Facchinetti F, Vaccaro V
Unit of Gynecology and Obstetrics, Mother-Infant Department, University of Modena and Reggio Emilia, Modena, Italy.
Minerva Ginecol. 2009 Oct;61(5):401-9.
Preterm delivery (PTD) is defined by the World Health Organization as birth before 37 completed weeks of gestation. In Western countries, PTD accounts for over 75% of all perinatal morbidity and mortality. The social importance of PTD derives from the consideration that it causes near three quarter of neonatal deaths not caused by malformations. Progesterone is a steroid hormone which plays a crucial role in each step of human pregnancy. Early in pregnancy progesterone is produced by the corpus luteum and it is fundamental for pregnancy maintenance until placenta takes over this function at 7-9 weeks of gestation. Late in pregnancy, the role of progesterone is less clear: certainly, it may be importance in maintaining uterine quiescence in the latter half of pregnancy by limiting the production of stimulatory prostaglandins and inhibiting the expression of contraction-associated protein genes (ion channels, oxytocin and prostaglandin receptors, and gap junctions) within the myometrium. In this review, the authors included those controlled clinical studies that have used either 17 hydroxy progesterone caproate (17P), or progesterone (P) or its synthetic derivatives (progestins) in order to avoid or reduce the incidence of preterm delivery, in populations of women at increased risk of preterm birth. The authors conclude that: 1) the treatment with 17P reduces the incidence of PTD in pluriparous women with a previous history of PTD or with recurrent abortion, as well as in nulliparous women with an actual risk; 2) the treatment with P reduces PTD in nulliparous women, namely in the presence of a silent cervical shortening; 3) 17P has no efficacy in multiple pregnancy and it is proven not to have adverse effects on the infants.
世界卫生组织将早产定义为妊娠满37周前分娩。在西方国家，早产占所有围产期发病率和死亡率的75%以上。早产的社会重要性在于，它导致了近四分之三并非由畸形引起的新生儿死亡。孕酮是一种类固醇激素，在人类妊娠的每个阶段都起着关键作用。妊娠早期，孕酮由黄体产生，在胎盘于妊娠7至9周接管该功能之前，它对维持妊娠至关重要。妊娠晚期，孕酮的作用尚不清楚：当然，它可能通过限制刺激性前列腺素的产生并抑制子宫肌层内收缩相关蛋白基因（离子通道、催产素和前列腺素受体以及缝隙连接）的表达，在妊娠后半期维持子宫静息状态方面具有重要意义。在本综述中，作者纳入了那些在早产风险增加的女性群体中，使用己酸17羟孕酮（17P）、孕酮（P）或其合成衍生物（孕激素）以避免或降低早产发生率的对照临床研究。作者得出结论：1）17P治疗可降低有早产史或复发性流产的经产妇以及有实际风险的初产妇的早产发生率；2）P治疗可降低初产妇的早产发生率，即在存在无症状宫颈缩短的情况下；3）17P对多胎妊娠无效，且已证实对婴儿无不良影响。
