■臨床および実験報告
医師の立ち会わない院内助産における胎児心拍数モニタリング
三宅 秀彦1, 2, 五十嵐 美和1, 2, 里見 操緒1, 2, 鈴木 俊治2
1日本医科大学大学院医学研究科女性生殖発達病態学
2葛飾赤十字産院産婦人科，東京
Fetal Heart Rate Monitoring in Midwifery Maternity Care during Labor
Hidehiko Miyake1, 2, Miwa Igarashi1, 2, Misao Satomi1, 2 and Shunji Suzuki2
1)Division of Reproductive Medicine, Perinatology and Gynecologic Oncology, Graduate School of Medicine, Nippon Medical School
2)Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo
Midwifery care for "low-risk" pregnant women during labor is associated with high maternal satisfaction. However, low-risk pregnant women are sometimes referred from midwives to obstetricians due to a shift to the "high-risk" status. Recently, cardiotocogram (CTG) is used for standard delivery care in several Japanese maternity care units. Therefore, we retrospectively examined the influence of CTG management on perinatal outcomes among low-risk pregnant women who preferred maternity care from a midwife during labor.
During the study period, from April to September 2008, 247 pregnant women chose midwifery maternity care during labor at Katsushika Red Cross maternity hospital. Of the 247 cases, 113 (45.8%) were referred from midwives to obstetricians. CTG abnormality was the main reason for referral and accounted for approximately 30% of referrals; weak labor pain was also a main reason for referral. Variable deceleration was observed in more than half of the women referred with CTG abnormality. Among the referred cases with CTG abnormality, the rate of spontaneous delivery was lower and the rate of cesarean section was higher than in referred cases without CTG abnormality. Umbilical arterial pH of cases with CTG abnormality was significantly lower than the low-risk group.
Abnormal CTG findings considerably influenced referrals from midwives to obstetricians. Because of the low umbilical arterial pH in the group with CTG abnormality, our decision for operative delivery might have been correct. We conclude that evaluation and improvement of CTG management is needed in order to achieve high maternal satisfaction and safety in perinatal care.
日医大医会誌 2010; 6(1), 13-16
Key words
maternity care, cardiotocogram, obstetric care
Correspondence to
Hidehiko Miyake, Department of Obstetrics and Gynecology, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama Tokyo 206-8512, Japan
E-mail：hidehiko@pluto.dti.ne.jp
受付：2009年8月7日 受理：2009年8月31日 |
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