I 緒言
血液型不適合に起因しない非免疫性胎児水腫は，1943年Potter26)により初めて報告され，本症は，異常な赤血球造血を伴わず，Rh(＋）の初産の母親から産まれ，次回妊娠の予後がよいという点で従来多く見られたRh不適合妊娠に起因する胎児水腫と異なることが指摘された。非免疫性胎児水腫に関連する胎児の異常や母親の合併症については，その後多くの報告3), 8), 18), 20), 23), 31)がなされてはいるものの，全身に著明な浮腫を認める特異な病態の原因についてはいまだ不明な点が多い。また，非免疫性胎児水腫の出産頻度は諸外国の報告8), 18), 20)では数千の分娩に1例とされているが，わが国では多くの症例を検討した報告はなく，その発生頻度も明らかではない。
本研究は，関連病院の協力を得て，129,915例の分娩を調査し，非免疫性胎児水腫と診断された30症例について妊娠経過，分娩様式，新生児所見などの臨床像を検討したものである。
Thirty cases of nonimmunologic hydrops fetalis in 14 hospitals were studied. The incidence of nonimmunologic hydrops fetalis was 1 in 4,330 deliveries at all hospitals and 1 in 4,389 deliveries at Tokyo University Hospital. Among these, 13 cases with various kinds of fetal anomalies and 5 cases commplicating twin to twin transfusion syndrome were found. Polyhydramnions (78%), preeclampsia (20%), anemia (34%), and hypoproteinemia (64%) were the commonest prenatal maternal complications, whereas high incidence of abnormal NST patterns such as loss of variability was found, although urinary E3 levels were within normal range. High rates of premature labor, Caesarian section and vacuum extraction were found at the deliveries of nonimmunologic hydrops fetalis. Prenatal diagnoses were made in 30 % and 85 % of the cases before 1977 and between 1978 and 1982, respectively. Ultrasound examination was confirmed to be very useful in detecting hydropic state at the later period. The perinatal mortality from nonimmunologic hydrops fetalis was high (90%) ; and it was 1OO% in the cases with anomalies or twin to twin transfusion syndrome. The main cause of neonatal death was respiratory insufficiency due to hypoplasty of lungs and pleural effusion.
