Sanchez-Ramos Luis, Kaunitz Andrew M, Delke Isaac
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Florida Health Science Center, 653-1 West 8th Street, Jacksonville, FL 32209, USA.
Obstet Gynecol. 2005 Feb;105(2):273-9. doi: 10.1097/01.AOG.0000150559.59531.b2.
To perform an updated systematic review with meta-analysis to further elucidate the efficacy of progestational agents for the prevention of preterm births in patients at elevated risk.
Computerized databases, references in published studies, and textbook chapters in all languages were used to identify randomized controlled trials (RCTs) evaluating the use of progestational agents for the prevention of preterm births in women at elevated risk.
We identified RCTs that compared progestational agents with placebo for patients at risk for preterm birth and evaluated at least one of the following: delivery before 37 weeks of gestation, birth weight less than 2,500 g, threatened preterm labor, respiratory distress syndrome, and perinatal mortality. The primary outcomes assessed were preterm delivery and perinatal mortality.
TABULATION, INTEGRATION, AND RESULTS: Ten studies met inclusion criteria for this review. For each study with binary outcomes, an odds ratio (OR) with 95% confidence intervals (CIs) was calculated for selected outcomes. Homogeneity was tested across the studies. Compared with women allocated to receive placebo, those who received progestational agents had lower rates of preterm delivery (26.2% versus 35.9%; OR 0.45, 95% CI 0.25-0.80). Similar results were noted when comparing patients who were specifically treated with 17alpha-hydroxyprogesterone caproate (29.3% versus 40.9%; OR 0.45, 95% CI 0.22-0.93). Additionally, subjects allocated to receive 17alpha-hydroxyprogesterone caproate had lower rates of birth weights less than 2,500 g (OR 0.50, 95% CI 0.36-0.71). No differences in rates of hospital admissions for threatened preterm labor or perinatal mortality were noted for subjects receiving progestational agents in general or for those receiving only 17alpha-hydroxyprogesterone caproate specifically.
The use of progestational agents and 17alpha-hydroxyprogesterone caproate reduced the incidence of preterm birth and low birth weight newborns.
进行一项更新的系统评价并荟萃分析，以进一步阐明孕激素类药物对高危患者预防早产的疗效。
使用计算机数据库、已发表研究中的参考文献以及所有语言的教科书章节，以识别评估孕激素类药物用于预防高危女性早产的随机对照试验（RCT）。
我们确定了将孕激素类药物与安慰剂进行比较的RCT，这些研究针对有早产风险的患者，并评估了以下至少一项：妊娠37周前分娩、出生体重低于2500克、先兆早产、呼吸窘迫综合征和围产期死亡率。评估的主要结局为早产和围产期死亡率。
制表、整合与结果：十项研究符合本评价的纳入标准。对于每项具有二分类结局的研究，计算选定结局的比值比（OR）及95%置信区间（CI）。对各项研究进行同质性检验。与分配接受安慰剂的女性相比，接受孕激素类药物的女性早产率较低（26.2%对35.9%；OR 0.45，95%CI 0.25 - 0.80）。比较接受己酸羟孕酮特异性治疗的患者时也有类似结果（29.3%对40.9%；OR 0.45，95%CI 0.22 - 0.93）。此外，分配接受己酸羟孕酮的受试者出生体重低于2500克的发生率较低（OR 0.50，95%CI 0.36 - 0.71）。总体接受孕激素类药物的受试者或仅接受己酸羟孕酮的受试者在先兆早产住院率或围产期死亡率方面未发现差异。
使用孕激素类药物和己酸羟孕酮可降低早产和低出生体重新生儿的发生率。
