Pinto Pedro Filipe Viana Ferreira, Ferraz Tiago José Santos Matos, Ramalho Carla Maria Almeida, Montenegro Nuno Aires Mota de Mendonça
Centro Hospitalar S. João, Porto, Portugal.
Universidade do Porto, Porto, Portugal.
Rev Bras Ginecol Obstet. 2015 Oct;37(10):467-72. doi: 10.1590/SO100-720320150005440.
The administration of a single-course antenatal corticosteroid treatment is recommended for pregnant women between 24 and 34 weeks with risk of premature birth. The maximum effect is achieved when antenatal corticosteroids are administered between 24h and 7 days before delivery. The objective of this study was to evaluate the occurrence of birth within seven days of corticosteroid therapy in major obstetric situations with risk of preterm birth.
Retrospective cohort study including 209 pregnant women hospitalized in risk of preterm delivery, submitted to corticosteroid therapy for fetal lung maturation. The study was carried out between January 2012 and March 2014 at a university hospital. Main outcome measure was the number of women who delivered within 7 da ys after antenatal corticosteroid administration. Two groups were defined according to the reason for starting corticosteroids: threatened preterm labour (Group APPT) and other indications for corticosteroid therapy (Group RPPT). A Kaplan-Meier survival analysis was performed and a p value <0.05 was considered statistically significant.
46.4% (n=97) of pregnant women gave birth in the seven days following corticosteroid administration. Delivery within 7 days occurred more frequently on group 2 in comparison to group 1 (57.3 versus 42.4%; p=0.001). There is a statistically significant difference between the survival curve for groups 1 and 2, with a hazard ratio for delivery within 7 days 1.71 times higher for group 2 (95%CI 1.23-2.37; p<0.001).
It can be concluded that the probability of an event (birth within 7 days after corticosteroids) is smaller in the group of pregnant women admitted in the context of threatened preterm labor than for other indications. The use of corticosteroids in pregnant women admitted for suspected preterm labor should be subject to rigorous clinical evaluation.
对于有早产风险的24至34周孕妇，建议给予单疗程产前皮质类固醇治疗。在分娩前24小时至7天给予产前皮质类固醇时可达到最大效果。本研究的目的是评估在有早产风险的主要产科情况下，皮质类固醇治疗后7天内分娩的发生率。
回顾性队列研究，纳入209例因早产风险住院并接受皮质类固醇治疗以促进胎儿肺成熟的孕妇。该研究于2012年1月至2014年3月在一家大学医院进行。主要结局指标是产前皮质类固醇给药后7天内分娩的妇女数量。根据开始使用皮质类固醇的原因定义了两组：先兆早产（APPT组）和皮质类固醇治疗的其他指征（RPPT组）。进行了Kaplan-Meier生存分析，p值<0.05被认为具有统计学意义。
46.4%（n = 97）的孕妇在皮质类固醇给药后的7天内分娩。与第1组相比，第2组在7天内分娩的情况更频繁（57.3%对42.4%；p = 0.001）。第1组和第2组的生存曲线之间存在统计学显著差异，第2组7天内分娩的风险比高1.71倍（95%CI 1.23 - 2.37；p < 0.001）。
可以得出结论，因先兆早产入院的孕妇组发生事件（皮质类固醇治疗后7天内分娩）的概率低于其他指征的孕妇组。对于因疑似早产入院的孕妇使用皮质类固醇应进行严格的临床评估。
