Haram Kjell, Mortensen Jan Helge Seglem, Wollen Anne-Lone
Department of Obstetrics and Gynecology, Helse-Bergen, Bergen, Norway.
Acta Obstet Gynecol Scand. 2003 Aug;82(8):687-704. doi: 10.1034/j.1600-0412.2003.00218.x.
Preterm delivery is the leading factor causing neonatal mortality and morbidity. We have conducted a PubMed literature search to obtain an update on the etiology, diagnostic problems and therapeutic considerations of preterm delivery. Approximately 5-10% of all births are premature. Preterm labor is associated with preterm rupture of membranes, cervical incompetence, polyhydramnion, fetal and uterine anomalies, infections, social factors, stress, smoking, heavy work and other risk factors. The diagnosis is made on the patients presenting symptoms, clinical findings and of progressive effacement and dilatation of the cervix. Biochemical markers of preterm delivery are of minor importance in daily clinical work. Measurement of the cervix, however, is a practical and valuable tool to predict preterm delivery. Cervical cerclage can be useful in selected cases. Antibiotics may help to prevent preterm labor in cases of known etiologic agents (e.g. preterm rupture of membranes and urinary infection). The use of tocolytic agents such as beta-sympathetic receptor stimulators can be advocated for a few days. There is evidence that their long-term use is not beneficial and could even be harmful to the fetus. Calcium channel blockers (nifedipine) and a new selective oxytocin receptor antagonist, atosiban, appear to be as effective as beta-sympathomimetic drugs on uterine contractions with fewer side-effects. Prostaglandin synthetase inhibitors such as indomethacin may prevent uterine contractions and can be used prior to the 32nd week of pregnancy. A single course of corticosteroid treatment in two doses of 12 mg betamethasone or 6 mg of dexamethasone is important for the prevention of respiratory distress between the 24th and 34th weeks of pregnancy. Multiple doses may be harmful and should be avoided. In these cases management should depend on gestation age (fetal maturity). Uterine contractions after 34 weeks' gestation are not an indication for tocolytic treatment.
早产是导致新生儿死亡和发病的主要因素。我们进行了一次PubMed文献检索，以获取有关早产的病因、诊断问题和治疗考量的最新信息。所有分娩中约5-10%为早产。早产与胎膜早破、宫颈机能不全、羊水过多、胎儿及子宫异常、感染、社会因素、压力、吸烟、繁重工作及其他危险因素相关。根据患者的症状、临床发现以及宫颈的进行性消退和扩张来做出诊断。早产的生化标志物在日常临床工作中重要性较低。然而，测量宫颈是预测早产的实用且有价值的工具。宫颈环扎术在某些特定病例中可能有用。对于已知病因（如胎膜早破和泌尿系统感染）的情况，抗生素可能有助于预防早产。可以主张使用β-交感神经受体激动剂等宫缩抑制剂几天。有证据表明长期使用它们并无益处，甚至可能对胎儿有害。钙通道阻滞剂（硝苯地平）和一种新型选择性催产素受体拮抗剂阿托西班在抑制子宫收缩方面似乎与β-拟交感神经药物同样有效，且副作用较少。前列腺素合成酶抑制剂如吲哚美辛可预防子宫收缩，可在妊娠32周前使用。在妊娠24至34周期间，单次给予两剂12毫克倍他米松或6毫克地塞米松的皮质类固醇治疗对于预防呼吸窘迫很重要。多次给药可能有害，应避免。在这些情况下，治疗应取决于孕周（胎儿成熟度）。妊娠34周后的子宫收缩并非宫缩抑制治疗的指征。
