Doggrell Sheila A
The University of Queensland, School of Biomedical Sciences, QLD 4072, Australia.
Expert Opin Pharmacother. 2004 Sep;5(9):1917-28. doi: 10.1517/14656566.5.9.1917.
Preterm delivery (before 37 completed weeks of gestation) is the major determinant of infant mortality. In women with a previous preterm birth associated with bacterial vaginosis, prophylactic antibiotics (e.g., metronidazole) reduce the risk of preterm birth and low birth weight. Trichomonas vaginalis increases the risk of preterm delivery, but metronidazole is not beneficial for this and may even be detrimental. Antibiotic use (e.g., erythromycin) prolongs pregnancy in late premature rupture and has health benefits for the neonate. However, antibiotics are probably not useful in preterm labour. Intramuscular 17alpha-progesterone and vaginal progesterone reduce the rate of preterm labour in high-risk pregnancies, including previous spontaneous preterm delivery. Magnesium sulfate, beta2-adrenoceptor agonists and the oxytocin-receptor antagonist, atosiban, are effective in reducing uterine contractions short-term, but there is little evidence that this leads to improved outcomes for the neonate. However, tocolysis with calcium-channel blockers does seem to lead to better outcomes for the neonate. Fetal side effects, such as ductus arteriosus constriction and impaired renal function, are associated with the inhibition of prostaglandin synthesis with indomethacin. New approaches and more effective drugs are required in the treatment of preterm delivery.
早产（妊娠满37周前）是婴儿死亡的主要决定因素。在既往早产且与细菌性阴道病相关的女性中，预防性使用抗生素（如甲硝唑）可降低早产和低出生体重的风险。阴道毛滴虫会增加早产风险，但甲硝唑对此并无益处，甚至可能有害。抗生素使用（如红霉素）可延长晚期胎膜早破孕妇的孕周，并对新生儿有益。然而，抗生素在早产临产时可能并无作用。肌内注射17α-孕酮和阴道用孕酮可降低高危妊娠（包括既往自发性早产）的早产发生率。硫酸镁、β2肾上腺素能受体激动剂和催产素受体拮抗剂阿托西班可有效短期减少子宫收缩，但几乎没有证据表明这会改善新生儿结局。然而，使用钙通道阻滞剂进行宫缩抑制似乎确实能为新生儿带来更好的结局。胎儿副作用，如动脉导管收缩和肾功能受损，与吲哚美辛抑制前列腺素合成有关。治疗早产需要新的方法和更有效的药物。
