2018/02/02 14:56:37 ll7e2-fgrrf-r20180131-p2 1tokaiobgy.org/soukai/138.pdf · tokai society of...

2018/02/02 14:56:37 LL7E2-FGRRF-R20180131-P2 1

TOKAI SOCIETY OF OBSTETRICS AND GYNECOLOGY

500

138

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2015 2

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1 4F

e

3 10 11:00 17:30 11:00 3 11 8:00 14:30 5,000

1 4F 141+142

3 10 11:00 18:30 3 11 8:00 16:00

1 4F 141+142

3 10 13:00 18:00 3 11 9:00 14:30

3 10 18:30 20:30 3 B1F

700

TEL 052-683-7711 138

1 4F 143

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10

1 6 1 3

5 1 6 2 3 9 3

PC Windows7

30 USB PC

PC Windows Power Point 2007/2010/2013

OS MS MS

USB a. wmv b. Power Point c. USB PCMacintosh PC Windows Windows

USB PC

Mini D-Sub15pin Macintosh Windows PC

ACUSB

PC

10

2018 3 10 11:30 12:00 2 1 4F

2018 3 10 12:10 12:40 2 1 4F

2018 3 10 15:30 15:45 1 1 4F

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3 10

13:05 14:05

1 1 4F

1 3 10

16:00 17:00

1 1 4F

2 3 11

9:50 10:50

1 1 4F

3 3 11

11:00 12:00

1 1 4F

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1 1 4F

e

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プログラム

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13:00 13:05

13:05 14:05

···········

14:15 15:20

1 1 ····························································· 2 5mg 1 ·············································· 3 ····························································· 4 ································································ 5 Postmortem magnetic resonance imaging 2 ····························································· 6 ··························································

15:30 15:45

16:00 17:00

SS1 ·····························

17:10 18:10

ES1 ··················································

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13:05 14:00

7 ·······················································

8 6 ·························································· 9 abscopal effect 1 ··················································· 10 1 ······················································· 11 1 ··································································· 12 ··················································

14:15 15:00

13 36 ·············································

14 ····················································· 15 da Vinci ··································································· 16

NSAIDs ··········································· JA 17 TLH ··························································

16:00 16:45

18 ASC-US HPV HPV

·····························································

19 46 ····························································· 20 Perivascular epithelioid cell tumor(PEComa) ····························································· 21 1 ····························································· 22 ···································································

17:10 18:10

ES2 ································

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13:05 16:05

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8:40 9:25

23 N-butyl-2-cyanoacrylate 1

·········································· 24

( ) ···························································· 25 1 ··············································· 26 ······················································· 27 PCOS ··················································

9:50 10:50

SS2 Bevacizumab EBM ·················

11:00 12:00

SS3 UAE ········

12:10 13:10

LS1 PCOS ·······················

13:20 14:20

·············

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14:25 15:30

28 CML 1 ······················································· 29 ,

·················································· 30 Third trimester ··································································· 31 ·················································· 32 1 ····························································· 33 Cystic PVL 3 ················································ 34 ··························································

15:30 15:40

8:40 9:45

35 PDPH

·····························

36

trial of labor after cesarean delivery : TOLAC ···························································· 37 DIC ······················ 38 14 ···································· 39 fibrinogen ································································ 40 ······································ 41 IVR Interventional radiology ··················································

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9:55 10:40

42 ··········································· JA

43 1 ············································ 44 ··························································

45 LSC

··········································· JA 46 5 ··················································

10:50 11:45

47 ·····························································

48 2 1 ······························· 49 11 1 ····························································· 50 19 1 ··················································· 51 ·············································· 52 ··········································· JA

12:10 13:10

LS2 ··························

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13:20 14:25

53

················································ 54 circular shunt physiology 1 ··································································· 55 2 ········································· 56 3 ···························································· 57 ··················· 58 sFlt-1 ··································································· 59 FGR HDP ································································

14:35 15:30

60

····························································· 61 ···························································· 62 ················································ 63 1 ············································ 64 1 ····················································· 65 1 ········································ JA

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2018/02/02 14:56:37 LL7E2-FGRRF-R20180131-P2 22

