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抑制妊娠女性急性早产临产后的处理

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

引言

早产临产(preterm labor, PTL)急性发作缓解后的最佳妊娠处理方案目前尚不明确。尚无大型随机试验对不同的处理策略进行过比较。

本专题将总结治疗急性特发性PTL后宫口扩张无进展的女性的处理方法。对疑似PTL女性的评估和处理将会单独讨论。 (参见“早产临产和早产概述”和“抑制急性早产临产”)

体力活动

住院治疗是否有益？ — 目前，对于疑似PTL发作治疗后病情稳定的女性，人们尚未就延长住院治疗时间的价值进行过研究。我们认为，对于产科情况不稳定的患者，例如宫口扩张有进展、阴道出血、胎儿状况不良，或者距离能够提供适当产科和新生儿医疗服务的医院路途较远的女性，继续住院观察可能是有用的，但我们会根据患者的具体情况来制定个性化的处理方案。这些情况与孕妇在三级医疗中心之外分娩的概率增加相关，并与可能引发母亲和/或新生儿严重并发症的分娩相关。

唯一一项相关的随机对照试验对比了在终止PTL后将女性收治入院与让其出院回家两种措施，旨在明确前者是否能增加36周及以后分娩的比例，但结果显示住院治疗并无明显益处[1]。在该试验中，101例单胎妊娠、胎膜完整、平均宫口扩张2.7cm、并在妊娠24-33+4周时被诊断为PTL终止的女性被随机分为两组，一组在完成1个疗程的地塞米松治疗后继续住院治疗直到妊娠34周，另一组则在接受相同治疗后出院回家。研究中未使用抗宫缩剂，仅采取保守治疗来停止宫缩。两组中，均有大约70%的女性在妊娠36周及以后分娩。该试验的检验效能不足，且其结果不适用于经抗宫缩剂治疗后PTL终止的女性这一更有临床意义的群体[2]。

卧床休息是否有益？ — 目前尚无证据支持卧床休息能够有效防止单胎[3,4]或双胎妊娠[5]发生自发性早产。卧床休息有已知的潜在危害：它能促进骨小梁骨密度的流失、增加静脉血栓栓塞的风险、导致骨骼肌肉失健，并给个人和家庭带来巨大的心理社会压力[3,6-12]。基于缺乏可证明卧床休息能有效预防早产的证据，加上其已知的重大风险，我们不推荐有近期PTL病史的女性卧床休息。

               

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-03.
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