新垣 達也, 仲村 将光, 濱田 尚子, 瀧田 寛子, 大場 智洋, 松岡 隆, 長谷川 潤一, 関沢 明彦

Tatsuya ARAKAKI, Masamitsu NAKAMURA, Shoko HAMADA, Hiroko TAKITA, Tomohiro OBA, Ryu MATSUOKA, Junichi HASEGAWA, Akihiko SEKIZAWA

昭和大学産婦人科学講座

Department of Obstetrics and Gynecology, Showa University School of Medicine

キーワード :

To access the efficiency of detecting fetal morphological abnormalities with ultrasound examinations and predicting pregnancy-induced hypertension（PIH）with measurement of placental volume and uterine artery（UtA）Doppler in the first trimester.
【Methods】
The prospective study was performed from 2011 to 2013 in our hospital. Pregnant women with singleton who underwent an ultrasound scan at 1113 weeks’gestation and delivered were enrolled in the study. In study 1，fetal morphological findings at first trimester were compared with babies after delivery. In study 2，UtA Doppler indices and placental volume were measured by 3D ultrasound at 1113 weeks’gestation, and the results were compared to the pregnancy outcome of early PIH（＜34 weeks）or late PIH（34 weeks）.
【Results】
STUDY1: 3758 singletons were subjected. Abnormal findings were detected in 51 cases（1.4％）. They included fetal edema or hydrops fetalis（27 cases）, cardiovascular morphological findings（11 cases）, cranial morphological findings（5 cases）, cystic hygroma（2 cases）, hydronephrosis（2 cases）, single umbilical artery（2 cases）, abnormal position of organs（1 case）, abnormalities of limbs and extremities（1 case）and abnormal crown rump length（1 case）. In these patients, chromosommal abnormalities or severe congenital abnormalities were detected in 33 cases（0.9％）and intrauterine fetal deaths without definitive diagnosis were in 5 cases（0.1％）. Eight cases of fetal edema and hydrops fetalis, 2 cases of fetal cardiovascular morphological findings and 2 cases of fetal cranial morphological findings were disappeared during the pregnancy period. One case resulted in intrauterine fetal deaths after normal karyotype.
STUDY2: Ten cases of early PIH, 67 cases of late PIH and 1285 unaffected pregnancies were analyzed. The UtA pulsatility index（PI）was higher in early PIH than in unaffected pregnancies（median, 2.35 vs. 1.79; P=0.043）, but we did not detect any difference between late PIH and unaffected pregnancies. Placental volume was smaller in early PIH than in unaffected pregnancies（median, 43 cm3 vs. 62 cm3; P = 0.003）, but was not different between late PIH and unaffected pregnancies. The area under the receiver-operating characteristics curve for the prediction of early PIH, by combining UtA-PI and placental volume, was 0.832（95％CI, 0.7420.921）, with this combination providing a detection rate for early PIH of 67.5％for a 5％false-positive rate.
【Conclusion】
Thirty-three cases of chromosommal or severe congenital abnormalities were detected in the first trimester, which were 40％of all abnormalities. The first trimester ultrasonographic screening would be effective for detecting fetal chromosomal or morphological abnormalies. Measurement of UtA-PI and placental volume would be effective for detecting early PIH due to the differences in pathophysiology between early and late PIH.