮筋層に癒着または浸潤し, 基底脱落膜の部分的もしくは完全な欠如を伴うまれな妊娠である. 絨毛浸潤の程度により癒着胎盤・嵌入胎盤・穿通胎盤に分類され, 穿通胎盤は周辺臓器にまで達することがある. 妊娠中や分娩時には, 子宮破裂や致死的大量出血, 母体の重篤な合併症に対する子宮摘出術と, 将来の生殖能力を喪失するリスクが高い. 近年, 帝王切開数の増加に伴い, 異常浸潤性胎盤の発生率が増加している. しかし, この異常妊娠に対する適切な管理方法はいまだ確立されていない. われわれは, 最近経験した異常胎盤の周術期管理2症例を示し, 発生頻度や診断方法, 管理戦略などに関する最近の文献のレビューを行った.
AbstractList 異常浸潤性胎盤は, 子宮筋層に癒着または浸潤し, 基底脱落膜の部分的もしくは完全な欠如を伴うまれな妊娠である. 絨毛浸潤の程度により癒着胎盤・嵌入胎盤・穿通胎盤に分類され, 穿通胎盤は周辺臓器にまで達することがある. 妊娠中や分娩時には, 子宮破裂や致死的大量出血, 母体の重篤な合併症に対する子宮摘出術と, 将来の生殖能力を喪失するリスクが高い. 近年, 帝王切開数の増加に伴い, 異常浸潤性胎盤の発生率が増加している. しかし, この異常妊娠に対する適切な管理方法はいまだ確立されていない. われわれは, 最近経験した異常胎盤の周術期管理2症例を示し, 発生頻度や診断方法, 管理戦略などに関する最近の文献のレビューを行った.
異常浸潤性胎盤は, 子宮筋層に癒着または浸潤し, 基底脱落膜の部分的もしくは完全な欠如を伴うまれな妊娠である. 絨毛浸潤の程度により癒着胎盤・嵌入胎盤・穿通胎盤に分類され, 穿通胎盤は周辺臓器にまで達することがある. 妊娠中や分娩時には, 子宮破裂や致死的大量出血, 母体の重篤な合併症に対する子宮摘出術と, 将来の生殖能力を喪失するリスクが高い. 近年, 帝王切開数の増加に伴い, 異常浸潤性胎盤の発生率が増加している. しかし, この異常妊娠に対する適切な管理方法はいまだ確立されていない. われわれは, 最近経験した異常胎盤の周術期管理2症例を示し, 発生頻度や診断方法, 管理戦略などに関する最近の文献のレビューを行った. 「はじめに」異常浸潤性胎盤は, 子宮筋層に癒着もしくは浸潤し, 周辺臓器にまで達することがある. 妊娠経過中に突然の子宮破裂や, 出産時の生命に危険を及ぼす大量出血, 急性呼吸促迫症候群(acute respiratory distress syndrome:ARDS), 多臓器不全(multiple organ failure:MOF), 播種性血管内凝固(disseminated intravascular coagulation:DIC), シーハン症候群, 腎不全, 尿路障害などの重篤な合併症が発生することもあり致死的可能性のある病態である1).
Author 岸川, 洋昭
寺嶋, 克幸
古市, 昌之
大江, 裕美子
坂本, 篤裕
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References 33) Pepas LP, Arif-Adib M, Kadir RA: Factor VIIa in puerperal hemorrhage with disseminated intravascular coagulation. Obstet Gynecol 108: 757-761, 2006
22) Pelosi MA III, Pelosi MA: Modified cesarean hysterectomy for placenta previa percreta with bladder invasion: retrovesical lower uterine segment bypass. Obstet Gynecol 93: 830-833, 1999
3) Mazouni C, Gorincour G, Juhan V, et al. : Placenta accreta: a review of current advances in prenatal diagnosis. Placenta 28: 599-603, 2007
6) Palacios Jaraquemada JM, Pesaresi M, Nassif JC, et al. : Anterior placenta percreta: surgical approach, hemostasis and uterine repair. Acta Obstet Gynecol Scand 83: 738-744, 2004
29) Parekh N, Husaini SW, Russell IF: Caesarean section for placenta praevia: a retrospective study of anaesthetic management. Br J Anaesth 84: 725-730, 2000
38) Michalska-Krzanowska G, Stasiak-Pikula E, Sajdak R: Recombinant activated factor VII--a new treatment for obstetric haemorrhage? Anestezjologia Intensywna Terapia 35: 110-112, 2003
34) Sundaram R, Brown AG, Koteeswaran SK, et al. : Anaesthetic implications of uterine artery embolisation in management of massive obstetric haemorrhage. Anaesthesia 61: 248-252, 2006
16) Palacios Jaraquemada JM, Bruno CH: Magnetic resonance imaging in 300 cases of placenta accreta: surgical correlation of new findings. Acta Obstet Gynecol Scand 84: 716-724, 2005
13) O'Brien JM, Barton JR, Donaldson ES: The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol 175: 1632-1638, 1996
15) Palacios Jaraquemada JM, Bruno C: Gadolinium-enhanced MR imaging in the differential diagnosis of placenta accreta and placenta percreta. Radiology 216: 610-611, 2000
1) Comstock CH: Antenatal diagnosis of placenta accreta: a review. Ultrasound Obstet Gynecol 26: 89-96, 2005
2) Sumigama S, Itakura A, Ota T, et al. : Placenta previa increta/percreta in Japan: a retrospective study of ultrasound findings, management and clinical course. J Obstet Gynaecol Res 33: 606-611, 2007
9) ACOG Committee on Obstetric Practice: ACOG Committee opinion. Number 266, January 2002: placenta accreta. Obstet Gynecol 99: 169-170, 2002
35) Roberts HR, Monroe DM, White GC: The use of recombinant factor VIIa in the treatment of bleeding disorders. Blood 104: 3858-3864, 2004
