JP4839074B2 - Model for training of external rotation technique - Google Patents
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- JP4839074B2 JP4839074B2 JP2005352822A JP2005352822A JP4839074B2 JP 4839074 B2 JP4839074 B2 JP 4839074B2 JP 2005352822 A JP2005352822 A JP 2005352822A JP 2005352822 A JP2005352822 A JP 2005352822A JP 4839074 B2 JP4839074 B2 JP 4839074B2
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- 210000003754 fetus Anatomy 0.000 claims description 37
- 210000004291 uterus Anatomy 0.000 claims description 23
- 210000004381 amniotic fluid Anatomy 0.000 claims description 19
- PEDCQBHIVMGVHV-UHFFFAOYSA-N Glycerine Chemical compound OCC(O)CO PEDCQBHIVMGVHV-UHFFFAOYSA-N 0.000 claims description 14
- 235000011187 glycerol Nutrition 0.000 claims description 6
- 239000004094 surface-active agent Substances 0.000 claims description 3
- 208000034423 Delivery Diseases 0.000 description 6
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Description
本発明は骨盤位膣分娩の周産期死亡率の低減並びに骨盤位帝王切開の減少を目的に行われる、外回転手技を習得するためのトレーニング用モデルに関する。 The present invention relates to a training model for acquiring an external rotation technique for the purpose of reducing the perinatal mortality rate of pelvic position vaginal delivery and reducing the pelvic position caesarean section.
骨盤位とは妊娠、分娩時における胎児の頭部よりも骨盤部が下に来る場合、いわゆる逆子と呼ばれている場合であって、骨盤位経膣分娩の周産期死亡率は、頭位分娩と比較すると有意に高く、また周産期障害の発生率も高いことが指摘されている。そこで骨盤位経膣分娩を避け帝王切開が行われることが多いのが現状である。
1991年、米国では骨盤位のために約113,000例の帝王切開が行われ、骨盤位経膣分娩は約10%と推定されている。骨盤位の経膣分娩の危険性については多くの分娩統計が報告されているが、1992年の英国における満期、単胎骨盤位3,447分娩の統計によると、経膣分娩は27.9%（961例）で、1,457例（42.3%）は陣痛発来前に、1,029例（29.9%）は分娩途中から緊急帝切となっている。その結果、分娩前胎児死亡と先天奇形による死産を除外した児死亡は、経膣群8例（分娩中4例、新生児期4例）（0.83%）、帝切時1例、（新生児死亡）（0.03%）で、この間、満期、単胎、骨盤位以外で経膣分娩した群の分娩中および新生児期の児死亡率0.08% （77/93,602）で経膣群の予後の悪さが顕著である。また、新生児予後は予定帝切群と経膣分娩群、分娩中の緊急帝切群を比較すると、新生児特別管理室収容には有意差が見られなかったがアプガースコアー低値や挿管例は経膣分娩、緊急帝切群は予定帝切群の２倍であったという。
同様の結果がカナダのChengらも報告している。（Obstet. Gynecol., 82：605,1993）これらの報告を元に、骨盤位を予定帝切とする考えが確実に根付きつつあるのが現状である。
しかしながら骨盤位の帝王切開を減少させるためには、骨盤位そのものを無くする努力のほうがはるかに効率の良い選択肢であると考え、そのために外回転手技が考案されている。外回転手技とは子宮内の胎児をイメージしながら手によるマッサージで胎児を回転させる手技であるが、外回転手技で生じると予測されるさまざまなトラブルを懸念して外回転手技は普及していない。
The pelvic position is when the pelvic part comes below the head of the fetus during pregnancy and delivery, which is called a reverse, and the perinatal mortality rate of pelvic transvaginal delivery is the head position. It has been pointed out that it is significantly higher than parturition and has a higher incidence of perinatal disorders. Therefore, cesarean section is often performed to avoid pelvic transvaginal delivery.
