Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 West 168th Street, New York, NY 10032, USA.
Obstet Gynecol Clin North Am. 2012 Mar;39(1):47-63. doi: 10.1016/j.ogc.2011.12.006.
Though the preterm birth rate in the United States has finally begun to decline, preterm birth remains a critical public health problem. The administration of antenatal corticosteroids to improve outcomes after preterm birth is one of the most important interventions in obstetrics. This article summarizes the evidence for antenatal corticosteroid efficacy and safety that has accumulated since Graham Liggins and Ross Howie first introduced this therapy. Although antenatal corticosteroids have proven effective for singleton pregnancies at risk for preterm birth between 26 and 34 weeks’ gestation, questions remain about the utility in specific patient populations such as multiple gestations, very early preterm gestations, and pregnancies complicated by IUGR. In addition, there is still uncertainty about the length of corticosteroid effectiveness and the need for repeat or rescue courses. Though a significant amount of data has accumulated on antenatal corticosteroids over the past 40 years, more information is still needed to refine the use of this therapy and improve outcomes for these at-risk patients.
尽管美国的早产率终于开始下降，但早产仍是一个严重的公共卫生问题。产前给予皮质类固醇以改善早产的结局是产科最重要的干预措施之一。本文总结了自 Graham Liggins 和 Ross Howie 首次引入该疗法以来，在产前皮质类固醇的疗效和安全性方面积累的证据。虽然产前皮质类固醇已被证明对 26 至 34 孕周有早产风险的单胎妊娠有效，但在多胎妊娠、极早期早产和 IUGR 合并妊娠等特定患者人群中的应用仍存在疑问。此外，皮质类固醇的有效时间以及是否需要重复或挽救疗程仍存在不确定性。尽管在过去 40 年中已经积累了大量关于产前皮质类固醇的数据，但仍需要更多信息来完善该疗法的应用并改善这些高危患者的结局。
