Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester School of Medicine, New York, NY, USA.
Paediatr Perinat Epidemiol. 2013 Sep;27(5):452-60. doi: 10.1111/ppe.12070. Epub 2013 Jul 12.
Current knowledge of the natural outcomes of untreated women in preterm labour is both incomplete and outcomes vary significantly between the available studies. The aim of this study was to systematically review outcomes of preterm labour without tocolysis and determine if outcome variation could be accounted for by differences in study populations. Such data could potentially assist in the interpretation of intervention trials that do not include a no-treatment arm.
Included studies reported outcomes of women in clinically diagnosed preterm labour without tocolytic treatment between 1950 and 2011. Studies that were limited to preterm prelabour rupture of membranes, recurrent preterm labour or in which the women without tocolysis represented a potentially biased subgroup, or were not tocolysed because of contraindications were excluded. Study quality, design, and population characteristics were abstracted. Outcomes included pregnancy prolongation and the proportion of women undelivered at 48-72 h, 7 days, and term. Study characteristics associated with differing odds of preterm birth were explored through logistic regression.
Three hundred and eighty-five citations were initially identified, of which 26 were included encompassing 1383 women. The percentage of patients who were undelivered at 48-72 hours was 62.8%, at 7 days 53.4% and 40.4% delivered at term, though the range was very wide. Characteristics associated with decreased odds of delivery were not consistent among reported outcome measures.
Most women without tocolysis do not deliver within 7 days, although the range is very wide. The majority of this variation is unrelated to reported differences in study design or reported population characteristics.
目前对于未经治疗的早产妇女的自然结局的认识既不完整，而且在现有研究之间结果也存在显著差异。本研究的目的是系统地综述未经保胎治疗的早产结局，并确定研究人群的差异是否可以解释结局的变化。此类数据可能有助于解释不包括未治疗组的干预试验。
纳入的研究报告了 1950 年至 2011 年间临床上诊断为早产且未使用保胎治疗的妇女的结局。排除了仅限于早产胎膜早破、复发性早产或未使用保胎治疗的妇女可能代表有偏见的亚组的研究，或因禁忌证而不能保胎的研究。提取了研究质量、设计和人群特征。结局包括妊娠延长和在 48-72 小时、7 天和足月时未分娩的妇女比例。通过逻辑回归探讨了与早产发生率不同相关的研究特征。
最初确定了 385 条引文，其中 26 条被纳入，共包括 1383 名妇女。在 48-72 小时时未分娩的患者比例为 62.8%，7 天时为 53.4%，足月时为 40.4%，但范围很广。与未分娩的可能性降低相关的特征在报告的结局指标中并不一致。
大多数未经保胎治疗的妇女在 7 天内不会分娩，尽管范围很广。这种差异的大部分与报告的研究设计或报告的人群特征无关。
