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Studies on Uterine Blood Flow in Late Pregnancy by Cervical-Myometrial Clearance Method Takehiko ITAHASHI Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Japan (Director: Prof. Ryuji Yamaguchi) Advances in Obsterics and Gynecology, Vol. 26, No. 3, 1974 A simple method for determination of myometrial clearance was proposed to make easy the evaluation of utero-placental blood flow. To the woman of late pregnancy, thiamine-propyldisulfide (TPD), 5ml (1ml), was injected into the uterine cervix with a No. 12 Kobak's needle thrust 1cm deep at the 12 o'clock position. The TPD clearance time (TPD time) was decided to coincide with the time from the start of injection to the woman's first sensing of a garlic-like smell of TPD. The results showed: (1) The substance injected in the cervix scarcely moved to the corpus, but cervical blood flow usually conformed readily to the changes in corporeal blood flow in response to the loading of oxytocin or phenylephrine, suggesting cervical approach available for determining myometrial clearance. (2) Experiments with 99mTc corroborate that TPD was almost compatible with 99mTc in sensitivity and clearance. (3) In women of 35 to 41 weeks of normal pregnancy, the TPD time was usually lagging with pregnancy weeks. (4) Toxemia cases with hypertension as the main symptom and those of chronic or mixed type tended to have delayed TPD times. (5) Women of prolonged pregnancy showed delayed TPD time with a remarkably wide deviation. (6) Women of toxemia or prolonged pregnancy with delayed TPD times were generally associated with a high incidence of low Apgar score. With the findings of basic and clinical experiments, the author believes that the TPD test is a fovorable, simple and harmless means of clinical assessing utero-placental blood flow.

産婦 進 歩 第26巻3号 板橋:.頚 部Clearance法 Photo. 1. Fig. 1. Relationship phenylephrine-hci に よ る妊娠 子 宮 血 流 動 態 Outflow pathway of cervically injected (14 seconds after Urografin injection). between corporeal (500μCi of substance and cervical blood flow RIHSA intravenously 257-49 (I): Influence of injected).

258-50 板 橋:頚 部Clearance法 Fig. 2. Relationship between oxytocin(500μc1 Fig. 3. Half-period 99mTc corporeal of RIHSA clearance cervically に よ る妊 娠 子 宮 血 流 動態 and cervical intravenously time(t1/2) injected). blood flow(ii): 産 婦進 歩 第26巻3号 Influence injected). of 99mTC at the cervix(100μci of

産婦 進 歩 第26巻3号 板 橋:頚 部Clearance法 Fig. 4. Scintigram at the nose and に よ る妊 娠 子宮 血 流 動 態 heart (100μCi 99mTc 259-51 cervically injected). の 臭 い を感 ず べ き鼻部 で どの よ うな 推 移 を と るか を見 る 目的 で, TPD(1ml)と99mTC(lml)と 時 に子 宮 頚 部 に 注射 す る とFig. を混 じ 同 3, 4の よ うに, 頚 部 で は急 激 な立 ち 上 りと緩 や か な 減衰 曲線 を 示 した が, 子 宮体 部 では 極 め てわ ず か な 上 昇 を示 す の み で あ っ た. 一 方, 鼻 部 お よび心 臓 部 で は 頚 部 の立 ち上 りか らや や 遅 れ て放 射 能 の立 ち上 りが 見 ら れ, 以 後 緩 徐 に 上昇 し て い っ た. 2. TPDと99mTcの つ ぎにTPD 相関 5mg(1ml)と99mTc の 混合 液 計2mlを 100μCi(1ml) 子 宮 頚 部 に注 射 し, 臭 覚 発 現時 間 Fig. と99mTcの a) 各 変 化 をみ る と次 の よ うで あ る. TPD-timeと99TC build-up TPD-timeとscintigraphか build-up 数r=0.87, r=0.948と timeと timeの 5. TPD-time at the and build-up time of 99mTc cervix. 関係 ら 計 測 した99mTc の相 関 関 係 は頚 部 に お い て は 相関 係 鼻 部 に おい ては 頚部 よ り や や 遅 れ るが い う結 果 が得 られ た(Fig. 5, 6). なか ん ず く鼻 部 に おけ る99mTcと 臭 覚発 現 時 間 との 間 の密 接 な 関 係 は, 鼻部 へ のTPDと99mTcの ど 同時 で あ り, か つ99mTc放 到 達 が ほ とん 射 能検 出 限界 と臭 初感 閾 値 とが ほ とん ど 異 ら な い こ とを 意 味 し てお り, TPD が 極 め て 敏感 な ク リア ラン ス物 質 で あ るこ とを 示 して Fig. い る. b) build-up time at the nose and TPD-time. 頚 部組 織 にお け る99mTcのT1/2とTPD-time Fig. 8に 示 す よ うに, との関 係 組 織 ク リア ランス の 指 標 とな るT1/2とTPD-time との関 係 はFig. に おい て もTPD臭 7の よ うにr=0.81で あ り, この 点 覚 発 現 時 間 は頚 部 の物 質 ク リア ラ ン スを ほ ぼ忠 実 に 反 映す る もの で あ る ことが うか がわ れ た. c) 6. 99mTc TPD 1ml+99Tc1ml計2ml注 独注射 よりも 射 の 方が 臭 覚発 現 時 間 が早 くな るが, 両 者 の相 関 はr=0.91で, 注射量 に よっ て臭 覚 発 現 時 間 に デ タ ラ メな 変 化 は生 じな い こ とを 示 し てい る. 3. 注 入量 と臭 覚 発 現時 間 と の関 係 TPD 1ml単 胎盤 付 着 部 位 に よる影 響 Fig. 9の よ うに 胎 盤 の付 着 側 で は88.01±27.36秒

Fig. 11. TPD-time in non-pregnant, pregnant and puerperal states. Table 1. Influence of Uterine Contraction on TPD-time. Table 2. Effects of Phenylephrine-HCl on TPD-time.

Table 3. TPD test and prolonged (Apgar score). pregnancy Table 4. TPD test and prolonged (Placenta/infant pregnancy weight ratio). Fig. 12. TPD-time in prolonged pregnancies.

Fig. 13. TPD-time in pregnancy toxemias. Fig. 15. Correlation between TPD time and fetus-placental parameters in hypertensive toxemias. Fig. 14. TPD-time in pregnancy toxemias. Fig. 16. TPD-time in abnormal pregnancies.

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