Jarde Alexander, Lewis-Mikhael Anne-Mary, Dodd Jodie M, Barrett Jon, Saito Shigeru, Beyene Joseph, McDonald Sarah D
Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON.
Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON.
J Obstet Gynaecol Can. 2017 Dec;39(12):1192-1202. doi: 10.1016/j.jogc.2017.07.007.
To systematically examine the evidence around the combination of interventions to prevent preterm birth.
Without language restrictions, we searched clinicaltrials.gov and five electronic databases (Medline, EMBASE, CINAHL, Cochrane CENTRAL, and Web of Science) up to July 7, 2016. We included randomized and non-randomized studies where asymptomatic women at risk of preterm birth received any combination of progesterone, cerclage, or pessary compared with either one or no intervention. Primary outcomes were preterm birth <34 and <37 weeks and neonatal death. Two independent reviewers extracted data using a piloted form and assessed risk and direction of bias. We pooled data with unlikely or unclear bias using random-effects meta-analyses. Comparisons with likely bias (e.g., confounding by indication) were not pooled.
We screened 1335 results and assessed 154 full texts, including seven studies. In singletons, we found no differences in preterm birth <34 weeks when comparing pessary & progesterone with pessary alone (RR 1.30, 95% CI 0.70-2.42) or progesterone alone (RR 1.16, 95% CI 0.79-1.72). Similarly, we found no differences in preterm birth <37 weeks when comparing cerclage & progesterone with cerclage alone (RR 1.04, 95% CI 0.56-1.93) or with progesterone alone (RR 0.82, 95% CI 0.57-1.19) nor between pessary & progesterone and pessary alone (RR 1.04, 95% CI 0.62-1.74). No data were available for neonatal death in singletons.
Despite being a common clinical practice, evidence to support the combined use of multiple versus single interventions for preventing preterm birth is scarce.
系统审查有关预防早产的联合干预措施的证据。
不受语言限制，我们检索了clinicaltrials.gov以及五个电子数据库（Medline、EMBASE、CINAHL、Cochrane CENTRAL和Web of Science），检索截止至2016年7月7日。我们纳入了随机和非随机研究，这些研究中，有早产风险的无症状女性接受了黄体酮、宫颈环扎术或子宫托的任何组合，并与单一干预或无干预进行比较。主要结局为孕34周前和孕37周前早产以及新生儿死亡。两名独立的审阅者使用预先试用的表格提取数据，并评估偏倚的风险和方向。我们使用随机效应荟萃分析汇总了偏倚可能性不大或不明确的数据。未汇总存在可能偏倚（例如，指征性混杂）的比较数据。
我们筛选了1335条结果并评估了154篇全文，包括7项研究。在单胎妊娠中，比较子宫托与黄体酮联合使用和单独使用子宫托时，我们发现孕34周前早产无差异（风险比1.30，95%置信区间0.70 - 2.42），比较联合使用黄体酮和单独使用黄体酮时也无差异（风险比1.16，95%置信区间0.79 - 1.72）。同样，比较宫颈环扎术与黄体酮联合使用和单独使用宫颈环扎术时，我们发现孕37周前早产无差异（风险比1.04，95%置信区间0.56 - 1.93），与单独使用黄体酮比较时也无差异（风险比0.82，95%置信区间0.57 - 1.19），比较子宫托与黄体酮联合使用和单独使用子宫托时也无差异（风险比1.04，95%置信区间0.62 - 1.74）。单胎妊娠中没有关于新生儿死亡的数据。
尽管联合使用多种干预措施预防早产是一种常见的临床做法，但支持联合使用多种干预措施与单一干预措施预防早产的证据很少。
