Bergsjø P, Villar J
Centre for International Health, University of Bergen, Norway.
Acta Obstet Gynecol Scand. 1997 Jan;76(1):15-25. doi: 10.3109/00016349709047779.
There is uncertainty concerning antenatal care as a tool to eliminate or alleviate adverse outcomes in the newborn. We identified congenital conditions, intrauterine infections, intrauterine growth retardation, preterm birth and some specific infectious diseases in the mother with a view to prophylactic and other interventions. The value of some special diagnostic tools is also under discussion.
Review of recent literature, especially randomized controlled trials and systematic reviews.
Genetic abnormalities cannot be prevented after conception, but many of them, and a number of acquired conditions, can be discovered by ultrasonographic and biochemical diagnostics. The advisability of screening must be determined locally for each condition, based on prevalence, treatment options and the legal requirements for abortion. Smoking, excessive alcohol intake, and severe undernutrition cause fetal growth retardation. Interventions to reduce maternal smoking have had limited success. Protein-energy supplementation only modestly affects birthweight. Routine measurement of uterine height is a good predictor of severe growth retardation and in rural settings of perinatal death. Preterm birth has been linked to ascending infection and subsequent rupture of the membranes. Attempts to eradicate local infections have shown some benefit but results are not convincing yet. Cervical cerclage and betamimetic drugs have little, if any, effect. Claims for reduction of physical strain (standing > 5 hours) at work should be supported. Tuberculosis in the mother should be discovered and treated. Malaria prophylaxis during pregnancy will protect the mother and possibly benefit the fetus. Adequate tetanus immunization of all mothers is a high priority intervention in developing countries. In HIV-positive mothers, Zidovudine ante- and perinatally will lower perinatal HIV-transmission significantly. Risk scoring may help identify some women for referral to higher level of care. Routine ultrasonography does not improve the outcome of pregnancy in terms of live births and morbidity, but may influence mortality through discovery and abortion of fetuses with major malformations. One vaginal examination during pregnancy is recommended but no repeat procedure unless medically indicated.
产前护理作为消除或减轻新生儿不良结局的一种手段，仍存在不确定性。我们识别出母亲的先天性疾病、宫内感染、宫内生长受限、早产以及一些特定的传染病，以便进行预防性和其他干预措施。一些特殊诊断工具的价值也在讨论之中。
回顾近期文献，尤其是随机对照试验和系统评价。
受孕后无法预防基因异常，但其中许多异常以及一些后天性疾病可通过超声和生化诊断发现。对于每种情况，必须根据患病率、治疗选择和堕胎的法律要求在当地确定筛查的可取性。吸烟、过量饮酒和严重营养不良会导致胎儿生长受限。减少母亲吸烟的干预措施成效有限。蛋白质能量补充对出生体重的影响不大。常规测量宫高是严重生长受限以及农村地区围产期死亡的良好预测指标。早产与上行性感染及随后的胎膜破裂有关。根除局部感染的尝试已显示出一些益处，但结果尚不令人信服。宫颈环扎术和β-拟交感神经药物几乎没有效果。减少工作时身体劳损（站立超过5小时）的说法应得到支持。应发现并治疗母亲的结核病。孕期预防疟疾可保护母亲，可能对胎儿也有益处。在发展中国家，所有母亲进行充分的破伤风免疫接种是一项高度优先的干预措施。对于感染艾滋病毒的母亲，产前和围产期使用齐多夫定可显著降低围产期艾滋病毒传播率。风险评分可能有助于识别一些需要转诊至更高护理级别的女性。常规超声检查在活产和发病率方面并不能改善妊娠结局，但可能通过发现并终止有严重畸形的胎儿来影响死亡率。建议孕期进行一次阴道检查，除非有医学指征，否则无需重复检查。