指導医講習会・共通講習（医療安全）

指導医講習会・共通講習（医療安全）について受講確認はe医学会カードで行いますので、必ずご持参ください。第1会場受付でe医学会カードをご提示いただきバーコードを読み込みます。講演開始後、10分を過ぎますと受付できませんので、ご留意ください。なお、平成28年度より受講証の発行は行いません。

2018/02/02 14:56:37 LL7E2-FGRRF-R20180131-P2 23


1960 SP 50

2000VR

199944000 88

10

2002

2001

2005 OSCEOSCE

1990 computer assisted surgery CAS

2000 digital surgical training virtual surgical training VR

2006 ITVR

2006 NU-ESS2013

2016

cadaver Clinical Anatomy Labo, Nagoya: CALNACALNA

62 3 62 6 63 4 05 8 2 11 1 12 4

11 6 16 3 16 4

21 9 23 4 25 4

27 6

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1999 1527 28

1994.3 2001.4 2003.7 2004.4 2005.10 2008.3 2010.4 2011.4 2012.11 2015.4

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2018/02/02 14:56:37 LL7E2-FGRRF-R20180131-P2 26

専攻医教育の為のスポンサードセミナーについて受講確認はe医学会カードで行いますので、必ずご持参ください。第1会場受付でe医学会カードをご提示いただきバーコードを読み込みます。講演開始後、10分を過ぎますと受付できませんので、ご留意ください。なお、平成28年度より受講証の発行は行いません。

共催セミナー（専攻医教育の為のスポンサードセミナー、イブニングセミナー、ランチョンセミナー）

2018/02/02 14:56:37 LL7E2-FGRRF-R20180131-P2 27

2018/02/02 14:56:37 LL7E2-FGRRF-R20180131-P2 28


SS1.

QOLQOL

18

5

HRT

HRT 2017 11 HRT2017

RCT SSRI SNRI

61 3 61 5

6 3 10 4 7 5 10 7 4 12 4 12 5 14 4 16 4 17 8 19 4 20 4

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SS2. Bevacizumab EBM

80 CDDP90 PTX 2 TP

CBDCA CDDP GOG158 AGOCBDCA PTX TC

Bevacizumab VEGF-A GOG0218 ICON-7TC PFS

PFS2013

2009 5 B

19.5% JCOG0505OS TP TC 2014 GOG240

BevacizumabPFS OS Bevacizumab 2016

Bevacizumabbevacizumab

03 10 11 16 23 25

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SS3. UAE

UAEEU 20000 UAE

Level A Evidence 50-6080-90 80-90

152017 CQ215

UAE CUAE 2014 1

K615 UAE

UAE 50UAE Overview Clinical Question

1995 03 1995 04 1995 06 1996 06 1998 3 31 1998 04 2002 10 2002 11 2004 12 31 2005 01 2007 4 15 2007 04 2009 10 2012 09

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ES1.

Tender Loving Care 65

RCT

CAM 32CAM

PCRlong term tocolysis

55 59 59 60 61 5 62 7

02 09 10 16 21 3 23 25 3

17 10 21 4 22 11 23 4 25 3 25 4 27 3 25 4 28 3 6 28 4

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ES2.

Chronic endometritis CE CE

CECE 60

CE66.7% 16/24 vs. 61.5% 24/39

1 CE CECE

CE 7-8

estrogen receptor ER progesterone receptor PR A B H-ScoreCE score endometrial stromal cell :ESC

CE PRLIGHBP-1 RNA CE CE

CE

1993 04 1993 06 1995 06 1999 10 2000 09 2002 11 2007 09 University of Massachusetts Amherst Postdoctoral fellow 2008 09 University of Massachusetts Amherst Senior research associate 2010 11 2011 04 2011 10 2015 07

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LS1. PCOS

polycystic ovary syndrome, PCOS

PCOSPCOS 50-80%

PCOSunopposed estrogen

PCOS

PCOS PCOS

1995 06 01 2001 04 01 2001 06 01 2003 02 16 2003 04 01 2007 02 01 2012 04 01 2012 08 01 2014 11 01 2015 04 01 2018 02 01

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LS2.

motivation

2

HBOC

DVT/PE

1 2

1995 05 2000 12 2001 01 2002 09 2002 10 2005 08 2005 09 2010 03 2010 04 2015 03 2015 04

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2018/02/02 14:56:37 LL7E2-FGRRF-R20180131-P2 36

一般演題

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2018/02/02 14:56:37 LL7E2-FGRRF-R20180131-P2 38


1 2

1 2

1 1,2 1 1 1 1 1 1 1

DIC

1 28 G1P0 25 3

26 2MRI 90

63mmAFI38

CTAR

26 6 CTARMCA-PSVmax

1148g Apger Score 4 /5 /7 (1 /5 /10 )Hb9.8g/dl

93

, ,

. 1 , .

