Haas David M
Department of Obstetrics and Gynecology, Indiana University School of Medicine, Wishard Memorial Hospital, Indianapolis, USA.
BMJ Clin Evid. 2011 Apr 4;2011:1404.
Preterm birth occurs in about 5% to 10% of all births in resource-rich countries, but in recent years the incidence seems to have increased in some countries, particularly in the USA. We found little reliable evidence for incidence in resource-poor countries. The rate in northwestern Ethiopia has been reported to vary from 11% to 22%, depending on the age group of mothers studied, and is highest in teenage mothers.
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of preventive interventions in women at high risk of preterm delivery? What are the effects of interventions to improve neonatal outcome after preterm rupture of membranes? What are the effects of treatments to stop contractions in preterm labour? What are the effects of elective compared with selective caesarean delivery for women in preterm labour? What are the effects of interventions to improve neonatal outcome in preterm delivery? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 58 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: amnioinfusion for preterm rupture of membranes, antenatal corticosteroids, antibiotic treatment, bed rest, beta-mimetics, calcium channel blockers, elective caesarean, enhanced antenatal care programmes, magnesium sulphate, oxytocin receptor antagonists (atosiban), progesterone, prophylactic cervical cerclage, prostaglandin inhibitors (e.g., indometacin), selective caesarean, and thyrotropin-releasing hormone (TRH) (plus corticosteroids).
在资源丰富的国家，早产发生率约为所有分娩的5%至10%，但近年来，一些国家的发生率似乎有所上升，尤其是在美国。我们几乎没有找到关于资源匮乏国家早产发生率的可靠证据。据报道，埃塞俄比亚西北部的早产率在11%至22%之间，具体取决于所研究母亲的年龄组，在青少年母亲中最高。
我们进行了一项系统综述，旨在回答以下临床问题：对早产高危女性进行预防性干预有哪些效果？胎膜早破后改善新生儿结局的干预措施有哪些效果？治疗早产宫缩的措施有哪些效果？对于早产临产的女性，选择性剖宫产与择期剖宫产相比有哪些效果？改善早产分娩新生儿结局的干预措施有哪些效果？我们检索了：截至2010年6月的医学文献数据库（Medline）、荷兰医学文摘数据库（Embase）、考克兰图书馆以及其他重要数据库（《临床证据》综述会定期更新；请查看我们的网站获取本综述的最新版本）。我们纳入了来自美国食品药品监督管理局（FDA）和英国药品及医疗保健产品监管局（MHRA）等相关组织的危害警示。
我们找到了58项符合我们纳入标准的系统综述、随机对照试验或观察性研究。我们对干预措施的证据质量进行了GRADE评估。
在这项系统综述中，我们提供了以下干预措施有效性和安全性的相关信息：胎膜早破时羊膜腔灌注、产前使用糖皮质激素、抗生素治疗、卧床休息、β-拟交感神经药、钙通道阻滞剂、择期剖宫产、强化产前护理方案、硫酸镁、催产素受体拮抗剂（阿托西班）、孕酮、预防性宫颈环扎术、前列腺素抑制剂（如吲哚美辛）、选择性剖宫产以及促甲状腺激素释放激素（TRH）（加糖皮质激素）。
