Chien Edward K, Gibson Kelly S
Department of Reproductive Biology, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Metrohealth Medical Center, 2500 Metrohealth Drive, Suite G237, Cleveland, OH 44109, USA.
Department of Reproductive Biology, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Metrohealth Medical Center, 2500 Metrohealth Drive, Suite G237, Cleveland, OH 44109, USA.
Clin Perinatol. 2017 Jun;44(2):347-360. doi: 10.1016/j.clp.2017.01.011. Epub 2017 Mar 9.
Periviable birth contributes disproportionately to perinatal morbidity and mortality. By analyzing the most relevant outcomes after a preterm birth some information can be provided on the potential benefit of interventions. This article discusses surgical and medical interventions that may offer neonatal benefit including cerclage, amniocentesis, progesterone, antenatal corticosteroids, magnesium sulfate for neuroprotection, and tocolysis. Cervical cerclage has the greatest promise at reducing morbidity and mortality related to periviable birth even though it may not reduce the overall preterm birth rate. The use of antenatal corticosteroids, magnesium sulfate, progesterone, and tocolytics may also improve outcome. Studies specifically evaluating these interventions are needed.
超早产儿出生对围产期发病率和死亡率的影响尤为突出。通过分析早产之后最相关的结局，可以提供一些关于干预措施潜在益处的信息。本文讨论了可能对新生儿有益的手术和药物干预措施，包括宫颈环扎术、羊膜穿刺术、孕酮、产前糖皮质激素、用于神经保护的硫酸镁以及宫缩抑制。宫颈环扎术在降低与超早产儿出生相关的发病率和死亡率方面最具前景，尽管它可能无法降低总体早产率。使用产前糖皮质激素、硫酸镁、孕酮和宫缩抑制剂也可能改善结局。需要有专门评估这些干预措施的研究。