27 , G1P0. , , .

. .

18 , . 23

, , 1 . 1

, . CK 3187

IU/l . K . ,

. , , CK MM 98% .

CK 11746 IU/l , .

, , . 28 ,

, CK 500 IU/l, .

, , ,

.

, , .

- 39 -

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3 4

1000 3000 1

2006 4 2017 3 6

126

1

1 1525

5cm1

37

1 36

8 3cm28

53 2

pH7 2

40 50

31 G2P1

37 4

2400g2

JCS 300 140 / SpO2 70%

CT45

Zn-CP1,STNC1

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5 6

1 2

1 2

1 1 1 1 1 2

1 1 1 1 1 1 1 2

Postmortem magnetic resonance imaging (PMMRI)

PMMRI

1: 36 1646,XX

20310 g

PMMRI

2: 22 14

46,XX20

24

450g

24 5 742g AP0/0

PMMRI

PMMRI 1

2

40 2 1 37 0

2600g 22CTG 150bpm

4.4/ L

HELLP23 2

23 22FAX 23 31

32 407g2674g pH6.994 BE 18.3 pO2

32.5mmHg pCO2 59.9mmHg Apgar score0/0/0

ICU110 34

20 76

25 30

1

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7 8

1 2 3

4

1 2

1 1 1 1 1 1 1 1 1 1 1 1

1 1 2 3 4 1

1 1 1 1 2 1

HBOCBRCA1 BRCA2

HBOC2014 8 27 HBOC

2017 BRCA1/2HBOC

RRSO

2014 8 27 2017 7 31

BRCA

23 30 8 34.8%2 8.7%

5 21.7%6 26.1%

11 47.8%5 21.7%

1 4.3%

13 56.5% BRCA1/24 30.8% 4

1 32

HBOC

RRSO

2015(HBOC)

(RRSO)RRSO

RRSO

2014 7 2017 8

RRSO6

Menopause-Specific Quality of Life QuestionnaireMEN-QOL

6 35 54 41.5BRCA1 3 BRCA2

3 51

2

RRSO

RRSO RRSO 6 MEN-QOL

RRSO

QOL

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9 10

1 2 3

1 1 1 1 1 1 1 1 1 1 1 1 2 1 3 1

74 2 2 45

Squamous cell carcinoma60mm

SCC 14.6B

48.6Gy/27fr

20mm7

40

1 93 G4P4

CTfree air

G3 pT2 pNX pMX40

ADL

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11 12

(Uterine Tumor Resembling Ovarian Sex Cord TumorsUTROSCT)

19

3cm

MRI3cm

UTROSCTCK-AE1/AE3 -SMA WT1

UTROSCT

UTROSCT

45 3

WBC21400 / l, CRP 33.5 mg/dl Cre 1.58 mg/dl

Hb 3.1 g/dlCA19-9 1106 U/ml, CA125 1440 U/ml

MRI T2

40cm16,450ml

RCC54 FFP45 PC4024 5

1062

94B

3 3 440mm

410

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13 14

1 2 3

1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 3 1

2013 7 2017 10

36 ( )

35.5 (14-74) 30 (83.3%)

11 (30.6%)( )

70.5mm(30-166) 279

23 (63.9%) 180 144012

23 8

41 (

) 8475/ L 4750-15650

1 13 5

CT 6cm

CT

5mm 3

7cm1080

100ml25

451g 3

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15 16

JA

20173 da Vinci 7

2 2017 3 11 CIN 3 4

A1 ( ) 1 B11 B2 1

(RSH) (RmRH) (RRH) DVSS Si 12mm 3cm 18mm 2 1 12mm

5Air seal RRH

49 39~71

RSH 4 21848ml RmRH 1 266 300ml RRH 2435 120ml 5

5-28 2 RRH 17/206

50 1B2

TLRH

TLRH

( ®)

