1] Wayne State University School of Medicine, Detroit, MI, USA [2] Children's Hospital of Michigan, Division of Genetic and Metabolic Disorders, Detroit, MI, USA.
1] Division of Maternal-Fetal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA [2] Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
J Perinatol. 2015 Aug;35(8):561-5. doi: 10.1038/jp.2015.38. Epub 2015 Apr 23.
To review the published literature on whether the use of empiric perioperative tocolytic medications could provide additional benefit when used in combination with cerclage.
Systematic review of published medical literature reporting the efficacy of empiric tocolytics used as a perioperative adjunct to vaginal cerclage in high-risk patients. A PubMed search without date criteria of various tocolytics and cerclage yielded 42 studies. Review articles were excluded, as were reports of abdominal cerclage, emergent cerclage, or cerclage for the purpose of delayed interval delivery in twin gestations.
Only five publications on the topic of perioperative tocolytic use at the time of history or ultrasound-indicated vaginal cerclage placement were identified. These included zero clinical trials, three retrospective cohort studies, one case series and one case report. Only one cohort study compared cerclage with indomethacin and cerclage without indomethacin and suggested no difference between the groups. The other two published cohort studies had no referent group who received cerclage without tocolysis. One case series and one case report were also published reporting cerclage with empiric beta-mimetic and progesterone adjunctive therapy.
There is a paucity of published data on the topic of adjunctive perioperative tocolytics with cerclage. Adequately powered clinical trials on perioperative use of tocolysis with cerclage compared with a standard cerclage placement alone are needed to establish efficacy. Until adequately studied, this practice should be considered investigational.
综述已发表的文献，探讨在宫颈环扎术围手术期使用经验性宫缩抑制剂是否能带来额外获益。
对已发表的关于高危患者围手术期使用经验性宫缩抑制剂作为阴道宫颈环扎术辅助治疗的有效性的医学文献进行系统性评价。在 PubMed 上进行了无日期限制的各种宫缩抑制剂和宫颈环扎术的搜索，共检索到 42 项研究。排除综述文章，以及腹部环扎术、紧急环扎术或为双胎妊娠延长间隔分娩而进行的环扎术的报告。
仅确定了五项关于围手术期宫缩抑制剂使用的出版物，这些出版物均在病史或超声提示阴道宫颈环扎术放置时使用。这些出版物中无一为临床试验，包括三项回顾性队列研究、一项病例系列研究和一份病例报告。只有一项队列研究比较了环扎术联合吲哚美辛与环扎术不联合吲哚美辛，结果显示两组之间无差异。另外两项已发表的队列研究没有参考组，该组患者未接受宫缩抑制剂治疗的环扎术。一份病例系列研究和一份病例报告也报道了在宫颈环扎术时使用经验性β激动剂和孕激素辅助治疗。
关于宫颈环扎术围手术期辅助宫缩抑制剂的研究数据很少。需要进行充分的、关于围手术期宫缩抑制剂使用与单独标准环扎术比较的临床试验，以确定其疗效。在充分研究之前，这种治疗方法应被视为研究性的。
