Haram Kjell, Mortensen Jan Helge, Morrison John C
Department of Obstetrics and Gynecology, Haukeland University Hospital , Bergen , Norway .
J Matern Fetal Neonatal Med. 2014 Nov;27(16):1710-5. doi: 10.3109/14767058.2013.876003. Epub 2014 Mar 31.
The most significant action of progesterone appears to be on the cervix and in prevention rather than on treatment of preterm delivery. In women with singleton gestations, no prior PTB, and CL <20 mm at <24 weeks, vaginal progesterone, either 90 mg gel or 200 mg suppository, is associated with reduction of both preterm birth (PTB) and perinatal morbidity/mortality. Cerclage is as effective as vaginal progesterone in women with CL <25 mm. Treatment of women with previous PTB with 17OHP-C from 16 to 20 weeks' gestation until 36 weeks could reduce significantly both the risk of delivery at <37, <35 and <32 weeks' gestation, as well as the rates of NEC, the need for supplemental oxygen and IVH. In women successfully treated with tocolytics progesterone combined with corticosteroid therapy lengthens pregnancy, reduces occurrence of respiratory distress syndrome and low birth weight. However, there is currently insufficient evidence on the role of progesterone after arrested preterm labor. It is reasonable to support an approach with CL screening of women with prior PTB starting at 16 to 19 weeks and administration of progesterone to women with a short cervix. Cerclage may be offered to those with a CL<25 mm. A combination of traditional tocolytics, corticosteroids and progesterone might be beneficial.
孕酮最显著的作用似乎是作用于子宫颈，且主要是预防而非治疗早产。对于单胎妊娠、既往无早产史且孕24周前宫颈长度<20mm的女性，阴道用孕酮，无论是90mg凝胶还是200mg栓剂，均与降低早产及围产期发病率/死亡率相关。对于宫颈长度<25mm的女性，宫颈环扎术与阴道用孕酮效果相当。对既往有早产史的女性，在妊娠16至20周直至36周使用17α-羟孕酮醋酸酯治疗，可显著降低妊娠<37周、<35周和<32周分娩的风险，以及坏死性小肠结肠炎的发生率、吸氧需求和脑室内出血的发生率。在成功接受宫缩抑制剂治疗的女性中，孕酮联合皮质类固醇治疗可延长孕周，降低呼吸窘迫综合征的发生率和低出生体重。然而，目前关于早产宫缩停止后孕酮作用的证据不足。支持对既往有早产史的女性从妊娠16至19周开始进行宫颈长度筛查，并对宫颈短的女性给予孕酮的方法是合理的。对于宫颈长度<25mm者可考虑行宫颈环扎术。传统宫缩抑制剂、皮质类固醇和孕酮联合使用可能有益。