27) Levy DM: Emergency Caesarean section: best practice. Anaesthesia 61: 786-791, 2006
8) Bretelle F, Courbière B, Mazouni C, et al. : Management of placenta accreta: morbidity and outcome. Eur J Obstet Gynecol Reprod Biol 133: 34-39, 2007
24) Weiniger CF, Elram T, Ginosar Y, et al. : Anaesthetic management of placenta accreta: use of a pre-operative high and low suspicion classification. Anaesthesia 60: 1079-1084, 2005
12) Chaoui R, Heling KS: Three-dimensional ultrasound in prenatal diagnosis. Curr Opin Obstet Gynecol 18: 192-202, 2006
19) Sekizawa A, Yokokawa K, Sugito Y, et al. : Evaluation of bidirectional transfer of plasma DNA through placenta. Hum Genet 113: 307-310, 2003
23) Oyelese Y, Smulian JC: Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 107: 927-941, 2006
36) Barletta JF, Ahrens CL, Tyburski JG, et al. : A review of recombinant factor VII for refractory bleeding in nonhemophilic trauma patients. J Trauma 58: 646-651, 2005
39) Zeteroglu S, Ustun Y, Engin-Ustun Y, et al. : Peripartum hysterectomy in a teaching hospital in the eastern region of Turkey. Eur J Obstet Gynecol Reprod Biol 120: 57-62, 2005
18) Washecka R, Behling A: Urologic complications of placenta percreta invading the urinary bladder: a case report and review of the literature. Hawaii Med J 61: 66-69, 2002
37) Brice A, Hilbert U, Roger-Christoph S, et al. : Recombinant activated factor VII as a life-saving therapy for severe postpartum haemorrhage unresponsive to conservative traditional management. Ann Fr Anesth Reanim 23: 1084-1088, 2004
17) Kim JA, Narra VR: Magnetic resonance imaging with true fast imaging with steady-state precession and half-Fourier acquisition single-shot turbo spin-echo sequences in cases of suspected placenta accreta. Acta Radiol 45: 692-698, 2004
4) Wu S, Kocherginsky M, Hibbard JU: Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 192: 1458-1461, 2005
20) Daskalakis G, Anastasakis E, Papantoniou N, et al. : Emergency obstetric hysterectomy. Acta Obstet Gynecol Scand 86: 223-227, 2007
26) Bodner LJ, Nosher JL, Gribbin C, et al. : Balloon-assisted occlusion of the internal iliac arteries in patients with placenta accreta/percreta. Cardiovasc Intervent Radiol 29: 354-361, 2006
21) Timmermans S, van Hof AC, Duvekot JJ: Conservative management of abnormally invasive placentation. Obstet Gynecol Surv 62: 529-539, 2007
7) Seow KM, Huang LW, Lin YH, et al. : Caesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol 23: 247-253, 2004
11) Silver RM, Landon MB, Rouse DJ, et al. ; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network: Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 107: 1226-1232, 2006
14) Khunda A, Tay J: Caesarean scar pregnancy. BJOG 114: 253-263, 2007
28) Munnur U, de Boisblanc B, Suresh MS: Airway problems in pregnancy. Crit Care Med 33 (10 Suppl) : S259-S268, 2005
5) Miller DA, Chollet JA, Goodwin TM: Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 177: 210-214, 1997
40) 危機的出血への対応ガイドライン. (社) 日本麻酔科学会ホームページ (http://www.anesth.or.jp
25) Kuczkowski KM: Anesthesia for the repeat cesarean section in the parturient with abnormal placentation: what does an obstetrician need to know? Arch Gynecol Obstet 273: 319-321, 2006
30) Bhavani-Shankar K, Lynch EP, Datta S: Airway changes during cesarean hysterectomy. Can J Anaesth 47: 338-341, 2000
32) Ramachandran K, Kirk P: Massive hemorrhage in a previously undiagnosed abdominal pregnancy presenting for elective Cesarean delivery. Can J Anaesth 51: 57-61, 2004
