Su Lin-Lin, Samuel Miny, Chong Yap-Seng
Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital, 5 Lower Kent Ridge Wing, Singapore, Singapore, 119074.
Cochrane Database Syst Rev. 2014 Jan 31;2014(1):CD006770. doi: 10.1002/14651858.CD006770.pub3.
Prematurity is not only the leading cause of perinatal morbidity and mortality but is associated with long-term impairment. Studies of various tocolytic agents have shown mixed results with little effect in improving pregnancy duration and insufficient data to confirm a definite beneficial effect on neonatal morbidity or mortality. Progesterone is known to have an inhibitory effect on uterine contractility and is thought to play a key role in the maintenance of pregnancy until term.
To determine if the use of progestational agents is effective as a form of treatment or co-treatment for women with threatened or established preterm labour with intact membranes.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2013), CENTRAL (The Cochrane Library 2013, Issue 10), MEDLINE (1966 to August 31 2013) and Embase (1974 to 31 August 2013). We checked the reference lists of all included studies to identify any additional studies and communicated with authors and the pharmaceutical industry.
Randomised controlled trials that compared progestational agents, given either alone or in combination with other tocolytics, with a control group receiving another tocolytic, placebo or no treatment, for the treatment of preterm labour.
Two review authors independently extracted data and assessed trial quality.
Eight studies were included in this review, involving 563 women, but only seven studies, involving 538 women, contributed data for analyses. There are some data suggesting that the use of progestational agents results in a reduction of preterm deliveries at less than 37 weeks of gestation and an increase in birthweight. The use of a progestational agent may also reduce the frequency of uterine contractions, prolong pregnancy and attenuate the shortening of cervical length. However, the analysis was limited by the relatively small number of available studies. The power of the meta-analysis was also limited by the varying types, dosages and routes of administration of progesterone.
AUTHORS' CONCLUSIONS: There is insufficient evidence to advocate progestational agents as a tocolytic for women presenting with preterm labour.
早产不仅是围产期发病和死亡的主要原因，还与长期功能损害相关。对各种宫缩抑制剂的研究结果不一，在延长孕期方面效果甚微，且缺乏足够数据来证实其对新生儿发病率或死亡率有明确的有益影响。已知孕酮对子宫收缩有抑制作用，并且被认为在维持妊娠至足月过程中起关键作用。
确定使用孕激素制剂作为治疗或辅助治疗胎膜完整的先兆早产或已确诊早产妇女的一种方法是否有效。
我们检索了Cochrane妊娠与分娩组试验注册库（2013年8月31日）、Cochrane系统评价数据库（《Cochrane图书馆》2013年第10期）、医学期刊数据库（1966年至2013年8月31日）和Embase数据库（1974年至2013年8月31日）。我们查阅了所有纳入研究的参考文献列表以识别任何其他研究，并与作者及制药行业进行了沟通。
随机对照试验，比较单独使用或与其他宫缩抑制剂联合使用孕激素制剂，与接受其他宫缩抑制剂、安慰剂或不治疗的对照组，用于治疗早产。
两位综述作者独立提取数据并评估试验质量。
本综述纳入了8项研究，涉及563名妇女，但只有7项研究（涉及538名妇女）提供了用于分析的数据。有一些数据表明，使用孕激素制剂可降低孕37周前的早产率并增加出生体重。使用孕激素制剂还可能减少子宫收缩频率、延长孕期并减缓宫颈长度缩短。然而，分析受到现有研究数量相对较少的限制。荟萃分析的效能也受到孕酮类型、剂量和给药途径不同的限制。
没有足够证据支持将孕激素制剂作为早产妇女的宫缩抑制剂。
