Torricelli Michela, Voltolini Chiara, Conti Nathalie, De Bonis Maria, Biliotti Giulia, Picciolini Enrico, Petraglia Felice
Department of Pediatrics, University of Siena, Siena, Italy.
J Matern Fetal Neonatal Med. 2011 Jan;24(1):43-6. doi: 10.3109/14767058.2010.482614. Epub 2010 Jun 29.
Inflammation/infection is the most frequent conditions leading to preterm delivery (PTD). A few studies have assessed the clinical efficacy of long-term tocolysis with ritodrine hydrochloride. In this study, the relationship among inflammatory/infective risk factors of PTD, the response to long-term tocolysis, and timing of delivery were evaluated in women with preterm labor.
On the basis of different responses to long-term tocolysis, defined as ≥ 7 days tocolysis, the cohort were classified as: (i) patients delivering at term (Group A) and (ii) patients delivering preterm (group B). Group B was subclassified as: (i) delivery before 48 h (group B1); (ii) delivery between 48 h and 7 days (Group B2), and (iii) delivery after 7 days (Group B3). Group B is divided in early preterm (<32 weeks) (Group B early) and late PTD (32-36 weeks) (Group B late).
Group A delivered at term and Group B preterm. Group B showed significantly higher (p < 0.0001) rate of CRP, bacterial vaginosis, and chorioamnionitis at placental histological examination than Group A. The same parameters were statistically higher (p < 0.0001) in group B1 than in B3. CRP, chorioamnionitis at placental histological examination was statistically higher (p < 0.0001) in Group B early than in Group B late.
This retrospective study suggested that in women affected by preterm labor, the long-term tocolysis with intravenous ritodrine is able to prolong gestation beyond 7 days, in absence of inflammatory/infective risk factors of PTD.
炎症/感染是导致早产(PTD)最常见的情况。一些研究评估了盐酸利托君长期保胎治疗的临床疗效。在本研究中,对早产孕妇中PTD的炎症/感染风险因素、长期保胎治疗的反应以及分娩时间之间的关系进行了评估。
根据对长期保胎治疗(定义为保胎治疗≥7天)的不同反应,将队列分为:(i)足月分娩的患者(A组)和(ii)早产的患者(B组)。B组又细分为:(i)48小时前分娩(B1组);(ii)48小时至7天之间分娩(B2组),以及(iii)7天后分娩(B3组)。B组分为早期早产(<32周)(B早期组)和晚期PTD(32 - 36周)(B晚期组)。
A组足月分娩,B组早产。B组胎盘组织学检查时的CRP、细菌性阴道病和绒毛膜羊膜炎发生率显著高于A组(p < 0.0001)。B1组的相同参数在统计学上高于B3组(p < 0.0001)。B早期组胎盘组织学检查时的CRP、绒毛膜羊膜炎在统计学上高于B晚期组(p < 0.0001)。
这项回顾性研究表明,在早产孕妇中,在不存在PTD的炎症/感染风险因素的情况下,静脉注射盐酸利托君进行长期保胎治疗能够将妊娠期延长至7天以上。