NSAIDs ( ®)( ®)

2015 12 2016 11

1821 ®4000

/ ®200 /

VAS

CRP®

34 (38 ) 33 Grade12

® 2 (2%)® 7 (8%)

® ®

® ®

®

®

NSIADs

- 46 -

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17

18

TLH

TLHBS

TLH/BS

5mm

2

201020 49 HPV

20167 ASC-US

HPV 64229

ASC-US 813 1.3%HPV 20-49 682 HPV

416 HPV233 56.0 HPV416 HPV 233 183ASC-US HPV

ASC-US HPV

CIN 66.5% CIN2 20.1LSIL

ASC-US HPV88 4 CIN3 9

ASC-US HPV 62NILM 3 4 CIN2 CIN3

1 2 CIN20-49 HPV

HPV 266HPV

NILM HPV 2CIN3 CIN

5 CIN3 HPVCIN3 14

HPV CIN3 1 ASC-US HPV

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19 20

(ART) ART

2010 5 2017

10 ART 46ART IA2 IB1

2cm 1645

5mm 32(24-38)

IA2 4 ( 2 2 ) IB142 ( 35 7 )

15

42.5(0.6-106.6) 3 (6.5%)1 ART

24 12 (50.0%)15 7 7 (

3 3 1 ) 61 1

ART

ARTART

Perivascular epithelioid cell tumor(PEComa)perivascular epithelioid cell(PEC)

PEComa

PEComa43 0 0 2011

cellular leiomyoma

2014 MRI

PET CT

2015

adenomyosis leiomyoma

adenomyosis leiomyomaretroperitoneal cyst of mullerian type

2CT

CTPEComa

2011 2015PEComa 2017

PEComaPEComa

PEComa

PEComa

- 48 -

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21 22

(NET),

(SCNEC) .,

SCNEC . 60 ,2 2 , 51 .

. ,6cm

.CT , , ,, . B .SCNEC . EP(+ ) (CCRT)

., .

, .

. 5 ,.

, . NET 1-6%

, SCNEC.

,1

., ,

. ,,

..

2007 10 2016 1277

3

218 8

52 1

6 70%

32

QOL

- 49 -

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23 24

1 2

1 1 1 1 1 1 1 1 2

N-butyl-2-cyanoacrylate(NBCA)

1 434

GnRH

53 1

7

3D-CT

NBCA

NBCA

microwave endometrial ablation:MEA

,. , 43

. 26 2 29 11

, MEA 2414 , 10 ,MEA

19 ( 4 , 3 ,12 ) .

(mean SD):72.3mm 10.1mm56~100 , :6.0 0.9 (4~8) ,

43 15 34 ,. ,2,1 , 1

GnRHa ,. , 2

MEA ,.

MEA ,43 41 95.3%

. ,2 , MEA

..

- 50 -

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25 26

1 2

1 1 2 1 1 1 1 1 1 1 1 1

,

2 1 484 ,

1 , ,39,

,SBT/ABPC 12g/ 4

E.Coli 14,

, ,1 ,

39,

E.Coli 10,

,

,, ,

AMPC/CVA ,,

, ,

(ART)

( )

2008 3 2017 11

16

67 3

16 143 4

1 13 3 1 ART

12 1

ART

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27 28

1 2

1 2

1 1 1 1 1 1 1 1

1 1 2 1 1 1

1 1 1 2

polycystic ovary syndrome PCOS

IR

PCOS PCOSPCOS WHO 3OGTT CC

PCOS 36 12

PCOS 19 PCOS

75 OGTT BSIRI 30,60,120 CC

2930 35 35 40 3 BMI

1 2 4 IRI12064 U/ml HOMA-R 2.0 IR

OGTT IRI120 IR

PCOS 36 9 PCOS 19 8PCOS

2 4 44% 1 1 11%4 44% IR

CC PCOS 35.7PCOS 52.7% IR

PCOS 60% BS120 140mg/dl

PCOS IRIR

2

OGTT

CML15-20% 10 1

CMLt(9;22)(q34;q11.2) 22

BCR-ABL

2CML

2413600/mm3

14.3g/dl 56.5 /mm3

41 0 341 3

25800/mm3

10.6g/dl 78.7 /mm3

4 101.1 /mm3

1 /7

BCR-ABL51% CML

2 CML

CML

- 52 -

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29 30

1 2

1 1 1 1 1 2

(CML) 101-1.6 ,

55 ,CML. ,

CML ,

. 31 , 1 0 .

