Sciscione A C, Stamilio D M, Manley J S, Shlossman P A, Gorman R T, Colmorgen G H
Department of Obstetrics and Gynecology, Medical Center of Delaware, Newark, USA.
Am J Perinatol. 1998 Mar;15(3):177-81. doi: 10.1055/s-2007-993921.
To determine whether hospital admission and parenteral tocolysis of patients with threatened preterm labor results in a decreased preterm delivery rate and improved perinatal outcome, we performed a prospective cohort study comparing tocolytic treatment versus no tocolytic treatment. Women between 20 and 37 weeks' gestation who presented with at least eight uterine contractions per hour and a cervical examination <2 cm dilated, <80% effaced, and no cervical change over a 2-hr period were entered into the study. Exclusion criteria included cervical change, multiple gestation, chorioamnionitis, rupture of membranes, placenta previa or abruption, undiagnosed vaginal bleeding, and prior tocolytic therapy in the current pregnancy. Seventy-five patients were admitted to the hospital for tocolysis (tocolysis cohort) and 81 were observed and discharged to home (observation cohort). There was no significant difference in mean gestational age at delivery, mean birth weight, or in preterm delivery rate between the two cohorts. Four of the eight women in the observation cohort who delivered preterm had a history of preterm delivery. We conclude that discharging women with preterm contractions without objective evidence of labor does not result in an increase in preterm births. More importantly, tocolysis did not decrease the preterm delivery rate in this cohort.
为了确定对先兆早产患者进行住院治疗及胃肠外使用宫缩抑制剂是否会降低早产率并改善围产期结局，我们开展了一项前瞻性队列研究，比较宫缩抑制剂治疗与不使用宫缩抑制剂治疗的效果。纳入研究的是妊娠20至37周、每小时至少出现8次子宫收缩且宫颈检查显示宫颈扩张<2厘米、消退<80%且在2小时内宫颈无变化的女性。排除标准包括宫颈变化、多胎妊娠、绒毛膜羊膜炎、胎膜破裂、前置胎盘或胎盘早剥、未确诊的阴道出血以及本次妊娠之前接受过宫缩抑制剂治疗。75例患者入院接受宫缩抑制剂治疗（宫缩抑制剂治疗组），81例患者接受观察并出院回家（观察组）。两组在平均分娩孕周、平均出生体重或早产率方面无显著差异。观察组8例早产女性中有4例有早产史。我们得出结论，对有早产宫缩但无客观分娩证据的女性出院处理不会导致早产率增加。更重要的是，在该队列中宫缩抑制剂治疗并未降低早产率。
