@article{oai:hama-med.repo.nii.ac.jp:00003376,
 author = {鈴木, 直宏 and 小阪, 謙三 and 室, 悠介 and 吉村, 耕治 and 李, 泰文 and 川村, 温子 and 高, 一弘 and 露木, 大地},
 issue = {1},
 journal = {静岡産科婦人科学会雑誌},
 month = {Mar},
 note = {二分脊椎症患者で神経因性膀胱に対する膀胱拡大術後の妊娠は稀であるが、二分脊椎症治療の進歩とともに妊娠例は今後増加すると考えられその対応は重要である。今回、重症妊娠高血圧腎症を発症し妊娠中期に帝王切開分娩を要した二分脊椎膀胱拡張術後妊娠を経験した。幼少期より二分脊椎に対する手術、神経因性膀胱に対する膀胱尿管逆流防止術、さらには回腸を使用した膀胱拡大術を施行されていた。自然妊娠に至ったが妊娠中期より尿路感染症を起こし抗菌薬治療を要した。29週で高度の両側水腎症と重症妊娠高血圧症候群を発症し帝王切開分娩を要した。麻酔法は二分脊椎術後であったことから全身麻酔とし新生児科医師の立ち会いを要した。術中膀胱損傷をきたしたが回腸使用部と考えられ泌尿器科医による修復を要した。術後経過は良好であったが、高血圧は産後早期に治療域こそ脱したものの蛋白尿とともに産後1年以上持続した。二分脊椎膀胱拡大術後の妊娠合併症として尿路感染症、切迫早産、妊娠高血圧症候群などが重要と考えられており、妊娠中期に重症妊娠高血圧症候群を発症し早期に娩出が必要となる可能性がある。泌尿器科、新生児科、麻酔科、産科による集学的治療の可能な施設での管理を要する。, Pregnancy in a woman with spina bifida (SB) after enterocystoplasty for a neurogenic bladder is rare. However, investigating such cases is important because the number of pregnant women treated for SB will increase with the progression of treatment for SB. We experienced a case of SB after ileocystoplasty in a woman who presented with severe bilateral hydronephrosis and severe hypertensive disorders of pregnancy (HDP) and needed emergency cesarean section (CS) at 29 weeks of gestation. She had undergone spinal cord surgery, anti-reflux operation, and ileocystoplasty for her neurogenic bladder. She became pregnant spontaneously and had an episode of febrile urinary tract infections, which were treated with antibiotics. At 29 weeks of gestation, she had severe hydronephrosis and severe hypertension, so we performed emergency CS.We used general anesthesia because she had had a spinal surgery, and consultation with neonatal pediatricians was necessary. Bladder injury occurred during the CS and was repaired by urologists. The outcome of the CS delivery was good, and her blood pressure recovered under therapeutic level early. However, hypertension and proteinuria persisted for about a year after the delivery. Therefore, evaluations for urinary tract infection, premature delivery, and HDP are important during the pregnancy of women with SB. In addition, severe hydronephrosis and HDP may occur. Thus, multidisciplinary treatment that includes urologists, neonatal pediatricians, anesthesiologists, and obstetricians is important to control the patients under hospital care.},
 pages = {28--36},
 title = {重症妊娠高血圧腎症を発症し妊娠中期に分娩となった二分脊椎膀胱拡大術後妊娠の一例},
 volume = {8},
 year = {2019}
}