最大限度地从产前类固醇使用中获益,同时避免过度使用.
Mark A Clapp1, Siguo Li, Alexander Melamed
1Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, and the Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts; the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, San Diego, California; and the Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida.
产前皮质类固醇的最佳时间仍然具有挑战性,只有56.7%的分娩发生在理想窗口内. 需要更好地预测早产,以确保在危险怀孕中及时给予类固醇.
科学领域:
- 产科和妇科 产科和妇科
- 新生儿周产医学 新生儿周产医学
- 临床药理学 临床药理学
背景情况:
- 产前皮质类固醇 (ACS) 对胎儿肺部成熟至关重要.
- 为最大限度地提高益处并最大限度地降低风险,ACS的最佳时间非常重要.
- 目前关于ACS时间和相关因素的现实数据有限.
研究的目的:
- 分析与分娩相关的产前皮质类固醇时间的现实数据.
- 为了确定与最佳ACS时间相关的患者因素和诊断.
- 为ACS管理提供基准测试目标和实际策略.
主要方法:
- 在两个学术医院对单独分娩 (2016-2024) 的回顾性队列研究.
- 主要队列:怀孕24 0/7至33 6/7周之间的分娩.
- 对ACS时间 (无,最佳,次优) 和多变量逻辑回归的分析.
主要成果:
- 在34周前的分娩中,56.7%的分娩时间是最佳的ACS.
- 与最佳时间相关的因素包括高血压疾病,早产和PPROM.
- 某些疾病,如焦虑症和胎盘前,与低于最佳时机相关.
结论:
- 实现最佳的产前皮质类固醇时间是一个重大的临床挑战.
- 需要改善早产预测和个性化评估.
- 及时获得高风险妊娠的ACS需要加强战略,以减少不必要的暴露.
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