. +AIH 2 2, 9 1

. 162, ,

CML . ,,

, ., 30 4 30.

35 1 , 34 6. 1

2058g,Apgar score1 8 ,5 9 , 21808g,Apgar score1 8 ,5 9 .

, 10

. NICU, follow .

CML.

,.

10~20%first trimester

third trimesterthird trimester 1

42 2 0 1

32 4

7mm

33 1

CT CT10cm

36 2

third trimester

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31 32

1200 1

three vessel trachea view3VTV

3VTV

3VTV

1 34 2 2

2232

36

39 52970g Apgar score

8/9 (1/5 ) pH7.283 BE 1.6mmol/L

1

5

3VTV

2000 5000 1

30 1 29 5

(9 7cm )

AFI 27cm 2cmMRI

30 3 MRI

variability2615g Apgar 4 /6

pH 7.314 BE 0.81

7 CT

12

50121

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33 34

1 2

1 1 1 1 1 1 1 2 2 2 2 2 2 2

cystic PVL

cystic PVL 3

1 21 1 0 27 51cm

29 1

1544g Apgar score 1 /5 8 /7pH7.384 1

54 MRI cystic PVL 2 36 2 2

23 29 530 5

1 1804g Apgar score 8/9 pH7.377 2 1768g

Apgar score 9 /9 pH7.289 114 55MRI cystic PVL 3 41 3 34 2

34 39cm

2062g Apgar score 3/9 pH7.164 3

21 MRI cystic PVL Cystic PVL

MRI

1

2015 3 2016 10

-1.5SD20

PDE520

NICU

P=0.01 HDPP=0.12 P=0.16

2(

20% 15%) (10% 10%)(0% 10%) (5% 5%)

(0% 0%)(0% 0%) (0% 0%)

(10% 0%) (0% 0%)(0% 0%) (30% 40%)

(55% 45%) (10% 10%)(0% 0%)

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35 36

1 2 1 2

1 2 1 1 1 1 1 1 1 1 1

1 1 1 1 1 1,2 1 1 1 1

PDPH(post dural puncture headache)

QuinkePDPH

PDPH

28 10 29 2180

1:Quinke 120

30 4PDPH 2:Pencil

point 6030 2 PDPH

5

PDPH 1: PDPH

53.3%13.3% 16.7%

10.0%3

2: PDPH PDPH Pencil

pointQuinke

TOLAC 45TOLAC

2013 1 2017 10

TOLAC45

TOLAC 45 36 (80%)(S ) 4 (11.1%)

(F ) 9 (20%)

S 31.44.2 F 31.8 4.5

BMI S 24.9 3.1kg/m2 F 26.4 2.1 kg/m2

S 13(36.1%) F 1 (11.1%)

TOLAC S 49.6 30.7 F48.9 50.2 S 39 1

10.2 F 39 5 17.7 S483.6 334.7 F

543.9 276.6S 2988.5 349.4g

F 3077.8 58.8g TOLAC

S F

TOLAC40

(BMI 30) 41 TOLACTOLAC

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37 38

DICrhTM AT-III

DICDIC

DIC rhTM

2007 2016DIC

DIC 61DIC DIC 8

DIC

DIC 29rhTM 19 DIC 32 rhTM

18 rhTM

DICrhTM

DICAT-III DIC

rhTM AT-IIIrhTM

DIC rhTM

Fib

FC 2014 1 2017 10

FC 14FC

4 3

3 31 1 1

4866ml2020ml-18000ml DIC 13.7 8-21 218 75-600 FC FC

Fib 51.5mg/dl 10mg/dl-128mg/dl FC202.3mg/dl 119mg/dl-269mg/dl FC1gFib 31.0mg/dl/g FC