In 1991, approximately 113,000 cesarean sections were performed in the United States for pelvic position, and pelvic transvaginal delivery was estimated at approximately 10%. Numerous birth statistics have been reported regarding the risk of vaginal delivery in the pelvic position, but according to the statistics for maturity in the 1992 UK, single pelvic position 3,447 delivery, vaginal delivery was 27.9% (961 cases) In 1457 cases (42.3%), before labor began, 1,029 cases (29.9%) had an emergency cesarean during delivery. As a result, the number of infant deaths excluding prepartum fetal death and stillbirth due to congenital malformation was 8 cases in the vaginal group (4 cases during delivery, 4 cases in neonatal period) (0.83%), 1 case at cesarean section, (death of newborn) (0.03%), during this period, the mortality rate of 0.08% (77 / 93,602) in the vaginal delivery group other than full term, singleton, and pelvic position was significantly worse in the vaginal group. is there. In addition, when comparing the scheduled cesarean section, the vaginal delivery group, and the emergency cesarean section during delivery, the neonatal prognosis was not significantly different in the neonatal special management room, but the low Apgar score and intubation were The vaginal delivery and emergency cesarean section were twice as many as the scheduled cesarean section.
Similar results are reported by Cheng et al. In Canada. (Obstet. Gynecol., 82 : 605, 1993) Based on these reports, the idea that the pelvic position is to be scheduled is now firmly taking root.
However, to reduce cesarean section at the pelvic position, efforts to eliminate the pelvic position itself are considered to be a much more efficient option, and external rotation techniques have been devised for that purpose. An external rotation technique is a technique in which the fetus is rotated by hand massage while imagining the fetus in the uterus. .
Russelらは、1985年〜1992年の統計で妊娠36週以降陣発までの間に外回転を行いその成功率は51% （174例／464例中）であったと述べているが（Am. J. Obst. Gynec.,172:1916,1995）、意外にも外回転手技に成功した174例中54例（31%）が帝王切開となり、満期、単胎分娩全体の帝王切開率15%を大きく上回っていたと報告されている。これは骨盤位矯正により臍帯巻絡が生じる可能性の増加等、危険性の増加が予想されるためである。外回転手技はその危険性だけが強調されるあまり実際に行っていることは少ないのが現実ではあるが、麻酔事故、おもわぬ大量出血、手技後の感染、血栓形成、その血栓が肺に流れていくことによって起こる肺梗塞などの母体合併症や、帝王切開で産まれた児に特有な呼吸障害などの潜在的な危険性を持つ骨盤位帝王切開を減少させる目的で、安全に効果的に外回転手技を施行するためには外回転手技の習得が重要となる。
産科を介助するためのトレーニングモデルとしては特許文献１がある。この文献では模擬胎児を含む模擬子宮のモデルで、出産等のトレーニングを目的としたモデルではあるが、外回転手技を習得するためのトレーニング用モデルではなく、外回転手技を習得するための適正なトレーニング用モデルは存在しなかった。
There is Patent Literature 1 as a training model for assisting obstetrics. Although this model is a model of a simulated uterus that includes a simulated fetus and is intended for training such as childbirth, it is not a training model for learning external rotation techniques, but an appropriate model for acquiring external rotation techniques. There was no training model.
そこで発明者らは外回転手技をトレーニングするためのモデルを開発すべく研究を行った結果、本発明を完成したもので、本発明の目的は外回転手技をトレーニングするためのモデルを提供することである。 Therefore, the inventors have completed the present invention as a result of research to develop a model for training the outer rotation technique, and the object of the present invention is to provide a model for training the outer rotation technique. It is.
本発明の要旨は、少なくとも模擬胎児、模擬子宮、模擬羊水からなる外回転手技トレーニング用モデルであって、模擬子宮内に模擬羊水が満たされ、その中に回転可能な模擬胎児が内在していることを特徴とする外回転手技トレーニング用モデルである。
そして、外回転手技トレーニング中模擬胎児の位置や状態を超音波によって観察することが出来るようにすることが好ましく、また、模擬胎児は月齢に応じてその大きさの異なる模擬胎児に交換できるようにすることが好ましい。
The gist of the present invention is an external rotation technique training model comprising at least a simulated fetus, a simulated uterus, and a simulated amniotic fluid, wherein the simulated uterus is filled with the simulated amniotic fluid, and a rotatable simulated fetus is contained therein. This is a model for training the outer rotation technique.