10) Gielchinsky Y, Rojansky N, Fasouliotis SJ, et al. : Placenta accreta—summary of 10 years: a survey of 310 cases. Placenta 23: 210-214, 2002
31) Kamani AA, Gambling DR, Christilaw J, et al. : Anaesthetic management of patients with placenta accreta. Can J Anaesth 34: 613-617, 1987
References_xml – reference: 30) Bhavani-Shankar K, Lynch EP, Datta S: Airway changes during cesarean hysterectomy. Can J Anaesth 47: 338-341, 2000
– reference: 33) Pepas LP, Arif-Adib M, Kadir RA: Factor VIIa in puerperal hemorrhage with disseminated intravascular coagulation. Obstet Gynecol 108: 757-761, 2006
– reference: 13) O'Brien JM, Barton JR, Donaldson ES: The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol 175: 1632-1638, 1996
– reference: 5) Miller DA, Chollet JA, Goodwin TM: Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 177: 210-214, 1997
– reference: 3) Mazouni C, Gorincour G, Juhan V, et al. : Placenta accreta: a review of current advances in prenatal diagnosis. Placenta 28: 599-603, 2007
– reference: 39) Zeteroglu S, Ustun Y, Engin-Ustun Y, et al. : Peripartum hysterectomy in a teaching hospital in the eastern region of Turkey. Eur J Obstet Gynecol Reprod Biol 120: 57-62, 2005
– reference: 21) Timmermans S, van Hof AC, Duvekot JJ: Conservative management of abnormally invasive placentation. Obstet Gynecol Surv 62: 529-539, 2007
– reference: 10) Gielchinsky Y, Rojansky N, Fasouliotis SJ, et al. : Placenta accreta—summary of 10 years: a survey of 310 cases. Placenta 23: 210-214, 2002
– reference: 36) Barletta JF, Ahrens CL, Tyburski JG, et al. : A review of recombinant factor VII for refractory bleeding in nonhemophilic trauma patients. J Trauma 58: 646-651, 2005
– reference: 18) Washecka R, Behling A: Urologic complications of placenta percreta invading the urinary bladder: a case report and review of the literature. Hawaii Med J 61: 66-69, 2002
– reference: 20) Daskalakis G, Anastasakis E, Papantoniou N, et al. : Emergency obstetric hysterectomy. Acta Obstet Gynecol Scand 86: 223-227, 2007
– reference: 32) Ramachandran K, Kirk P: Massive hemorrhage in a previously undiagnosed abdominal pregnancy presenting for elective Cesarean delivery. Can J Anaesth 51: 57-61, 2004
– reference: 40) 危機的出血への対応ガイドライン. (社) 日本麻酔科学会ホームページ (http://www.anesth.or.jp/)
– reference: 15) Palacios Jaraquemada JM, Bruno C: Gadolinium-enhanced MR imaging in the differential diagnosis of placenta accreta and placenta percreta. Radiology 216: 610-611, 2000
– reference: 25) Kuczkowski KM: Anesthesia for the repeat cesarean section in the parturient with abnormal placentation: what does an obstetrician need to know? Arch Gynecol Obstet 273: 319-321, 2006
– reference: 23) Oyelese Y, Smulian JC: Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 107: 927-941, 2006
– reference: 12) Chaoui R, Heling KS: Three-dimensional ultrasound in prenatal diagnosis. Curr Opin Obstet Gynecol 18: 192-202, 2006
– reference: 38) Michalska-Krzanowska G, Stasiak-Pikula E, Sajdak R: Recombinant activated factor VII--a new treatment for obstetric haemorrhage? Anestezjologia Intensywna Terapia 35: 110-112, 2003
– reference: 11) Silver RM, Landon MB, Rouse DJ, et al. ; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network: Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 107: 1226-1232, 2006
– reference: 31) Kamani AA, Gambling DR, Christilaw J, et al. : Anaesthetic management of patients with placenta accreta. Can J Anaesth 34: 613-617, 1987
