上田 優輔^{1, 2}, 廣瀬 雅哉², 伊藤 拓馬¹, 安本 晃司¹, 川口 浩実¹, 宗重 彰¹, 中島 正敬¹

Yusuke UEDA^{1, 2}, Masaya HIROSE², Takuma ITO¹, Koji YASUMOTO¹, Hiromi KAWAGUCHI¹, Akira MUNESHIGE¹, Masataka NAKAJIMA¹

¹長浜赤十字病院産科・婦人科, ²兵庫県立尼崎総合医療センター産婦人科

¹Department of Obstetrics and Gynecology, Nagahama Red Cross Hospital, ²Department of Obstetrics and Gynecology, Hyogo Prefectural Amagasaki General Medical Center

キーワード : uterine synechia, amniotic sheet, intrauterine cyst, pregnancy, vaginal ultrasound

妊娠中のuterine synechiaは，一般的に子宮腔を横切る索状構造物を同定することにより診断に至る．今回，妊娠中期に内子宮口付近に現れた嚢胞性病変を契機としてuterine synechiaと診断した症例を経験した．26歳の初産婦が，妊娠26週0日に初めて，経腟超音波検査上，68×44 mmの嚢胞性病変を内子宮口付近に認めた．妊娠30週5日のmagnetic resonance imagingで頭尾側が丸く中央がくびれた，ひょうたん型の羊水腔を認めた．上部の羊水腔に横位となった胎児を認め，子宮体部正中を前後に交通する索状構造物を認めた．上部の羊水腔から11×10×10 cmの球状の羊水腔が内子宮口に向かって膨隆していた．妊娠36週6日に臍帯が下部の羊水腔に下垂しているのが観察されたため，妊娠37週3日に選択的帝王切開術を施行し，3,062 gの女児をアプガースコア9／9（1分／5分）で娩出し，索状構造物も同時に摘出した．経腟超音波で内子宮口付近の嚢胞性病変を同定することは，uterine synechiaの診断の契機になり，これを正確に診断することにより妊娠中の合併症を防止することにつながるものと考えられた．

Uterine synechia during pregnancy is generally diagnosed based on the presence of band-like structures in the uterine cavity. We treated a woman in the second trimester of pregnancy who had uterine synechia that was initially manifested as an intrauterine cyst just above the uterine ostium. A 26-year-old Japanese woman, gravida 1, para 0, was referred to Nagahama Red Cross Hospital because of a 68×44-mm intrauterine cyst located just above the uterine ostium found during a vaginal ultrasound examination at 26 weeks of gestation. Magnetic resonance imaging at 30 5/7 weeks of gestation revealed a transverse band-like structure attached anteriorly through the posterior at the center of the cavity, which incompletely divided the cavity into upper and lower compartments. The fetus was lying in a transverse position in the upper compartment, while the lower compartment was an 11×10×10-cm globular amniotic cavity protruding from the upper compartment. At 36 6/7 weeks of gestation, serial ultrasonography showed that the umbilical cord had penetrated into the lower compartment. Therefore, an elective cesarean delivery was conducted at 37 3/7 weeks of gestation, and a healthy female was delivered with a weight of 3,026 g and Apgar score of 9/9 (1 min/5 min). The synechia was resected during the operation. Detection of an intrauterine cyst during pregnancy may suggest the presence of uterine synechia, and accurate diagnosis can contribute to avoiding complications during pregnancy.