It is preferable that the position and state of the simulated fetus can be observed with ultrasound during the training of the outer rotation technique, and the simulated fetus can be replaced with a simulated fetus having a different size depending on the age. It is preferable to do.
本発明においては模擬羊水中に回転可能な模擬胎児が内在しているため、外部より子宮内の胎児をイメージしながら腹部を掌でマッサージすることによって模擬胎児を回転させることができるので、これによって外回転手技がトレーニングできる。 In the present invention, there is a rotatable fetus in the simulated amniotic fluid, so the simulated fetus can be rotated by massaging the abdomen with the palm while imaging the fetus in the uterus from the outside. You can train the outer rotation technique.
以下の本発明を詳細に説明する。
外回転手技は、先に述べたように、子宮内の胎児をイメージしながら手によるマッサージで胎児を回転させ胎児の頭部が骨盤部の下に来るようにする手技であるが、その外回転の途中を度々超音波によって胎児の位置、状態を確認することが行われる。
そこで本発明にかかるトレーニングモデルにおいても外回転手技をトレーニングできるよう、羊水に胎児が入っている状態で、外回転手技を施工することで実際の外回転手技と同じ感触、強さで胎児を回転できるモデルであることが重要である。更に超音波による観察ができるモデルであることが好ましい。本モデルは全身モデルであっても腹部のみの部分モデルのいずれであっても良く、全身モデルで外回転手技以外の部分は特に生体を模した外形を持てばよい。そして、この人体モデルの腹部に模擬子宮を内在させる。
The present invention is described in detail below.
As mentioned above, the external rotation technique is a technique in which the fetus is rotated by hand massage while the fetus in the uterus is imaged so that the fetal head comes under the pelvis. During this period, the position and state of the fetus are often confirmed by ultrasound.
Therefore, in the training model according to the present invention, the fetus can be rotated with the same feel and strength as the actual external rotation procedure by applying the external rotation procedure with the fetus in amniotic fluid so that the external rotation procedure can be trained. It is important that the model be able to. Furthermore, it is preferable that the model can be observed with ultrasonic waves. This model may be either a whole body model or a partial model with only the abdomen, and the whole body model may have an external shape that imitates a living body. Then, a simulated uterus is contained in the abdomen of this human body model.
模擬子宮としては容積約５Ｌの袋状体で、模擬子宮内部に胎児を模した模擬胎児を内在させておく。模擬胎児の大きさ並びに模擬子宮の大きさは外回転手技が施行される月齢に合わせた大きさにすれば良い。
模擬子宮内には羊水を模した液体を充填するが、種々検討の結果、模擬羊水として潤滑性を持つ液体を使うことで模擬胎児を回転させることが可能であった。具体的には液体洗剤等の界面活性剤、グリセリン水溶液等が可能であった。液体洗剤については家庭用洗剤をそのまま、または希釈して使用することができ、その希釈倍率は１倍から１０倍の範囲で用いることができる。またグリセリン水溶液についてはグリセリンの混合率が０．１％〜１００％の範囲で用いることができる。模擬子宮は生体と類似した物性を持つ材料を使い製造することができ、具体的にはシリコーン、ポリウレタン、ポリ塩化ビニル等を用いることが出来る。また、模擬胎児も生体と類似した物性を持つ材料を使い製造することができ、具体的にはシリコーン、等を用いることが出来る。模擬胎児には臍帯類似物を具備することも可能である。臍帯類似物を具備することで臍帯巻絡を予防するトレーニングも含めより実体に近いトレーニングが可能となる。
模擬子宮には注入口を備えていることが望ましい。具体的には模擬子宮の頭部側等トレーニングに問題のない場所に注入口を設ける。注入口は模擬羊水を注入するための開口部であって、必要に応じて模擬羊水を注入し、それ以外の時には模擬羊水が漏出することを防ぐための密栓ができる必要がある。また本注入口が有ることで模擬羊水の調節可能となる。具体的には界面活性剤、グリセリンの濃度を調製することが可能となり、より生体の状態と近い状態でのトレーニングを行うことができる。
また超音波による観察が可能になるためには模擬胎児、模擬子宮をシリコーンで作成し、模擬羊水としてグリセリン及びその水溶液を用いることで観察は可能となる。
The simulated uterus is a bag having a volume of about 5 L, and a simulated fetus imitating a fetus is contained inside the simulated uterus. The size of the simulated fetus and the size of the simulated uterus may be set according to the age at which the external rotation procedure is performed.