Fib 13.8mg/dl/g FC14

FCFib

2017 Fib

FC

FCFC

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39 40

fibrinogenfibrinogen

Point of care test POCT

fibrinogen

2017 8 11fibrinogen 15

18CS-5100,

fibrinogen FibCare,

15 4

3 3 11 1 1

1 1

1 14 17

36.3 40.7 24.9 , 4.4 1.2 2

r2 = 0.992, p < 0.0001fibrinogen

268.0 120.2 vs 324.0 150.8, p < 0.0001

fibrinogen fibrinogenfibrinogen

POCT fibrinogen

2014 1 2016 8

1176954

(982vs578ml;p<0.001 )

(1357vs988ml:p<0.001)57 17 2 (11.8%)

40 2 (5%)

526 1 0525

3918 4 (22.2%)

21 5 (23.8%)

332 6 2 (33.3%)326 7 (

2.1%) 7%

23%

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41 42

JA

IVR Interventional radiology

31 153cm 38kg

383300g

297g 13 100/54mmHg 156

/

Hb7.2g/dLDIC 8 CT

IVR

IVR ICU 4RCC18 FFP20 PC157 MRI

18

IVR

IVR

2008 4 2017 10

2008 4 2017 10

146431 (2.1 )

2009 3.92.0%

18(58.1 )

9 (50.0 )5 (27.8 ) 4

(22.2 )13 (72.2 )

7(38.9 )

4(12.9 ) 1000ml

2 1

600ml2

3.75mg 411cm

- 59 -

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43 44

1.7%

56 162cm 104 BMI

39.6 1

MRICT

CMZ 4g/

CTRX 4g/CD MNZ 1.5g/

16

16cm 12cm

Prevotella CMZMRI

3 3 ,

,

,,Le Fort

4,direct 5mm

sealing device ,Endo Relief

,

,

2017 5,

,,

,

,, ,

,,

- 60 -

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45 46

JA 1 2

3

1 1 1 1 1 1 1 1

1 1 1 1 2 1 3 1

2014 10

LSC LSC

2008 1

2017 10604

241LSC 40

LSC 1

1

29

2

LSC

112 65LSC 38

74 LSC

LSC

65

2013 7 2017 9

65

1579 123 (7.8%) 6587

53 (43%) 51(41%) 16 (13%)

50 (41%)+ (LSC) 40 (33%)

(TLH) 32 (26%)1 TLH

12 (38%) 5(16%) 5 (16%) 4(13%) 1

5 (16%)

06 1 03

3 LSC

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47 48

1 2

1 2 2 2 2 2 2 2 2

40 4 3

64mmMRI

72mmperitoneal inclusion cyst

200ml 45 3mlMullerian cyst

5%

21

58 G2P2

8cmMRI 116x85mm

CA125320U/ml CA19-9 28U/ml PET-CT

2 1 1CT

CTCA125

448U/ml CA19-9 141U/ml

TC Bev 3CT

TC Bev 5Bev 12 CT

TC Bev

- 62 -

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49 50

1 2

1 1 1 1 1 1 1 1 2

Tumor-to-tumor Metastasis TTM,

.Krukenberg ,

.

. 50 .2 2 .11

. ,,

49pg/ml ,.MRI

84mm T2,

..

,

,. ,

. HECall-Exner body

.AE1/AE3 PAS Mib-1

.

. PET-CT ,.

,8 .

TTM ,TTM

.

Gynandroblastoma

1

1918

19

10cm

70%30%

Stage IC1

TC 6 3

3

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51 52

1 2 JA

1 1 1 1 2 1

90 9564 67

2010 4 2013 8

280

91.4%97.7% 82.0% 89.8%

24 8.6%

3

MRI

2008 1 2017 11

110

110

7 30

2

80%10%

403

- 64 -

2018/02/02 14:56:37 LL7E2-FGRRF-R20180131-P2 64


53 54

1 2 3

1 1 1 1 1 1 1 1 1 1 1 1

1 2 3 1

(MD )(TTTS)

TTTS

31 MD

10 16TTTS

19 0184g(-1.4SD)( A )

134g(-2.7SD)( B ) 6.7cm3.0cm TTTS

2123 A(MCA-PSV) B

24 3 AB MCA-PSV

B

BMCA-PSV B AFI 40cm

27 2(1400mL )

