Pregnancy Concerns in Marfan Syndrome and Loeys-Dietz Syndrome
36:11-38:43
So delivery recommendation sort of "How," "When," and "Where."
出産について、「方法」、「時期」、「場所」の観点で見ていきます。
So "How." It's either vaginal delivery or a c-section. And this is going to depend on your institution, somewhat depends on your aortic root size. Again we talked about, if it's a vaginal delivery, a lot of the times we'll use the forceps or the vacuum to decrease your time and effort of pushing.
まず「方法」は、通常分娩あるいは帝王切開になります。出産する病院、大動脈基部のサイズによって変わります。繰り返しになりますが、通常分娩では、多くの場合、出産にかかる時間やいきみの時間を減らすために、鉗子やバキュームを用います。
We think that vaginal delivery is safe if your aorta is less than 4 to 4.5 and cesarean delivery is recommended if your aorta is bigger than 4.5 or if you've had rapid growth.
通常分娩は大動脈の大きさが4～4.5cmの場合に安全性が高く、4.5cmを超える場合や、拡張速度が速い場合には、帝王切開が推奨されます。
Caveat with this is that really I think the jury is still out as to whether c-section is protective if you have a bigger aorta. These are things that are really expert opinion and we are working really hard with some funding from The Marfan Foundation to build bigger registries and really know if this is true because I think caesarean delivery has a lot of potential, you know, just risks from having surgery.
ですが、大動脈のサイズが大きい場合、帝王切開に保護的な効果があるかについては結論が出ていません。専門的な知見が必要であり、帝王切開の場合、外科手術であることによるリスクが考えられるため、現在我々は、The Marfan Foundationから資金を得ながら大規模な患者レジストリを構築し、この真偽を検証すべく懸命に取り組んでいるところです。
And so this would be something that I think we still need to get the data to say that this is actually what we should recommend for women with connective tissue disorders.
そのため、結合組織疾患の女性に帝王切開を推奨するためには、データを収集する必要があります。
In terms of "When," typically for delivery, so full a full-term baby is 40 weeks. For women with these conditions, we typically want to have like everything planned as best as we can, which, you know, with pregnancy nothing is really ever planned.
「時期」についてですが、妊娠40週目で生まれた場合には満期での出産となります。マルファン症候群やロイス・ディーツ症候群の女性の場合には、我々は通常、できる限り計画通りに進めたいと思っています。とはいっても、出産は思い通りにはなりません。
But typically will we think that at 39 weeks like a week before the delivery, we can induce labor if a woman has not gone into labor yet and we think at that point, the risks of prematurity for the baby are gone.
妊娠39週目あたりであれば、まだ陣痛に至っていない場合には陣痛を促すことができ、未熟児のリスクも回避できると考えています。
And it just depends on the situation, though. This is another thing where I think we don't really know when the right time is to deliver and we don't want to deliver somebody too early because there's risks of prematurity for the baby and it just really depends on what's going on on an individual basis with a woman as to when she should be delivered.
とはいえ、状況次第です。適切な出産時期については、まだわかっていないのです。あまり早い時期に出産させてしまうと、未熟児となるリスクがあります。やはり、患者さん個々の状態に基づいて判断する必要があります。
In terms of "Where," again hospital where they have cardiovascular surgery available for an emergency, which is typically going to be a tertiary care center and just making sure that on your team there's also this cardiologist and cardiovascular surgeon.
出産の「場所」は、緊急事態に備えて、心臓血管外科医のいる病院です。通常は、3次救急に対応できる医療施設となります。担当チームには、循環器内科医と心臓血管外科医がいることを確認してください。
The Marfan Foundation did not participate in the translation of these materials and does not in any way endorse them. If you are interested in this topic, please refer to our website, Marfan.org, for materials approved by our Professional Advisory Board.
The Marfan Foundation は、当翻訳には関与しておらず、翻訳内容に関してはいかなる承認も行っておりません。このトピックに興味をお持ちの方は、Marfan.org にアクセスし、当協会の専門家から成る諮問委員会が承認した内容をご参照ください。
