今日の臨床サポート

切迫早産

著者: 牧野康男 庄原赤十字病院産婦人科

監修: 金山尚裕 静岡医療科学専門大学校

著者校正/監修レビュー済:2020/03/26
参考ガイドライン:
日本産科婦人科学会日本産婦人科医会:産婦人科診療ガイドライン―産科編2017. CQ302 切迫早産の診断と管理の注意点は? p152-157.2017.
患者向け説明資料

概要・推奨   

  1. 妊娠週数24〜33週の早産が1週以内に予想される場合、ベタメタゾン12mgを24時間ごと、計2回、筋肉内投与する(推奨度2)。
  1. 妊娠週数22〜23週の早産が1週以内に予想される場合、ベタメタゾン12mgを24時間ごと、計2回、筋肉内投与する(推奨度2)。
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
牧野康男 : 未申告[2021年]
監修:金山尚裕 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 産婦人科診療ガイドライン2017に基づき、切迫早産の診断週数とベタメタゾンの投与を修正した。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 切迫早産は、「妊娠22週0日から36週0日までの妊娠中に、規則的な子宮収縮が認められ、かつ子宮頸管の開大度・展退度に進行が認められる場合、あるいは初回の診察で子宮頸管の開大が2cm以上となっているなど、早産となる危険性が高いと考えられる状態」と定義されている[1]
 
「早産・切迫早産」について

早産になりかかっている状態、つまり早産の一歩手前の状態を切迫早産といいます。
早産とは
 早産とは正期産(妊娠37週0日~妊娠41週6日まで)以前の出生をいいます。日本では妊娠22週0日~妊娠36週6日までの出産を早産と呼びます。妊娠22週未満の出産は流産といい、早産とは区別されます。国による医療技術の違いにより、妊娠24週以降や、妊娠28週以降に出産しなければ、早産として扱わない国も多くあります。妊娠22週で生まれた場合、早産となりますが赤ちゃんの体重は500g前後で長期間の新生児医療(新生児集中治療室での治療)が必要となり、また、小さく生まれた赤ちゃんほど、後で重篤な障害が出現する可能性が高くなります。最近では、妊娠34週以降の、正常の分娩時期に近い早産であっても、呼吸障害など長期に障害を残すことが報告されています。ですから、早産にならないように妊娠中、定期的な健診を受けていただき、早産になりやすい状況の早期診断と予防が必要になります。ちなみに早産は全妊娠の5%に発生し、その原因は感染や体質によることが多いといわれています。また、妊娠高血圧症候群、前置胎盤(胎盤が子宮口をふさいでいる状態)、常位胎盤早期剥離(分娩前に胎盤が子宮の壁からはがれてしまうこと)、胎児機能不全(胎児の元気がなくなってくる状態)などでは子宮内では赤ちゃんが生きられない状態になり、人工的に早産とせざるを得ない場合もあります。
切迫早産とは
 早産になりかかっている状態、つまり早産の一歩手前の状態を切迫早産といいます。子宮収縮が頻回におこり、子宮の出口(子宮口)が開き、赤ちゃんが出てきそうな状態や破水(子宮内で胎児を包み、羊水が漏れないようにしている膜が破れて、羊水が流出している状態)をしてしまった状態のことです。
 切迫早産の治療では、子宮口が開かないようにするために、子宮収縮を抑える目的で子宮収縮抑制剤を使用します。また、切迫早産の原因である細菌による腟内感染を除去するために抗生剤を使用することもあります。子宮収縮の程度が軽く、子宮口があまり開いていない場合は外来通院による治療でもいいのですが、子宮収縮が強く認められ、子宮口の開大が進んでいる状態では、入院して子宮収縮抑制剤の点滴治療が必要です。
 妊娠32週より前に破水した場合は、赤ちゃんが自分で呼吸できる状態になるまで抗菌剤を投与し感染を抑えることが一般的です。妊娠34週以降であれば、赤ちゃんは自分で呼吸できる可能性が高いので、赤ちゃんに細菌が感染する前に出産し、生まれた後に治療室での治療を行います。
 また、子宮口が開きやすい体質を子宮頸管無力症といい、どんどん子宮口が開大し、流産や早産になるので状況により頸管(子宮の出口)をしばることがあります。これを子宮頸管縫縮術といいます。

