School of Nursing and Midwifery, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
Women Birth. 2011 Dec;24(4):141-7. doi: 10.1016/j.wombi.2010.12.002. Epub 2011 Feb 1.
Preterm birth is a significant global health problem with serious short and long term consequences. This paper reviews the research literature to answer the question how effective are the medical interventions that aim to reduce the rates of preterm birth?
A systematic search was carried out in CINAHL, Cochrane, Medline and Embase in relation to following medical treatments aimed at preventing preterm births: anti-infective medications, tocolytics, progesterone and cervical cerclage. The research underpinning each type of intervention is critically analysed in order to establish the validity of knowledge claims that are made for each type of intervention.
In relation to reducing the rates of preterm births, anti-infectives are only effective in the presence of known infection. Screening for infections during pregnancy is ineffective. Tocolytic agents are not effective in decreasing the preterm birth rates. Progesterone seems to be effective in a select group of pregnant women at higher risk of preterm birth. Cervical cerclage plays a small and an occasional role in preventing some preterm births.
This literature review demonstrates that medical interventions aimed at preventing, not just delaying, preterm birth, are not effective at a population level. Providing holistic, antenatal midwifery care for women living in socio-economic disadvantage and/or with an increased risk of preterm birth seems to be a promising strategy to address the negative effects of the social determinants of disease and thus to reduce the rate of preterm births at an individual and a population level.
早产是一个全球性的重大健康问题，会带来严重的短期和长期后果。本文回顾了研究文献，旨在回答以下问题：旨在降低早产率的医疗干预措施效果如何？
系统检索了 CINAHL、Cochrane、Medline 和 Embase 中与以下旨在预防早产的医疗治疗相关的文献：抗感染药物、保胎药、孕酮和宫颈环扎术。批判性地分析每种干预措施的研究基础，以确定针对每种干预措施提出的知识主张的有效性。
就降低早产率而言，抗感染药物仅在存在已知感染的情况下有效。在怀孕期间进行感染筛查是无效的。保胎药并不能有效降低早产率。孕酮似乎对处于较高早产风险的特定孕妇群体有效。宫颈环扎术在预防某些早产方面作用较小且偶有发生。
本文献综述表明，旨在预防早产而不仅仅是延迟早产的医疗干预措施在人群层面上无效。为生活在社会经济劣势和/或有较高早产风险的妇女提供整体的、产前助产护理，似乎是解决疾病社会决定因素的负面影响并因此降低个体和人群早产率的有前途的策略。
