[2025年孕激素在患有早产风险的人群中的使用指示]
Ninon Dupuis1, Christophe Vayssière2
1Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU de Toulouse, Toulouse, France.
Gynecologie, obstetrique, fertilite & senologie
|October 11, 2025
概括
在某些高危妊娠中,阴道孕激素可能有助于预防早产 (PTB). 然而,目前的证据并不支持对所有女性的常规使用,特别是那些没有短宫的女性.
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
- 药理干预药理干预
背景情况:
- 根据患者的风险,考虑使用阴道孕激素来预防早产 (PTB).
- 最近不一致的研究和大型试验表明,对于有PTB病史但没有短宫的女性来说,没有明显的益处.
研究的目的:
- 审查目前关于阴道孕激素在各种风险档案中用于PTB预防的证据.
- 为了告知临床实践,并确认现有的关于孕激素处方的建议.
主要方法:
- 对用于预防PTB的阴道孕激素最近的研究和大型临床试验进行系统的审查和分析.
- 根据患者的风险因素分层评估数据,包括PTB病史,宫长度,多胎妊娠,子宫异常和症状表现.
主要成果:
- 对于以前患有PTB和没有短宫的女性,没有显示出一致的益处;不支持常规处方.
- 对于患有多个自发性PTB或特定妊娠年龄的前PTB的女性数据不足;建议共享决策.
- 多胎妊娠的混合结果,只有在子宫长度<25mm时才有好处. 对子宫形/肌瘤的数据有限.
- 对症状患者 (有威胁的PTB/流产) 的异质数据显示,对妊娠延长或新生儿结局没有益处.
结论:
- 目前的文献和法国的建议并不支持在所有情况下用于预防PTB的常规性阴道孕激素.
- 在数据不足的特定高风险群体中,共享决策至关重要.
- 在多胎妊娠和有症状的患者中,疗效的证据有限,除非符合特定标准,否则在这些情况下没有证明的益处.
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