Krispin Eyal, Hadar Eran, Chen Rony, Wiznitzer Arnon, Kaplan Boris
a Helen Schneider Hospital for Women, Rabin Medical Center , Petah Tikva , Israel.
b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.
J Matern Fetal Neonatal Med. 2019 Oct;32(20):3452-3457. doi: 10.1080/14767058.2018.1465555. Epub 2018 Apr 26.
We aimed to compare the efficacy of commonly available progesterone preparations for preterm birth prevention. A retrospective cohort study of all women treated with progesterone to prevent preterm birth and delivered in a single university-affiliated tertiary medical-center. Four progesterone preparations were compared: vaginal Endometrin 100 mg twice daily, vaginal Crinone 8% gel 90 mg daily, vaginal Utrogestan 200 mg daily, and intramuscular 17α-hydroxyprogesterone caproate (17-OHPC) 250 mg weekly. All women were considered at risk for preterm birth according to: prior preterm birth or cervical length below 25 mm measured during the second trimester. Significant maternal morbidity, pregnancy achieved by artificial reproductive technique and cerclage placement were excluded. Primary outcome was the rate of preterm birth prior to 37 weeks of gestation. Overall, 422 women were allocated to four study groups according to progesterone preparation: Endometrin 175 (41.5%), Crinone 73 (17.3%), Utrogestan 154 (36.5%), and 17-OHPC 20 (4.7%). Rates of preterm birth prior to 37 gestational weeks were lowest on the Endometrin treatment group (12.6 versus 20.5, 17.5, and 35% in the rest, = .05). Multivariate analysis revealed that the progesterone preparation was associated with preterm birth prior to 37 gestational weeks (LR = 8.3, = .004). The need for maternal red blood cells transfusion was significantly higher in the Endometrin subgroup (4% versus 0 in all others, = .018). This finding remained significant after adjustment to potential confounders (LR 16.44, < .001). Neonatal outcomes did not differ between groups. Different progesterone preparations prescribed to women at risk, may possess different efficacy in preventing preterm delivery prior to 37 weeks of gestation.
我们旨在比较常用孕酮制剂预防早产的疗效。对在一所大学附属三级医疗中心接受孕酮治疗以预防早产并分娩的所有女性进行了一项回顾性队列研究。比较了四种孕酮制剂：阴道用安琪坦100毫克，每日两次；阴道用雪诺酮8%凝胶90毫克，每日一次；阴道用天然微粒化孕酮胶囊200毫克，每日一次；以及肌肉注射己酸羟孕酮250毫克，每周一次。根据以下情况，所有女性均被视为有早产风险：既往有早产史或孕中期测量的宫颈长度低于25毫米。排除严重的母体并发症、通过辅助生殖技术实现的妊娠和宫颈环扎术。主要结局是妊娠37周前的早产率。总体而言，422名女性根据孕酮制剂被分配到四个研究组：安琪坦组175名（41.5%），雪诺酮组73名（17.3%），天然微粒化孕酮胶囊组154名（36.5%），己酸羟孕酮组20名（4.7%）。妊娠37周前的早产率在安琪坦治疗组中最低（12.6%，其余组分别为20.5%、17.5%和35%，P = 0.05）。多变量分析显示，孕酮制剂与妊娠37周前的早产有关（似然比 = 8.3，P = 0.004）。安琪坦亚组中母体红细胞输血的需求显著更高（4%，其他组均为0，P = 0.018）。在对潜在混杂因素进行调整后，这一发现仍然显著（似然比16.44，P < 0.001）。各组间新生儿结局无差异。给有风险的女性开不同的孕酮制剂，在预防妊娠37周前早产方面可能具有不同的疗效。