– reference: 9) ACOG Committee on Obstetric Practice: ACOG Committee opinion. Number 266, January 2002: placenta accreta. Obstet Gynecol 99: 169-170, 2002
– reference: 28) Munnur U, de Boisblanc B, Suresh MS: Airway problems in pregnancy. Crit Care Med 33 (10 Suppl) : S259-S268, 2005
– reference: 1) Comstock CH: Antenatal diagnosis of placenta accreta: a review. Ultrasound Obstet Gynecol 26: 89-96, 2005
– reference: 37) Brice A, Hilbert U, Roger-Christoph S, et al. : Recombinant activated factor VII as a life-saving therapy for severe postpartum haemorrhage unresponsive to conservative traditional management. Ann Fr Anesth Reanim 23: 1084-1088, 2004
– reference: 17) Kim JA, Narra VR: Magnetic resonance imaging with true fast imaging with steady-state precession and half-Fourier acquisition single-shot turbo spin-echo sequences in cases of suspected placenta accreta. Acta Radiol 45: 692-698, 2004
– reference: 7) Seow KM, Huang LW, Lin YH, et al. : Caesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol 23: 247-253, 2004
– reference: 22) Pelosi MA III, Pelosi MA: Modified cesarean hysterectomy for placenta previa percreta with bladder invasion: retrovesical lower uterine segment bypass. Obstet Gynecol 93: 830-833, 1999
– reference: 35) Roberts HR, Monroe DM, White GC: The use of recombinant factor VIIa in the treatment of bleeding disorders. Blood 104: 3858-3864, 2004
– reference: 24) Weiniger CF, Elram T, Ginosar Y, et al. : Anaesthetic management of placenta accreta: use of a pre-operative high and low suspicion classification. Anaesthesia 60: 1079-1084, 2005
– reference: 16) Palacios Jaraquemada JM, Bruno CH: Magnetic resonance imaging in 300 cases of placenta accreta: surgical correlation of new findings. Acta Obstet Gynecol Scand 84: 716-724, 2005
– reference: 27) Levy DM: Emergency Caesarean section: best practice. Anaesthesia 61: 786-791, 2006
– reference: 19) Sekizawa A, Yokokawa K, Sugito Y, et al. : Evaluation of bidirectional transfer of plasma DNA through placenta. Hum Genet 113: 307-310, 2003
– reference: 26) Bodner LJ, Nosher JL, Gribbin C, et al. : Balloon-assisted occlusion of the internal iliac arteries in patients with placenta accreta/percreta. Cardiovasc Intervent Radiol 29: 354-361, 2006
– reference: 6) Palacios Jaraquemada JM, Pesaresi M, Nassif JC, et al. : Anterior placenta percreta: surgical approach, hemostasis and uterine repair. Acta Obstet Gynecol Scand 83: 738-744, 2004
– reference: 29) Parekh N, Husaini SW, Russell IF: Caesarean section for placenta praevia: a retrospective study of anaesthetic management. Br J Anaesth 84: 725-730, 2000
– reference: 14) Khunda A, Tay J: Caesarean scar pregnancy. BJOG 114: 253-263, 2007
– reference: 4) Wu S, Kocherginsky M, Hibbard JU: Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 192: 1458-1461, 2005
– reference: 8) Bretelle F, Courbière B, Mazouni C, et al. : Management of placenta accreta: morbidity and outcome. Eur J Obstet Gynecol Reprod Biol 133: 34-39, 2007
– reference: 2) Sumigama S, Itakura A, Ota T, et al. : Placenta previa increta/percreta in Japan: a retrospective study of ultrasound findings, management and clinical course. J Obstet Gynaecol Res 33: 606-611, 2007
– reference: 34) Sundaram R, Brown AG, Koteeswaran SK, et al. : Anaesthetic implications of uterine artery embolisation in management of massive obstetric haemorrhage. Anaesthesia 61: 248-252, 2006
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SubjectTerms リコンビナント第VII因子
大量出血
急速輸血装置
癒着胎盤
穿通胎盤
Title 異常浸潤性胎盤妊婦の予定帝王切開術における周術期管理2症例と文献的考察
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