 
  1. 以下の妊婦は早産ハイリスクと認識する[2]
  1. 現症より:多胎妊娠、細菌性腟症、子宮頸管短縮例
  1. 既往歴より:早産既往歴妊婦、円錐切除後妊婦
  1. 子宮収縮の発来には、子宮収縮物質(プロスタグランジン[PGE2、PGF2α]、オキシトシン)や、そのレセプターおよび分解酵素の発現が関与している[3]
問診・診察のポイント  
問診:
  1. 子宮収縮の有無を確認する。

これより先の閲覧には個人契約のトライアルまたはお申込みが必要です。

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文献 

著者: G S Berkowitz, E Papiernik
雑誌名: Epidemiol Rev. 1993;15(2):414-43.
Abstract/Text
PMID 8174665  Epidemiol Rev. 1993;15(2):414-43.
著者: W J Morales
雑誌名: Obstet Gynecol. 1987 Aug;70(2):183-6.
Abstract/Text This report investigates the effect of chorioamnionitis on infant mental and psychomotor development at one year through the prospective study of 698 preterm pregnancies complicated by premature rupture of membranes and managed expectantly without antenatal corticosteroids or tocolytic agents. Ninety-two mothers (13%) developed chorioamnionitis, resulting in a statistically significant increase in neonatal mortality (25 versus 6%), respiratory distress syndrome (RDS) (62 versus 35%), intraventricular hemorrhage (56 versus 22%), and sepsis (28 versus 11%). A multidisciplinary team examined 43 surviving infants at corrected one year of life and measured their mental and psychomotor development by the Bayley scales. No statistically significant difference in outcomes was observed when their development was compared with that of a control group matched for birth weight, gestational age, severity of intraventricular hemorrhage, and severity of RDS.

PMID 3601280  Obstet Gynecol. 1987 Aug;70(2):183-6.
著者: J D Iams, R L Goldenberg, P J Meis, B M Mercer, A Moawad, A Das, E Thom, D McNellis, R L Copper, F Johnson, J M Roberts
雑誌名: N Engl J Med. 1996 Feb 29;334(9):567-72. doi: 10.1056/NEJM199602293340904.
Abstract/Text BACKGROUND: The role of the cervix in the pathogenesis of premature delivery is controversial. In a prospective, multicenter study of pregnant women, we used vaginal ultrasonography to measure the length of the cervix; we also documented the incidence of spontaneous delivery before 35 weeks' gestation.
METHODS: At 10 university-affiliated prenatal clinics, we performed vaginal ultrasonography at approximately 24 and 28 weeks of gestation in women with singleton pregnancies. We then assessed the relation between the length of the cervix and the risk of spontaneous preterm delivery.
RESULTS: We examined 2915 women at approximately 24 weeks of gestation and 2531 of these women again at approximately 28 weeks. Spontaneous preterm delivery (at less than 35 weeks) occurred in 126 of the women (4.3 percent) examined at 24 weeks. The length of the cervix was normally distributed at 24 and 28 weeks (mean [+/- SD], 35.2 +/- 8.3 mm and 33.7 +/- 8.5 mm, respectively). The relative risk of preterm delivery increased as the length of the cervix decreased. When women with shorter cervixes at 24 weeks were compared with women with values above the 75th percentile, the relative risks of preterm delivery among the women with shorter cervixes were as follows: 1.98 for cervical lengths at or below the 75th percentile (40 mm), 2.35 for lengths at or below the 50th percentile (35 mm), 3.79 for lengths at or below the 25th percentile (30 mm), 6.19 for lengths at or below the 10th percentile (26 mm), 9.49 for lengths at or below the 5th percentile (22 mm), and 13.99 for lengths at or below the 1st percentile (13 mm) (P < 0.001 for values at or below the 50th percentile; P = 0.008 for values at or below the 75th percentile). For the lengths measured at 28 weeks, the corresponding relative risks were 2.80, 3.52, 5.39, 9.57, 13.88, and 24.94 (P < 0.001 for values at or below the 50th percentile; P = 0.003 for values at the 75th percentile).
CONCLUSIONS: The risk of spontaneous preterm delivery is increased in women who are found to have a short cervix by vaginal ultrasonography during pregnancy.

