Group Health Cooperative, Spokane, WA 99201, USA.
Am Fam Physician. 2010 Feb 15;81(4):477-84.
Preventing preterm delivery remains one of the great challenges in modern medicine. Preterm birth rates continue to increase and accounted for 12.7 percent of all U.S. births in 2005. The etiology of preterm delivery is unclear, but is likely to be complex and influenced by genetics and environmental factors. Women with previous preterm birth are at increased risk of subsequent preterm delivery and may be candidates for treatment with antenatal progesterone. Fetal fibronectin testing and endovaginal ultrasonography for cervical length are useful for triage. For the patient in preterm labor, only antenatal corticosteroids and delivery in a facility with a level III neonatal intensive care unit have been shown to improve outcomes consistently. Tocolytic agents may delay delivery for up to 48 hours, enabling the administration of antenatal corticosteroids or maternal transfer. Routine use of antibiotics in preterm labor is not indicated except for group B streptococcus prophylaxis or treatment of chorioamnionitis.
预防早产仍然是现代医学的重大挑战之一。早产率持续上升，2005 年占美国所有分娩的 12.7%。早产的病因尚不清楚，但可能很复杂，并受遗传和环境因素的影响。有先前早产史的妇女随后早产的风险增加，可能是产前孕激素治疗的候选者。胎儿纤维连接蛋白检测和阴道内超声检查宫颈长度可用于分诊。对于有早产迹象的患者，只有产前皮质激素治疗和在具有三级新生儿重症监护病房的医疗机构分娩才能持续改善结局。宫缩抑制剂可能会将分娩延迟长达 48 小时，从而能够给予产前皮质激素或产妇转移。除非进行 B 组链球菌预防或治疗绒毛膜羊膜炎，否则早产时常规使用抗生素是没有指征的。
