Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada.
Provincial Council for Maternal and Child Health, Toronto, ON, Canada.
BJOG. 2019 Apr;126(5):556-567. doi: 10.1111/1471-0528.15566. Epub 2018 Dec 29.
Recent progesterone trials call for an update of previous syntheses of interventions to prevent preterm birth.
To compare the relative effects of different types and routes of administration of progesterone, cerclage, and pessary at preventing preterm birth in at-risk women overall and in specific populations.
We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL, and Web of Science up to 1 January 2018.
We included randomised trials of progesterone, cerclage or pessary for preventing preterm birth in at-risk singleton pregnancies.
We used a piloted data extraction form and performed Bayesian random-effects network meta-analyses with 95% credibility intervals (CrI), as well as pairwise meta-analyses, rating the quality of the evidence using GRADE.
We included 40 trials (11 311 women). In at-risk women overall, vaginal progesterone reduced preterm birth <34 (OR 0.43, 95% CrI 0.20-0.81) and <37 weeks (OR 0.51, 95% CrI 0.34-0.74), and neonatal death (OR 0.41, 95% CrI 0.20-0.83). In women with a previous preterm birth, vaginal progesterone reduced preterm birth <34 (OR 0.29, 95% CI 0.12-0.68) and <37 weeks (OR 0.43, 95% CrI 0.23-0.74), and 17α-hydroxyprogesterone caproate reduced preterm birth <37 weeks (OR 0.53, 95% CrI 0.27-0.95) and neonatal death (OR 0.39, 95% CI 0.16-0.95). In women with a short cervix (≤25 mm), vaginal progesterone reduced preterm birth <34 weeks (OR 0.45, 95% CI 0.24-0.84).
Vaginal progesterone was the only intervention with consistent effectiveness for preventing preterm birth in singleton at-risk pregnancies overall and in those with a previous preterm birth.
In updated NMA, vaginal progesterone consistently reduced PTB in overall at-risk pregnancies and in women with previous PTB.
最近的孕激素试验呼吁更新以前预防早产的干预措施综合分析。
比较不同类型和途径给予孕激素、宫颈环扎术和阴道栓剂预防整体高危人群和特定人群早产的相对效果。
我们检索了 Medline、EMBASE、CINAHL、Cochrane 中心数据库和 Web of Science，检索时间截至 2018 年 1 月 1 日。
我们纳入了预防高危单胎妊娠早产的孕激素、宫颈环扎术或阴道栓剂的随机试验。
我们使用了经过预试验的资料提取表格，并进行了贝叶斯随机效应网络荟萃分析，采用 95%可信度区间（CrI），以及成对荟萃分析，使用 GRADE 评估证据质量。
我们纳入了 40 项试验（11311 名妇女）。在整体高危人群中，阴道给予孕激素可降低早产<34 周（OR 0.43，95%CrI 0.20-0.81）和<37 周（OR 0.51，95%CrI 0.34-0.74），以及新生儿死亡（OR 0.41，95%CrI 0.20-0.83）。对于有早产史的妇女，阴道给予孕激素可降低早产<34 周（OR 0.29，95%CI 0.12-0.68）和<37 周（OR 0.43，95%CrI 0.23-0.74），17α-羟孕酮己酸酯可降低早产<37 周（OR 0.53，95%CrI 0.27-0.95）和新生儿死亡（OR 0.39，95%CI 0.16-0.95）。对于宫颈短（≤25mm）的妇女，阴道给予孕激素可降低早产<34 周（OR 0.45，95%CI 0.24-0.84）。
阴道给予孕激素是唯一对整体高危妊娠和有早产史的孕妇预防早产有一致效果的干预措施。
在更新的网络荟萃分析中，阴道给予孕激素一致降低了整体高危妊娠和有早产史的孕妇的早产率。
