在双胞胎怀孕中预防早产:国际德尔菲共识
H J Mustafa1, J Sheikh2, V Berghella3
1The Fetal Center at Riley Children's and Indiana University Health, Division of Maternal-Fetal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
概括
这项研究使用了德尔菲方法来了解专家在双胞胎怀孕中管理早产 (PTB) 的方法. 调查结果显示,PTB及其并发症的查和治疗策略在全球存在差异.
科学领域:
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 周围生理学 周围生理学
- 产科和妇科 产科和妇科
背景情况:
- 在双胞胎怀孕中,早产 (PTB) 存在重大风险.
- 双胞胎PTB的管理策略,包括双胞胎输血综合征 (TTTS) 和子宫变化等并发症,需要专家的共识.
- 现有的指导方针可能无法完全捕捉全球专家实践.
研究的目的:
- 应用德尔菲方法,以确定有关双胞胎怀孕中PTB产前诊断和管理的国际专家共识.
- 探索专家的方法来管理特定的并发症,如TTTS和短或扩张的子宫在双胞胎怀孕.
主要方法:
- 一个三轮的德尔菲进程,涉及一个国际专家小组.
- 专家是根据出版记录或组织成员关系来选择的.
- 数据收集采用了多选项和利克特级别的答案,≥70%的协议定义了共识.
主要成果:
- 超过70%的专家在18-23周之间经常查子宫长度 (CL),将短子宫定义为≤25mm.
- 对于短的,非扩张的宫,阴道孕激素是首选的,而不是阴道或 cerclage.
- 在24周前无症状扩张的宫中达成了宫 cerclage 的共识;然而,在宫扩张的TTTS中预防PTB方面没有共识.
结论:
- 德尔菲研究发现了双胞胎怀孕中PTB评估和管理的全球显著差异.
- 专家强调的做法往往与当前的国家和国际社会建议有所不同.
- 需要进一步的研究来协调实践变化,并优化双胞胎怀孕中PTB管理.
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