Whitworth Melissa, Quenby Siobhan, Cockerill Ruth O, Dowswell Therese
St Mary's Hospital, Central Manchester and Manchester Children's University Hospitals NHS Trust, Hathersage Road, Manchester, UK, M13 0JH.
Cochrane Database Syst Rev. 2011 Sep 7(9):CD006760. doi: 10.1002/14651858.CD006760.pub2.
Amongst the risk factors for preterm birth, previous preterm delivery is a strong predictor. Specialised clinics for women with a history of spontaneous preterm delivery have been advocated as a way of improving outcomes for women and their infants.
To assess using the best available evidence, the value of specialised antenatal clinics for women with a pregnancy at high risk of preterm delivery when compared with 'standard' antenatal clinics.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2011).
All published, unpublished, and ongoing randomised controlled trials (including cluster-randomised trials) examining specialised compared with standard antenatal clinic care for women with a singleton pregnancy considered at high risk of preterm labour.
Two review authors independently assessed trial quality and extracted data.
We included three trials with 3400 women, all carried out in the USA. All focused on specialised clinics for women at high risk of preterm birth. Gestational age at delivery, preterm delivery, or both were primary outcomes in all studies. The interventions in the three trials differed.Overall there was very little data on our prespecified outcomes. For most outcomes a single study provided data, hence there was not the statistical power to detect any possible differences between groups. There was no clear evidence that specialised antenatal clinics reduce the number of preterm births.
AUTHORS' CONCLUSIONS: Specialised antenatal clinics are now an accepted part of care in many settings, and carrying out further randomised trials may not be possible. Any future research in this area should include psychological outcomes and should focus on which aspects of service provision are preferred by women. Such research could underpin further service development in this area.
在早产的风险因素中，既往早产是一个强有力的预测指标。提倡为有自发早产史的女性设立专科诊所，以此改善母婴结局。
运用现有最佳证据，评估与“标准”产前诊所相比，为早产高危孕妇设立专科产前诊所的价值。
我们检索了Cochrane妊娠与分娩组试验注册库（2011年6月30日）。
所有已发表、未发表及正在进行的随机对照试验（包括整群随机试验），比较专科产前诊所与标准产前诊所对单胎妊娠且被认为有早产高危因素的女性的护理情况。
两位综述作者独立评估试验质量并提取数据。
我们纳入了三项试验，共3400名女性，均在美国开展。所有试验都聚焦于早产高危女性的专科诊所。分娩孕周、早产或两者均为所有研究的主要结局。三项试验中的干预措施有所不同。总体而言，关于我们预设结局的数据非常少。对于大多数结局，仅有一项研究提供了数据，因此没有统计学效力来检测组间任何可能的差异。没有明确证据表明专科产前诊所能减少早产数量。
专科产前诊所在许多情况下已成为公认的护理组成部分，进一步开展随机试验可能无法实现。该领域未来的任何研究都应纳入心理结局，并应关注女性更青睐服务提供的哪些方面。此类研究可为该领域进一步的服务发展提供依据。
