Yoneda Satoshi, Yoneda Noriko, Fukuta Kaori, Shima Tomoko, Nakashima Akitoshi, Shiozaki Arihiro, Yoshino Osamu, Kigawa Mika, Yoshida Taketoshi, Saito Shigeru
Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan.
Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka, Japan.
J Obstet Gynaecol Res. 2018 Mar;44(3):397-407. doi: 10.1111/jog.13547. Epub 2017 Dec 14.
We evaluated whether maintenance tocolysis (intravenous ritodrine hydrochloride and/or magnesium sulfate) was effective in cases of spontaneous preterm labor with intact membranes.
One hundred and thirty preterm labor patients who reached 36 weeks of gestation by maintenance tocolysis were selected. Immediate delivery (ID) after ceasing maintenance tocolysis was defined as an 'effective case'. The correlated factors between ID and no immediate delivery (NID) were statistically analyzed.
Thirty-six patients delivered < two days after ceasing maintenance tocolysis (27.7%) and were defined as effective cases. Multiple logistic regression analysis revealed that amniotic fluid interleukin-8 at admission (≥ 2.3 ng/mL; odds ratio [OR] 5.6, 95% confidence interval [CI] 2.1-17.6; P < 0.001), pre-pregnancy body mass index (≤ 21.4; OR 5.3, 95% CI 2.0-16.2; P < 0.001) and cerclage (OR 3.6, 95% CI 1.1-11.8; P = 0.028) were independent factors correlated with ID (< 2 days).
Maintenance tocolysis may be effective in limited cases with mild intra-amniotic inflammation, in lean women and in cerclage cases. Maintenance tocolysis should be ceased in cases without these clinical factors when clinical symptoms disappear.
我们评估了维持性tocolysis（静脉注射盐酸利托君和/或硫酸镁）在胎膜完整的自发性早产病例中是否有效。
选择130例通过维持性tocolysis达到妊娠36周的早产患者。停止维持性tocolysis后立即分娩（ID）被定义为“有效病例”。对ID和未立即分娩（NID）之间的相关因素进行统计学分析。
36例患者在停止维持性tocolysis后<2天分娩（27.7%），被定义为有效病例。多因素logistic回归分析显示，入院时羊水白细胞介素-8（≥2.3 ng/mL；比值比[OR]5.6，95%置信区间[CI]2.1-17.6；P<0.001）、孕前体重指数（≤21.4；OR 5.3，95%CI 2.0-16.2；P<0.001）和宫颈环扎术（OR 3.6，95%CI 1.1-11.8；P=0.028）是与<2天内ID相关的独立因素。
维持性tocolysis在羊膜腔内轻度炎症、体型偏瘦的女性和宫颈环扎术的有限病例中可能有效。当临床症状消失且无这些临床因素时，应停止维持性tocolysis。