28 3 A B31 1 A

BA : 290g B : 1288g

Apgar Score 1 8 5 8 Hb 18.5g/dLMRI

64

circular shunt physiology(CSP)

Ebstein s

MD CSP 25 2 1

MD 16 2

FLP ATTTS

18 0 FLP TTTSFLP CSP 22 3

CSP23 5

CSP CSPCSP

33 4

1948g 2138g

3

MDCSP CSP

CSP

- 65 -

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55 56

2 1 35 DD 30

35 37 01 2294g Apgar

Score8/9 2 2456g Apgar Score8/91478g SpO2 CT

7 810

EF33.5

283

2 35 1 MD 3337 3

1 2726g Apgar Score8/9 22632g Apgar Score9/9 1350g

4 CT

5 EF60.7

12 1300-4000 1

1 5

2 1

3

35BMI 32 34

30140mmHg

750mg/37 5

3338g Ap8/92

3X

BNP2000pg/ml EF35

92 BNP33pg/ml EF51%

- 66 -

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57 58

LVdD

LVdD

LVdD /

E/e 15 E/e 8 BNP 200 pg/mLLVdD

157BNP 2

BMI BNP100 pg/mL ( 160/110 mmHg)

LVdD1,000 mL

LVdD 16.6%

10.8% 26.3%LVdD 40(OR) 4.70 95% (CI) 1.24-17.79 BNP

100 pg/mL OR 4.88 95%CI 1.90-12.54BNP 100 pg/mL

OR 6.16 95%CI 1.77-21.44

2 LVdDBNP

Soluble Fms-like Tyrosine Kinase-1

(sFlt-1) HDP

2016 11 2017 10HDP 11

HDP2015 Termination

HDP180/110

Biophysical profile score44 30

Termination sFlt-1sFlt-1

35 28-42

7 64% sFlt-127 22-34 sFlt-1 8480pg/ml

763-22,600pg/ml 29 26-3815 0-48

11 7 Termination 4Termination

sFlt-1 sFlt-1R2 0.662 p=0.027

sFlt-1 HDP

- 67 -

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59 60

Fetal Growth Restriction:FGRPDE5

2017 10 FGR

FGR20 34

7070

20mgCommon

Terminology Criteria for Adverse Event(CTCEA)4.0

G3

14 11 (78.6%) 8 4 (50%)Hypertensive Disorders of Pregnancy(HDP)

21 2 (9.5%) 173 (17.6%)

FGR2+ 17

1 (5.9%) 14 4 (28.6%)

1998

1998 8 2017 719

Hb

154 600ml

75 (48.7%) 60 1136

ml 775ml 6

1112ml3268ml

Hb0.8 3.4

19

- 68 -

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61 62

1 2 3

1 1 1 1

1 1 1 1 1 1 1 1 2 1 3 1

LMAM

LMLM

2009 4 2017 3

LM 11

AM 161

11 37 30-406 LM

3.5 1-10 LM3 1-5

10 137 28-3841 26-941149mL 625-2140mL

7 6-72724g 1315-3154g

5 7 1 NICU2

1 28

AM974mL 200-3004mL 1

0LM

LM28

1

(Laparoscopic Myomectomy; LM)

LM

2013 7 2017 6 119LM 115

57

( BMI) (

)

57 32 ( 34 )25 7

19 ( 2 17 ) 8( )

12.5(3-38) 22 12( 1

1 10 ) 2

1LM

0 vs( ), p

34(28-43) vs 37(27-44) , p=0.0166

LM2

LM

- 69 -

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63 64

1%

7.7

32 1 1 ,9

0

13mm2cm hCG7,886mIU/ml

D&C

HCG 32

33 2 0-rFSH-HMG

5 05 6

HCG2188mIU/ml 62 HCG 9156mIU/ml

1 HCG 9501mIU/ml 4 HCG 20272mIU/ml

MRI 186 6

HCG 7735mIU/ml 5

ART

- 70 -

2018/02/02 14:56:37 LL7E2-FGRRF-R20180131-P2 70


65

JA

41 G5P1 1

4 IVF-ET19

1230ml

hCG1017mIU/ml

3D-CT

(TLH) 300ml 300g

2008 2017

48 24

UAE

UAETLH

hCG

- 71 -

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138

138

2018 1 31

50

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