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探究治疗短宫颈的疗效:来自回顾性研究的见解,以改善临床管理。

Unraveling the Efficacy of Therapeutic Interventions for Short Cervix: Insights from a Retrospective Study for Improved Clinical Management.

机构信息

Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.

Department of Obstetrics and Gynecology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.

出版信息

Medicina (Kaunas). 2023 May 24;59(6):1018. doi: 10.3390/medicina59061018.

Abstract

: Preterm birth (PTB) is associated with important neonatal mortality and morbidity. The aim of this study was to retrospectively evaluate the average treatment effects on the treated and the efficacity of various therapeutic interventions for PTB in a cohort of patients with singleton pregnancies and short cervical lengths. : This observational retrospective study included 1146 singleton pregnancies at risk of PTB that were segregated into the following groups: intravaginal progesterone (group 1), Arabin pessary (group 2), McDonald cerclage (group 3), intravaginal progesterone and Arabin pessary (group 4), and intravaginal progesterone and cerclage (group 5). Their treatment effects were evaluated and compared. : All evaluated therapeutic interventions significantly reduced the occurrence of late and early preterm births. The risk of late and early PTB was lowered for those pregnant patients who received progesterone and pessaries or progesterone and cerclage in comparison with those who received only progesterone. The extremely PTB risk of occurrence was significantly lowered only by the administration of progesterone in association with cervical cerclage in comparison with progesterone monotherapy. : The combined therapeutic interventions had the highest efficacy in preventing preterm birth. An individualized evaluation is needed to establish the best therapeutic approach in particular cases.

摘要

早产(PTB)与新生儿死亡率和发病率的重要因素有关。本研究的目的是回顾性评估在单胎妊娠和宫颈长度缩短的患者队列中,各种治疗干预措施对 PTB 的平均处理效果和疗效。

这项观察性回顾性研究纳入了 1146 例有早产风险的单胎妊娠,将其分为以下几组:阴道内孕酮(第 1 组)、阿拉伯树胶栓剂(第 2 组)、麦克唐纳宫颈环扎术(第 3 组)、阴道内孕酮和阿拉伯树胶栓剂(第 4 组)以及阴道内孕酮和环扎术(第 5 组)。评估并比较了它们的治疗效果。

所有评估的治疗干预措施均显著降低了晚期和早期早产的发生风险。与仅接受孕酮治疗的孕妇相比,接受孕酮和栓剂或孕酮和环扎术治疗的孕妇发生晚期和早期 PTB 的风险降低。与孕酮单一疗法相比,仅联合应用孕酮和宫颈环扎术可显著降低极早产的发生风险。

联合治疗干预措施在预防早产方面的疗效最高。在特殊情况下,需要进行个体化评估以确定最佳治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dce4/10303175/aa21011c6f91/medicina-59-01018-g001.jpg

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