阴道孕激素用于停止早产后的妊娠延长:一项随机临床试验
Zohar Nachum1,2, Yael Ganor Paz3,4,5, Manal Massalha1,2
1Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.
JAMA network open
|July 8, 2024
概括
阴道微化孕激素 (VMP) 没有延长怀孕时间,也没有防止早产停止的妇女的自发早产. 然而,VMP在双胞胎怀孕中显示出好处,这表明需要进一步研究.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 新生儿健康 新生儿健康
背景情况:
- 停止过早分娩 (APTL) 使女性面临自发过早分娩 (SPTD) 的高风险,这是新生儿死亡率和发病率的主要原因.
- 目前对APTL的维持疗法在延长怀孕方面没有被证明是有效的.
- 以前有方法限制的研究表明,阴道微化孕激素 (VMP) 对APTL的潜在疗效.
研究的目的:
- 评估每天400毫克VMP在经历APTL的妇女中延长怀孕的有效性.
- 评估VMP对37周妊娠前SPTD发病率的影响.
主要方法:
- 在以色列三个医疗中心进行了一项随机临床试验,涉及129名在APTL后单胎和双胎怀孕的妇女.
- 参与者每天两次接受200毫克VMP或没有治疗,直到36周6天怀孕.
- 主要终点包括从注册到分娩的平均日数和怀孕37周之前的SPTD率.
主要成果:
- 在VMP和无治疗组之间,没有观察到妊娠延长 (平均差异:2.6天;P=.44) 或SPTD率 (25%对30%;P=.52) 的显著差异.
- 在双胞胎怀孕中,VMP显著延长了孕期 (平均差异:17.6天;P=.02),推迟了分娩周 (P=.01),减少了新生儿重症监护病房 (P=.03) 和整体住院 (P=.03),并增加了出生体重 (P=.01).
结论:
- 每天两次服用200毫克VMP,对于延长怀孕或预防APTL妇女的SPTD是无效的.
- 在双胞胎怀孕中,VMP显示出显著的益处,包括延长妊娠期和改善新生儿结果,这需要在这个子组进行进一步的研究.
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