PMID 8569824  N Engl J Med. 1996 Feb 29;334(9):567-72. doi: 10.1056/N・・・
著者: H Leitich, C Egarter, A Kaider, M Hohlagschwandtner, P Berghammer, P Husslein
雑誌名: Am J Obstet Gynecol. 1999 May;180(5):1169-76.
Abstract/Text OBJECTIVE: We performed a meta-analysis to determine the value of cervicovaginal fetal fibronectin as a marker for preterm delivery.
STUDY DESIGN: Selection criteria confined the analysis to original, English-language reports of prospective studies including women at <37 weeks' gestation with intact amniotic membranes. For the outcomes of delivery at <37 or <34 weeks' gestation or delivery within 7, 14, 21, or 28 days after fibronectin sampling, we calculated sensitivity and specificity rates for each study, for subgroups of studies, and for all studies combined.
RESULTS: A total of 27 studies met our inclusion criteria. For the outcomes of delivery at <37 and <34 weeks' gestation, overall sensitivity rates were 56% and 61% and overall specificity rates were 84% and 83%, respectively. For the outcomes of delivery within 7, 14, 21, and 28 days, we calculated sensitivity rates of 76%, 68%, 61%, and 43% and specificity rates of 88%, 89%, 91%, and 93%, respectively. For the subgroup of patients with symptoms of preterm labor, sensitivity rates for delivery within 7, 14, 21, and 28 days of 89%, 78%, 76%, and 71% and specificity rates of 86%, 86%, 88%, and 83%, respectively, were calculated.
CONCLUSION: Among patients with symptoms of preterm labor, cervicovaginal fetal fibronectin appears to be among the most effective predictors of preterm delivery.

PMID 10329873  Am J Obstet Gynecol. 1999 May;180(5):1169-76.
著者: Austin Ugwumadu, Isaac Manyonda, Fiona Reid, Phillip Hay
雑誌名: Lancet. 2003 Mar 22;361(9362):983-8. doi: 10.1016/S0140-6736(03)12823-1.
Abstract/Text BACKGROUND: Abnormal vaginal flora and bacterial vaginosis are associated with amplified risks of late miscarriage and spontaneous preterm delivery. We aimed to establish whether antibiotic treatment early in the second trimester might reduce these risks in a general obstetric population.
METHODS: We screened 6120 pregnant women attending hospital for their first antenatal visit--who were at 12-22 weeks' gestation (mean 15.6 weeks)--for bacterial vaginosis or abnormal vaginal flora. We used gram-stained slides of vaginal smears to diagnose abnormal vaginal flora or bacterial vaginosis, in accordance with Nugent's criteria. We randomly allocated 494 women with one of these signs to receive either clindamycin 300 mg or placebo orally twice daily for 5 days. Primary endpoints were spontaneous preterm delivery (birth > or =24 but <37 weeks) and late miscarriage (pregnancy loss > or =13 but <24 weeks). Analysis was intention to treat.
FINDINGS: Nine women were lost to follow-up or had elective termination. Thus, we analysed 485 women with complete outcome data. Women receiving clindamycin had significantly fewer miscarriages or preterm deliveries (13/244) than did those in the placebo group (38/241; percentage difference 10.4%, 95% CI 5.0-15.8, p=0.0003). Clindamycin also reduced adverse outcomes across the range of abnormal Nugent scores, with maximum effect in women with the highest Nugent score of 10.
INTERPRETATION: Treatment of asymptomatic abnormal vaginal flora and bacterial vaginosis with oral clindamycin early in the second trimester significantly reduces the rate of late miscarriage and spontaneous preterm birth in a general obstetric population.

PMID 12660054  Lancet. 2003 Mar 22;361(9362):983-8. doi: 10.1016/S0140・・・
著者: S L Kenyon, D J Taylor, W Tarnow-Mordi, ORACLE Collaborative Group
雑誌名: Lancet. 2001 Mar 31;357(9261):989-94. doi: 10.1016/s0140-6736(00)04234-3.
Abstract/Text BACKGROUND: Preterm birth after spontaneous preterm labour is associated with death, neonatal disease, and long-term disability. Previous small trials of antibiotics for spontaneous preterm labour have reported inconclusive results. We did a randomised multicentre trial to resolve this issue.
METHODS: 6295 women in spontaneous preterm labour with intact membranes and without evidence of clinical infection were randomly assigned 250 mg erythromycin (n=1611), 325 mg co-amoxiclav (250 mg amoxicillin and 125 mg clavulanic acid; n=1550), both (n=1565), or placebo (n=1569) four times daily for 10 days or until delivery, whichever occurred earlier. The primary outcome measure was a composite of neonatal death, chronic lung disease, or major cerebral abnormality on ultrasonography before discharge from hospital. Analysis was by intention to treat.
FINDINGS: None of the trial antibiotics was associated with a lower rate of the composite primary outcome than placebo (erythromycin 90 [5.6%], co-amoxiclav 76 [5.0%], both antibiotics 91 [5.9%], vs placebo 78 [5.0%]). However, antibiotic prescription was associated with a lower occurrence of maternal infection.
INTERPRETATION: This trial provides evidence that antibiotics should not be routinely prescribed for women in spontaneous preterm labour without evidence of clinical infection.

