孕激素治疗早产抑制失败：一项随机临床试验报告和更新的荟萃分析

Progesterone in women with arrested premature labor, a report of a randomised clinical trial and updated meta-analysis.

机构信息

Department of Obstetrics and Gynaecology, University of Calgary, 4th Floor, North Tower, Foothills Medical Centre 1441 - 29th Street NW, Calgary, AB, T2N 2T9, Canada.

Alberta Children's Hospital Research Institute, Foothills Medical Centre, Room, rm C211 1403 - 29th Street NW, Calgary, AB, T2N 2T9, Canada.

出版信息

BMC Pregnancy Childbirth. 2017 Aug 2;17(1):258. doi: 10.1186/s12884-017-1400-y.

BACKGROUND

Progesterone may be effective in prevention of premature birth in some high risk populations. Women with arrested premature labor are at risk of recurrent labor and maintenance therapy with standard tocolytics has not been successful.

METHODS

Randomized double blinded clinical trial of daily treatment with 200 mg vaginal progesterone in women with arrested premature labor and an updated meta-analysis.

RESULTS

The clinical trial was terminated early after 41 women were enrolled. Vaginal progesterone treatment did not change the median gestational age at delivery: 36+2 weeks versus 36+4 weeks, p = .865 nor increase the mean latency to delivery: 44.5 days versus 46.6 days, p = .841. In the updated meta-analysis, progesterone treatment did reduce delivery <37 weeks gestation and increase latency to delivery, but this treatment effect was not evident in the high quality trials: (OR 1.23, 95% CI 0.91, 1.67) and (-0.95 days, 95% CI -5.54, 3.64) respectively.

CONCLUSION

Progesterone is not effective for preventing preterm birth following arrested preterm labor.

背景

孕激素可能对某些高危人群的早产预防有效。早产停止的妇女有复发早产的风险，而标准保胎药物治疗并未成功。

方法

对早产停止的妇女进行每日 200mg 阴道用孕激素治疗的随机双盲临床试验和更新的荟萃分析。

结果

41 名妇女入组后，临床试验提前终止。阴道用孕激素治疗并未改变中位分娩孕周：36+2 周与 36+4 周，p =.865 ，也未增加平均分娩潜伏期：44.5 天与 46.6 天，p =.841 。在更新的荟萃分析中，孕激素治疗确实减少了<37 周的分娩，增加了分娩潜伏期，但这种治疗效果在高质量试验中并不明显：（OR 1.23，95%CI 0.91，1.67）和（-0.95 天，95%CI -5.54，3.64）。