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抑制急性早产临产

Authors
Hyagriv N Simhan, MD, MS
Steve Caritis, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG
Translators
周希亚, 副主任医师

引言

本专题将讨论使用抗宫缩剂抑制急性早产临产的方法。包括发病机制、危险因素、临床表现和诊断、诊断性评估、预防及新生儿结局在内的其他早产临产相关问题参见其他专题。

●(参见“早产的危险因素”)

●(参见“早产临产和早产概述”)

效果

抗宫缩剂可降低子宫收缩的强度和频率。对于急性早产临产女性，2009年的一篇关于随机试验的meta分析发现：此类药物与安慰剂/对照组相比能更有效地延迟分娩48小时(抗宫缩剂组75%-93% vs 安慰剂/对照组53%)和7日(抗宫缩剂61%-78% vs 安慰剂/对照组的39%)，但并不能更有效地延迟分娩至37周[1]。值得注意的是，在该meta分析[1]和其他研究[2]中，相当一部分被诊断为早产临产的女性即使未接受抗宫缩治疗，也没有在短期内分娩，甚至并未早产。此外，给予抗宫缩剂并未使重要的临床结局出现有统计学意义的改善，如新生儿呼吸窘迫和生存情况[1]。

患者选择

处于急性早产临产早期阶段的女性宫口还未显著扩张，最宜接受抗宫缩剂治疗[3]。当延迟分娩的总体获益超过风险时，需行保胎治疗。美国妇产科医师学会(American College of Obstetricians and Gynecologists, ACOG)在一项实施公告中提出：“仅当早产临产女性处于推迟分娩将有益于新生儿的孕龄时，才应采取干预措施以降低分娩的可能性。由于抗宫缩剂治疗的有效时间通常可长达48小时，只有推迟分娩48小时能够使胎儿获益的女性才应接受抗宫缩剂治疗”[4]。

                                                            

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Literature review current through: 2017-06 . | This topic last updated: 2016-10-05.
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