PMID 11293641  Lancet. 2001 Mar 31;357(9261):989-94. doi: 10.1016/s014・・・
著者: ACOG Committee on Practice Bulletins--Obstetrics
雑誌名: Int J Gynaecol Obstet. 2003 Jul;82(1):127-35. doi: 10.1016/s0020-7292(03)00247-9.
Abstract/Text Preterm birth is the leading cause of neonatal mortality in the United States, and preterm labor precedes 40-50% of preterm births. Preterm birth accounts for 35% of all U.S. health care spending for infants and 10% of all such spending for children. Approximately 467,000 live births annually (11.5% of all live births) occur before term in the United States, and preterm births are responsible for three quarters of neonatal mortality and one half of long-term neurologic impairments in children. The purpose of this document is to present the various methods proposed to manage preterm labor and the evidence for their roles in clinical practice. Despite the numerous management methods proposed the incidence of preterm birth has changed little over the past 40 years (Fig. 1). Uncertainty persists about the best strategies for managing preterm labor.

PMID 12834934  Int J Gynaecol Obstet. 2003 Jul;82(1):127-35. doi: 10.1・・・
著者: P N Tara, S Thornton
雑誌名: Semin Fetal Neonatal Med. 2004 Dec;9(6):481-9. doi: 10.1016/j.siny.2004.08.005.
Abstract/Text The prevention of preterm birth should be one of the major aims of antenatal care. Unfortunately, identification of women who will subsequently deliver preterm is imprecise. Prevention is also difficult. Surgical prevention with cerclage may help a proportion of women. Medical prevention is currently limited to the identification and treatment of bacterial vaginosis, although recent studies have suggested that progesterone prophylaxis may be helpful in some women. Confirmation of efficacy and safety is required before progesterone is introduced as long-term prophylaxis for all women at high risk. The optimal medical treatment (rather than prevention) of threatened preterm labour is controversial. Tocolysis is generally accepted to improve neonatal outcome although this has never been convincingly demonstrated in appropriate trials. Antibiotics confer benefit in the presence of ruptured membranes but are not indicated in uncomplicated preterm labour. In future, it may be possible to identify a subgroup of women in preterm labour with intact membranes who will benefit from tocolysis. The choice of first-line tocolytic therapy is currently debated but atosiban or nifedipine are suggested in current UK guidelines. A direct comparison of these drugs is required in a clinical trial. Although indirect comparisons have been made, these are difficult to interpret due to methodological differences. Each of these drugs have their advocates. Nifedipine has been reported to delay delivery and improve outcome but there are inconsistencies in the clinical trials. Atosiban is also reported to delay delivery and is well tolerated but improved neonatal outcome may have been hidden in clinical trials due to the requirement for rescue tocolysis.

PMID 15691786  Semin Fetal Neonatal Med. 2004 Dec;9(6):481-9. doi: 10.・・・
著者: Soromon Kataoka, Takashi Yamada, Kazutoshi Chou, Ryutaro Nishida, Mamoru Morikawa, Mashiho Minami, Hideto Yamada, Noriaki Sakuragi, Hisanori Minakami
雑誌名: J Clin Microbiol. 2006 Jan;44(1):51-5. doi: 10.1128/JCM.44.1.51-55.2006.
Abstract/Text To examine the association between colonization by two newly classified species of genital ureaplasmas (Ureaplasma parvum and U. urealyticum) in early pregnancy and subsequent late abortion or preterm birth at <34 weeks of gestation, four species of genital mycoplasmas--Mycoplasma genitalium, M. hominis, U. parvum, and U. urealyticum--as well as Chlamydia trachomatis and Neisseria gonorrhoeae were examined by PCR-based methods in a prospective cohort study of 877 women with singleton pregnancies at <11 weeks of gestation. Antibiotics were used only in cases in which C. trachomatis and/or N. gonorrhoeae was detected. Multivariate logistic-regression analysis was used to assess independent risk factors after taking maternal low body weight and past history of preterm birth into account. M. genitalium, M. hominis, U. parvum, U. urealyticum, C. trachomatis, and N. gonorrhoeae were detected in 0.8%, 11.2%, 52.0%, 8.7%, 3.2%, and 0.1% of these 877 women, respectively. Twenty-one (2.4%) women experienced late abortion or preterm birth at <34 weeks of gestation. Three factors-detection of U. parvum in the vagina (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.1 to 8.5); use of antibiotics, such as penicillin and cefatrizine, for incidental inflammatory complications before 22 weeks of gestation (OR, 4.2; 95% CI, 1.6 to 10.0); and past history of preterm birth (OR, 10.4; 95% CI, 2.7 to 40.5)-were independently associated with late abortion and preterm birth. In conclusion, vaginal colonization with U. parvum, but not U. urealyticum, is associated with late abortion or early preterm birth.

