Society for Maternal-Fetal Medicine, Washington, DC.
Am J Obstet Gynecol. 2020 Jul;223(1):B16-B18. doi: 10.1016/j.ajog.2020.04.001. Epub 2020 Apr 8.
In late 2019, results from the Progestin's Role in Optimizing Neonatal Gestation (PROLONG) trial were published showing no benefit of weekly injections of 17-alpha hydroxyprogesterone caproate (17-)HPC) from 16-20 weeks of gestation in women with a history of a singleton PTB in reducing the rates of subsequent PTB and neonatal morbidity. The Society for Maternal-Fetal Medicine believes that the differences in these results from the earlier Meis, et al trial, which did show a benefit of 17-OHPC in reducing the rate of spontaneous PTB (sPTB), may be at least partially explained by differences in study populations. SMFM concludes that it is reasonable for providers to use 17-OHPC in women with a profile more representative of the very-high-risk population reported in the Meis trial. For all women at risk of recurrent sPTB, the risk/benefit discussion should incorporate a shared decision-making approach, taking into account the lack of short-term safety concerns but uncertainty regarding benefit.
2019 年末，孕激素在优化新生儿胎龄中的作用（PROLONG）试验的结果公布，结果显示在有单胎早产史的女性中，从 16 周到 20 周每周注射 17-α羟孕酮己酸酯（17-HPC）并不能降低随后早产和新生儿发病率的风险。母胎医学学会认为，这些结果与早期 Meis 等人的试验不同，后者确实表明 17-OHPC 可降低自发性早产（sPTB）的发生率，其差异至少部分可以用研究人群的差异来解释。SMFM 的结论是，对于更符合 Meis 试验报告的极高风险人群特征的女性，提供者使用 17-OHPC 是合理的。对于所有有复发性 sPTB 风险的女性，风险/获益讨论应采用共同决策方法，考虑到短期安全性担忧的缺乏，但获益方面存在不确定性。
