前次分娩孕周对孕酮预防复发性早产的影响

作     者：Spong C.Y. Meis P.J. Thom E.A. 高雪莲 

作者机构：National Institute of Child Health and Human Development Bethesda MD United StatesDr. 

出 版 物：《世界核心医学期刊文摘（妇产科学分册）》 (Core Journal in Obstetrics/Gynecology)

年 卷 期：2006年第2卷第1期

页      面：21-22页

学科分类：1002[医学-临床医学] 100211[医学-妇产科学] 10[医学] 

主　　题：分娩孕周 自然早产 Kruskal-Wallis检验 复发性 羟孕酮 logistic回归 安慰剂治疗 预防 随机对照试验 Fisher 

摘      要：Preterm birth occurs in 1 of 8 pregnancies and may result in significant morbidity and mortality. 17- alpha hydroxyprogesterone caproate (17- OHP caproate) has been found to be efficacious in reducing the risk of subsequent preterm delivery in women who have had a previous spontaneous preterm birth (sPTB). This analysis was undertaken to evaluate if 17- OHP caproate therapy works preferentially depending on the gestational age at previous spontaneous delivery. We hypothesized that treatment with 17- OHP caproate is more effective in prolonging pregnancy depending on the gestational age of the earliest previous preterm birth (20- 27.9, 28- 33.9 vs 34- 36.9 weeks). Study design: This was a secondary analysis of 459 women with a previous sPTB enrolled in a randomized controlled trial evaluating 17- OHP caproate versus placebo. Effectiveness of 17- OHP caproate for pregnancy prolongation was evaluated based on gestational age at earliest previous delivery according to clinically relevant groupings (20- 27.9, 28- 33.9, and 34- 36.9 weeks). Statistical analysis included the chi-square, Fisher exact, and Kruskal-Wallis tests, logistic regression, and survival analysis using proportional hazards. Results: Gestational age at earliest previous delivery was similar between women treated with 17- OHP caproate or placebo (P = .1). Women with earliest delivery at 20 to 27.9 weeks and at 28 to 33.9 weeks delivered at significantly more advanced gestational age if treated with 17- OHP caproate than with placebo (median 37.3 vs 35.4 weeks, P = .046 and 38.0 vs 36.7 weeks, P = .004, respectively) and were less likely to deliver 37 weeks (42% vs 63% , P = .026 and 34% vs 56% , P = .005, respectively). Those with earliest delivery at 34 to 36.9 weeks were not significantly different between 17- OHP caproate or control. Conclusion: 17- OHP caproate therapy given to prevent recurrent PTB is associated with a prolongation of pregnancy overall, and especially for women with a previous sp