The simulated uterus is filled with a fluid that simulates amniotic fluid. As a result of various studies, it was possible to rotate the simulated fetus by using a fluid having lubricity as the simulated amniotic fluid. Specifically, a surfactant such as a liquid detergent, a glycerin aqueous solution, and the like were possible. About a liquid detergent, household detergent can be used as it is or diluted, and the dilution rate can be used in the range of 1 to 10 times. Moreover, about the glycerol aqueous solution, the mixing rate of glycerol can be used in 0.1 to 100% of range. The simulated uterus can be manufactured using a material having physical properties similar to those of a living body. Specifically, silicone, polyurethane, polyvinyl chloride, or the like can be used. The simulated fetus can also be manufactured using a material having physical properties similar to those of a living body. Specifically, silicone or the like can be used. The simulated fetus can also have an umbilical cord analog. By providing an umbilical cord analog, training closer to the substance is possible including training to prevent umbilical cord winding.
It is desirable that the simulated uterus has an injection port. Specifically, an injection port is provided in a place where there is no problem in training such as the head side of the simulated uterus. The injection port is an opening for injecting simulated amniotic fluid, and it is necessary to inject simulated amniotic fluid as necessary and to be able to provide a sealed plug to prevent the simulated amniotic fluid from leaking out at other times. Also, the presence of this inlet makes it possible to adjust the simulated amniotic fluid. Specifically, it is possible to adjust the concentration of the surfactant and glycerin, and training can be performed in a state closer to the state of the living body.
In order to enable observation by ultrasound, a simulated fetus and a simulated uterus are made of silicone, and glycerin and its aqueous solution are used as simulated amniotic fluid.
実施例として図面をもって本発明をより詳細に説明する。
図１は模擬子宮の説明図である。シリコーンフィルムよりなる袋状体の模擬子宮１の一部に模擬羊水２を注入するための注入口３を設ける。そして、この模擬羊水４が存在する中に模擬胎児４を内在させる。模擬胎児４の大きさは外回転手技が施行される月齢に合わせた大きさにすれば良いのであるが、具体的には２０００ｇ〜３０００ｇで、月齢に合わせて交換する。模擬胎児４は模擬羊水中で模擬胎児の頭部の位置が変えられるように内在させる。そして、この模擬子宮１を人体モデルの腹部に入れ、その外部より子宮内の胎児をイメージしながら手によるマッサージで、模擬胎児の頭部が骨盤部の下に来るようにする。その状態を図２に示す。
模擬羊水２中の模擬胎児の状態及び位置を超音波によって観察が出来るようにするため模擬胎児をシリコーンで構成する。
The present invention will be described in more detail with reference to the drawings as embodiments.
FIG. 1 is an explanatory diagram of a simulated uterus. An injection port 3 for injecting simulated
The simulated fetus is made of silicone so that the state and position of the simulated fetus in the simulated
以上述べたように本発明に係るモデルによって外回転手技を習得し、骨盤位経膣分娩や帝王切開を避け、頭位分娩とすることによって骨盤位経膣分娩や帝王切開に基づく弊害を解消することが出来る。 As described above, the external rotation technique is mastered by the model according to the present invention, avoiding the pelvic position transvaginal delivery and caesarean section, and eliminating the adverse effects based on the pelvic position transvaginal delivery and cesarean section by using the head position delivery. I can do it.
１ 模擬子宮 ２ 模擬羊水 ３ 注出口 ４ 模擬胎児
５ 人体モデル
1
Claims (3)
The model for external rotation technique training according to claim 1 or 2, wherein the simulated amniotic fluid contains at least one of a surfactant and glycerin.
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