背景:阴道孕酮和宫颈环扎术都是减少早产(PTB)的有效干预措施。目前尚不清楚联合治疗是否比单一治疗有效。
目的:探讨宫颈环扎术联合阴道孕酮预防PTB的疗效。
方法:我们搜索了Medline(Ovid),EMBASE(Ovid),PsycINFO(Ovid),CINAHL(EBSCOhost),Cochrane图书馆(Wiley)和Scopus(从成立到2020年)。
方法:本综述接受了随机和伪随机对照试验,非随机对照试验,和队列研究。高危患者(宫颈长度缩短<25mm或先前的PTB)谁被分配宫颈环扎术,阴道孕酮,或两者都用于预防PTB。仅评估单胎妊娠。
方法:主要结果是出生<37周。次要结果包括出生<28-,<32-和<34周,分娩时的胎龄(GA),干预和交付之间的天数,早产胎膜早破,剖腹产,新生儿死亡率,新生儿重症监护病房入院,插管和出生体重。在标题和全文筛选之后,最终分析了11篇论文。使用Cochrane协作工具评估偏倚风险(ROBINS-I和RoB-2)。使用GRADE工具评估证据质量。
结果:联合治疗与单用环扎(RR0.51,95%CI0.37-0.79)或单用孕酮(RR0.75,95%CI0.58,0.96)相比,PTB<37周的风险较低。与仅环扎相比,联合治疗与PTB<34周相关,更少的PTB<32周,更少的PTB<28周,降低新生儿死亡率,出生体重增加,GA增加,干预和分娩之间的间隔时间更长。与单独的黄体酮相比,联合治疗与PTB<32周相关,更少的PTB<28周,降低新生儿死亡率,出生体重增加和GA增加。其他次要结果没有差异。
结论:与单一治疗相比,宫颈环扎术和阴道孕酮的联合治疗可能导致PTB的更大降低。需要进一步进行良好且足够有力的随机对照试验来评估这些有希望的发现。
Vaginal progesterone and cervical cerclage are both effective interventions for reducing preterm birth. It is currently unclear whether combined therapy offers superior effectiveness than single therapy. This study aimed to determine the efficacy of combining cervical cerclage and vaginal progesterone in the prevention of preterm birth.
We searched Medline (Ovid), EMBASE (Ovid), PsycINFO (Ovid), CINAHL (EBSCOhost), Cochrane Library (Wiley), and Scopus (from their inception to 2020).
The
review accepted randomized and pseudorandomized control trials, nonrandomized experimental control trials, and cohort studies. High risk patients (shortened cervical length <25mm or previous preterm birth) who were assigned cervical cerclage, vaginal progesterone, or both for the prevention of preterm birth were included. Only singleton pregnancies were assessed.
The primary outcome was birth <37 weeks. Secondary outcomes included birth <28 weeks, <32 weeks and <34 weeks, gestational age at delivery, days between intervention and delivery, preterm premature rupture of membranes, cesarean delivery, neonatal mortality, neonatal intensive care unit admission, intubation, and birthweight. Following title and full-text screening, 11 studies were included in the final analysis. Risk of bias was assessed using the Cochrane Collaboration tool for assessing the risk of bias (ROBINS-I and RoB-2). Quality of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) tool.
Combined therapy was associated with lower risk of preterm birth at <37 weeks than cerclage alone (risk ratio, 0.51; 95% confidence interval, 0.37-0.79) or progesterone alone (risk ratio, 0.75; 95% confidence interval, 0.58-0.96). Compared with cerclage only, combined therapy was associated with preterm birth at <34 weeks, <32 weeks, or <28 weeks, decreased neonatal mortality, increased birthweight, increased gestational age, and a longer interval between intervention and delivery. Compared with progesterone alone, combined therapy was associated with preterm birth at <32 weeks, <28 weeks, decreased neonatal mortality, increased birthweight, and increased gestational age. There were no differences in any other secondary outcomes.
Combined treatment of cervical cerclage and vaginal progesterone could potentially result in a greater reduction in preterm birth than in single therapy. Further, well-conducted and adequately powered randomized controlled trials are needed to assess these promising findings.