Carp H J A
a Department of Obstetrics & Gynecology , Sheba Medical Center , Tel Hashomer , Israel.
Climacteric. 2018 Aug;21(4):380-384. doi: 10.1080/13697137.2018.1436166. Epub 2018 Mar 22.
Progestational agents are often prescribed to prevent pregnancy loss. Progestogens affect implantation, cytokine balance, natural killer cell activity, arachidonic acid release and myometrial contractility. Progestogens have therefore been used at all stages of pregnancy including luteal-phase support prior to pregnancy, threatened miscarriage, recurrent miscarriage, and to prevent preterm labor. In luteal support, a Cochrane review reported that progestogens were associated with a higher rate of live births or ongoing pregnancy in the progesterone group (odds ratio 1.77, 95% confidence interval (CI) 1.09-2.86). Evidence suggests that progestogens are also effective for treating threatened miscarriage. Again, in a Cochrane Database review, progestogens were associated with a reduced odds ratio of 0.53 (95% CI 0.35-0.79) when progestogens were used. In recurrent miscarriage, progestogens also seem to have a beneficial effect. A meta-analysis of progestational agents showed a 28% increase in the live birth rate (relative risk 0.72, 95% CI 0.53-0.97). For the last 30 years, progestogens have been used to prevent preterm labor. Recent meta-analyses also report beneficial effects. This review summarizes the literature and the author's experience using progestogens to prevent pregnancy loss.
孕激素类药物常被用于预防流产。孕激素会影响着床、细胞因子平衡、自然杀伤细胞活性、花生四烯酸释放以及子宫肌层收缩。因此，孕激素已被应用于妊娠的各个阶段，包括妊娠前的黄体期支持、先兆流产、复发性流产以及预防早产。在黄体支持方面，一项Cochrane综述报告称，孕激素组的活产率或持续妊娠率较高（优势比1.77，95%置信区间（CI）1.09 - 2.86）。有证据表明，孕激素对治疗先兆流产也有效。同样，在Cochrane数据库综述中，使用孕激素时，其优势比降低至0.53（95% CI 0. (35 - 0.79)）。在复发性流产中，孕激素似乎也有有益作用。一项关于孕激素类药物的荟萃分析显示，活产率提高了28%（相对风险0.72，95% CI 0.53 - 0.97）。在过去30年里，孕激素一直被用于预防早产。近期的荟萃分析也报告了其有益效果。本综述总结了关于使用孕激素预防流产的文献及作者的经验。
