立体的評価による骨盤計測と児頭の比較によるＣＰＤ判定法に関する研究

• 福永 正平

  関西医科大学産科学婦人科学教室

書誌事項

タイトル別名

• Diagnosis of cephalopelvic disproportion by evaluating three-dimensional pelvimetry and the fetal head.

抄録

Cephalopelvic disproportion (CPD) is defined as dystocia due to a disproportion between the maternal pelvis and the fetal head. However, definite diagnostic criteria of CPD have not been clearly defined.<BR>In this study, X-ray pelvimetry and ultrasonographic measurement of the size of the fetal head and abdomen were analyzed by three-dimensional imaging in 187 cases suspected of CPD at term. The minimum plane of the pelvic inlet (minInP) was used to calculate the area of the minimum pelvic inlet (minPA) and circumference of the minimum pelvic inlet (minPC). The head area (HA) and head circumference (HC) on the plane of the fetal biparietal diameter were also measured. To provide a reliable criterion for CPD, the minInP was compared with fetal head measurements.<BR>(1) Comparing the diameter of the maternal pelvis and the diameter of the fetal head showed a low sensitivity for predicting CPD.<BR>(2) There was a very high sensitivity and specificity in predicting CPD by comparing the area and circumference of minInP with those of the fetal head, showing a total sum of 180-185 % and positive predictive value of 63-77 % in patients with an area difference (minPA-HA) under 12cm² and the circumference difference (minPC-HC) under 2cm.<BR>(3) In 13 patients with less than 5cm² of minPA-HA, vaginal delivery was impossible. In 9 patients who had the area between 5 and 8cm² of minPA-HA, the incidence of CPD was 78 %. In 32 patients who had the area between 8 and 15cm² of minPA HA, the incidence of CPD was 25 %. But, in 133 patients showing over 15cm² difference between the areas, the incidence of CPD was 1 %.<BR>(4) In 9 patients with less than 0.5 cm of difference between minPC and HC, vaginal delivery was impossible. In 14 patients who showed between 0.5 and 1.5 cm difference in minPC-HC, the incidence of CPD was 86 %. In 44 patients who showed between 1.5 and 3.0 cm difference in minPC-HC, the incidence of CPD was 18 %. However, among 120 patients with more than 3cm difference between the circumferences, there was no case of CPD.<BR>These results suggested that minPA-HA and minPC-HC were useful diagnostic parameters during labor. [Adv Obster Gynecol 47(1) : 20-33, 1995 (H7.1)]

収録刊行物

• 産婦人科の進歩

  産婦人科の進歩 47 (1), 34-46, 1995

  近畿産科婦人科学会

キーワード

• cephalopelvic disproportion
• X-ray pelvimetry
• fetal sonography
• cesarean section

詳細情報

• CRID: 1390282679922789504
• NII論文ID: 130004069581
• DOI: 10.11437/sanpunosinpo1949.47.34
• ISSN: 13476742
• ISSN: 03708446
• 本文言語コード: ja
• データソース種別:
  • JaLC
  • CiNii Articles
• 抄録ライセンスフラグ: 使用不可