@article{oai:hama-med.repo.nii.ac.jp:00003294,
 author = {諸井, 條太郎 and 小野田, 亮 and 近藤, 奈穂子 and 田村, 圭浩},
 issue = {2},
 journal = {静岡産科婦人科学会雑誌},
 month = {Sep},
 note = {症例は25歳、G1P0。自然妊娠成立し、近医にて妊娠管理されていたが、妊娠31週に切迫早産の診断となり前医紹介受診の後、妊娠33週で妊娠管理目的のため、当院に母体搬送、入院管理となった。妊娠34週4日の定期検査での胎児心拍陣痛図（CTG：cardiotocography）で心拍数基線140 bpm、約80分間の基線細変動減少と一過性頻脈の消失を認めた。その後RFS（reassuring fetal status）となったため経過観察としたが、妊娠34週6日に患者より6時間以上の胎動減少の訴えがあり、CTGを記録したところ、再び基線心拍数140 bpmで基線細変動減少と一過性頻脈の消失を認めた。腹部超音波断層法では胎児心拍数は約280 bpmであり、心房と心室の収縮は1:1であったため胎児上室性頻拍の診断となった。妊娠週数や推定される頻脈の持続時間などから総合判断し緊急帝王切開とした。児は2160g、Apgar score 1分値7点、5分値8点で出生した。出生直後に心エコーで心形態異常がないことを確認した。日齢3に12誘導心電図でPR間隔の短縮とΔ波状のQRS波を認め、WPW（Wolff-Parkinson-White）症候群の診断となった。日齢13に上室性頻拍を起こしたためATP（アデノシン三リン酸二ナトリウム水和物: Adenosine Triphosphate Disodium Hydrate）0.5 mgを投与し消失した。フレカイニドを投与開始され次第に上室性頻拍の発作頻度は減少した。CTG異常の鑑別として胎児頻脈性不整脈を検索すべきであり、また胎児頻脈性不整脈の管理方針については病態、週数に基づいた適切な管理が必要であると考える。, The patient, a 25-year-old woman (gravida: 1 para: 0), became pregnant naturally and was receiving prenatal care from her local physician. At 31 weeks of gestation, she was diagnosed with preterm labor and was referred for examination. At 33 weeks of gestation, she was transported to our hospital via an ambulance for prenatal management as an inpatient. At 34 weeks and 4 days of gestation, fetal heart rate cardiotocography (CTG) was performed as a routine test; this test revealed a baseline fetal heart rate of 140 bpm with decreased baseline variability for approximately 80 min and disappearance of acceleration. This status changed to reassuring fetal status; therefore, no action was taken. However, from 34 weeks and 6 days of gestation, the patient complained of decreased fetal movement for more than 6 h. Therefore, CTG was performed, which again revealed a baseline fetal heart rate of 140 bpm, decreased baseline variability, and disappearance of acceleration. Abdominal ultrasonic tomography revealed that the fetal heart rate was at approximately 280 bpm and that the contraction of the atrium and ventricle was at 1:1. Therefore, a diagnosis of fetal supraventricular tachycardia was established. Following a comprehensive consideration of all the factors, including gestational age and estimated tachycardia duration, emergency cesarean section was performed. An infant weighing 2160 g was delivered (Apgar score: 1 min, 7 points; 5 min, 8 points). Post-delivery echocardiography revealed that there was no morphological abnormality of the heart. When the infant was 3 days old, 12-lead electrocardiography revealed a shortened PR interval and a Δ wave-shaped QRS wave. Therefore, a diagnosis of Wolff–Parkinson–White syndrome was established. The infant exhibited supraventricular tachycardia at 13 days of age; therefore, 0.5 mg of adenosine triphosphate disodium hydrate was administered, after which the tachycardia disappeared. Flecainide administration was started, and the onset frequency of supraventricular tachycardia gradually decreased. Our results suggest that fetal supraventricular tachycardia should be considered for differential diagnosis in cases of abnormal CTG results, and such cases of fetal supraventricular tachycardia should be appropriately managed based on the pathophysiology and gestational age.},
 pages = {26--33},
 title = {胎児上室性頻拍のため緊急帝王切開を行なった先天性WPW症候群の1例},
 volume = {7},
 year = {2018}
}