PMID 16390947  J Clin Microbiol. 2006 Jan;44(1):51-5. doi: 10.1128/JCM・・・
著者: N Kanayama, L Chinarong, H Naruse, N Yamamoto, S Fujishiro, K Maehara, Y Morita, T Terao
雑誌名: Nihon Sanka Fujinka Gakkai Zasshi. 1992 Apr;44(4):477-82.
Abstract/Text Cervical maturation, dilatation and uterine contraction in imminent premature delivery are closely related to chemical mediators from activated granulocytes which infiltrate into the cervix. It is known that urinastatin (urinary trypsin inhibitor, UTI) inhibits many kinds of chemical mediators from granulocytes and macrophages such as granulocyte elastase (elastase) and interleukin 1. We examined the effect of a UTI suppository on uterine contraction and the elastase level in cervical mucus in cases of imminent premature delivery. We treated 43 cases of imminent premature delivery with tocolysis index 3 or 4 with 4 kinds of therapy: Group A (N = 12): ritodorine drop infusion therapy; Group B (N = 9): daily UTI suppository (1,000U) therapy; Group C (N = 14): daily UTI suppository + ritodorine drop infusion therapy; Group D: daily UTI suppository + ritodorine drop infusion + antibiotics (oral cepharosporine) therapy. The elastase level of cervical mucus before treatment was 0.76 +/- 0.40 micrograms/ml in group A, 0.93 +/- 0.43 micrograms/ml in group B, 0.85 +/- 0.40 micrograms/ml in group C and 0.90 +/- 0.41 micrograms/ml in group D. There was no significant difference between these groups. The elastase level in cervical mucus was 0.75 +/- 0.47 micrograms/ml in group A, 0.27 +/- 0.35 micrograms/ml in group B, 0.27 +/- 0.33 micrograms/ml in group C and 0.30 +/- 0.19 micrograms/ml in group D, respectively. The elastase level was decreased significantly in groups B, C and D. The time taken to depress uterine contraction was 65 +/- 66 min in group A, 375 +/- 336 min in group B, 70 +/- 64 min in group C and 58 +/- 53 min in group D, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

PMID 1343816  Nihon Sanka Fujinka Gakkai Zasshi. 1992 Apr;44(4):477-8・・・
著者: H Minakami, T Takahashi, A Izumi, H Itoi, T Tamada
雑誌名: BMJ. 1992 Jun 27;304(6843):1668. doi: 10.1136/bmj.304.6843.1668.
Abstract/Text
PMID 1378771  BMJ. 1992 Jun 27;304(6843):1668. doi: 10.1136/bmj.304.6・・・
著者: Dwight J Rouse, Deborah G Hirtz, Elizabeth Thom, Michael W Varner, Catherine Y Spong, Brian M Mercer, Jay D Iams, Ronald J Wapner, Yoram Sorokin, James M Alexander, Margaret Harper, John M Thorp, Susan M Ramin, Fergal D Malone, Marshall Carpenter, Menachem Miodovnik, Atef Moawad, Mary J O'Sullivan, Alan M Peaceman, Gary D V Hankins, Oded Langer, Steve N Caritis, James M Roberts, Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network
雑誌名: N Engl J Med. 2008 Aug 28;359(9):895-905. doi: 10.1056/NEJMoa0801187.
Abstract/Text BACKGROUND: Research suggests that fetal exposure to magnesium sulfate before preterm birth might reduce the risk of cerebral palsy.
METHODS: In this multicenter, placebo-controlled, double-blind trial, we randomly assigned women at imminent risk for delivery between 24 and 31 weeks of gestation to receive magnesium sulfate, administered intravenously as a 6-g bolus followed by a constant infusion of 2 g per hour, or matching placebo. The primary outcome was the composite of stillbirth or infant death by 1 year of corrected age or moderate or severe cerebral palsy at or beyond 2 years of corrected age.
RESULTS: A total of 2241 women underwent randomization. The baseline characteristics were similar in the two groups. Follow-up was achieved for 95.6% of the children. The rate of the primary outcome was not significantly different in the magnesium sulfate group and the placebo group (11.3% and 11.7%, respectively; relative risk, 0.97; 95% confidence interval [CI], 0.77 to 1.23). However, in a prespecified secondary analysis, moderate or severe cerebral palsy occurred significantly less frequently in the magnesium sulfate group (1.9% vs. 3.5%; relative risk, 0.55; 95% CI, 0.32 to 0.95). The risk of death did not differ significantly between the groups (9.5% vs. 8.5%; relative risk, 1.12; 95% CI, 0.85 to 1.47). No woman had a life-threatening event.
CONCLUSIONS: Fetal exposure to magnesium sulfate before anticipated early preterm delivery did not reduce the combined risk of moderate or severe cerebral palsy or death, although the rate of cerebral palsy was reduced among survivors. (ClinicalTrials.gov number, NCT00014989.)

2008 Massachusetts Medical Society
PMID 18753646  N Engl J Med. 2008 Aug 28;359(9):895-905. doi: 10.1056/・・・
著者: D Roberts, S Dalziel
雑誌名: Cochrane Database Syst Rev. 2006 Jul 19;(3):CD004454. doi: 10.1002/14651858.CD004454.pub2. Epub 2006 Jul 19.
Abstract/Text BACKGROUND: Respiratory distress syndrome (RDS) is a serious complication of preterm birth and the primary cause of early neonatal mortality and disability.
OBJECTIVES: To assess the effects on fetal and neonatal morbidity and mortality, on maternal mortality and morbidity, and on the child in later life of administering corticosteroids to the mother before anticipated preterm birth.
SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 October 2005).
SELECTION CRITERIA: Randomised controlled comparisons of antenatal corticosteroid administration (betamethasone, dexamethasone, or hydrocortisone) with placebo or with no treatment given to women with a singleton or multiple pregnancy, expected to deliver preterm as a result of either spontaneous preterm labour, preterm prelabour rupture of the membranes or elective preterm delivery.
DATA COLLECTION AND ANALYSIS: Two review authors assessed trial quality and extracted data independently.
MAIN RESULTS: Twenty-one studies (3885 women and 4269 infants) are included. Treatment with antenatal corticosteroids does not increase risk to the mother of death, chorioamnionitis or puerperal sepsis. Treatment with antenatal corticosteroids is associated with an overall reduction in neonatal death (relative risk (RR) 0.69, 95% confidence interval (CI) 0.58 to 0.81, 18 studies, 3956 infants), RDS (RR 0.66, 95% CI 0.59 to 0.73, 21 studies, 4038 infants), cerebroventricular haemorrhage (RR 0.54, 95% CI 0.43 to 0.69, 13 studies, 2872 infants), necrotising enterocolitis (RR 0.46, 95% CI 0.29 to 0.74, eight studies, 1675 infants), respiratory support, intensive care admissions (RR 0.80, 95% CI 0.65 to 0.99, two studies, 277 infants) and systemic infections in the first 48 hours of life (RR 0.56, 95% CI 0.38 to 0.85, five studies, 1319 infants). Antenatal corticosteroid use is effective in women with premature rupture of membranes and pregnancy related hypertension syndromes.
AUTHORS' CONCLUSIONS: The evidence from this new review supports the continued use of a single course of antenatal corticosteroids to accelerate fetal lung maturation in women at risk of preterm birth. A single course of antenatal corticosteroids should be considered routine for preterm delivery with few exceptions. Further information is required concerning optimal dose to delivery interval, optimal corticosteroid to use, effects in multiple pregnancies, and to confirm the long-term effects into adulthood.

PMID 16856047  Cochrane Database Syst Rev. 2006 Jul 19;(3):CD004454. d・・・
著者: Anthony C Sciscione
雑誌名: Am J Obstet Gynecol. 2010 Mar;202(3):232.e1-5. doi: 10.1016/j.ajog.2009.07.005. Epub 2009 Sep 20.
Abstract/Text Activity restriction is 1 of the most common interventions used in obstetrics. Although it is used for many reasons, 1 of the most common is to prevent preterm birth in those at risk. This review of the literature describes the potential advantages, disadvantages, and efficacy of activity restriction for the prevention of preterm birth.

Copyright 2010 Mosby, Inc. All rights reserved.
PMID 19766979  Am J Obstet Gynecol. 2010 Mar;202(3):232.e1-5. doi: 10.・・・

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