多因素综合评分预测早产的研究

先兆早产发生率为5％～10％，是导致围生儿病率及死亡率高的主要原因，早产尚无特别的治疗方法，预测并预防早产是围生医学的重要课题，需确认一种高效、微创、稳定的早产预测方法。目前认为，早产是由多种原因引起的子宫收缩宫颈扩张综合征，病理全过程为内分泌、免疫等多系统参与和相互作用，其预测诊断早产的依据有宫颈结构变化、生化因子和免疫因子等指标。我们综合了预测早产的多个因素，对人选病例综合评分，严密追踪与统计入选病例最终分娩周数，了解最终早产发生率与综合评分的相关性。     

超声测量宫颈长度预测早产风险

早产是围产儿发病与死亡的重要原因,孕期宫颈长度与早产的发病率高度相关,经阴道超声测量CL为最重要的检查方法,客观地评价宫颈条件、测量CL可预测早产高风险人群发生早产的可能性。本文就如何准确测量CL,包括测量途径、测量标准切面、测量方法的规范,以及预测早产常用的测量孕周和恰当切割值的选择等做一综述,旨在降低妊娠34周前的自发早产率,改善不良妊娠结局,同时也防止对早产风险并未增加的妇女进行不必要的干预。     

妊娠中期羊水中相关炎症介质预测早产的研究进展

早产指妊娠满28周至不足37周分娩,早产儿的多器官系统发育不成熟和相关并发症是导致新生儿发病和死亡的重要原因。早产防治的困难性主要在其多病因性,目前其发病机制尚不明确,多项研究表明感染是其主要因素,感染产生的炎症介质通过多种途径最终诱发宫缩,从而促进早产。此前较多采用胎儿纤维连接蛋白（FFN）、经阴道宫颈管长度测定、血清中相关炎症介质的检测等预测晚期症状性早产的发生,而对中期预测早产应用受限。已证实绒毛膜羊膜炎时妊娠组织产生的相关炎症介质如白细胞介素6（IL-6）、IL-16、C反应蛋白（CRP）、脂联素、抗菌肽等直接进入羊水中,同时羊膜腔穿刺术常规用于产前诊断领域,因此通过对妊娠中期羊水中相关炎症介质的进一步研究有望为中期预测早产提供新的方法。     

早产预测指标及其检查时机的研究

早产是围生儿并发症及死亡的主要原因之一。早产的预测是研究热点,大量文献分别从超声测量学角度,包括宫颈长度,胎儿 某内脏的测量;宫颈阴道分泌物中多项指标,如胎儿纤维结合蛋白、磷酸化及脱磷酸化胰岛素样生长因子连接蛋白-1、白细胞介素的测定;血生 化分析,如血清松弛肽、C反应蛋白、糖化血红蛋白含量的变化及羊水化验与感染有关的一些因子,如快速基质金属蛋白酶8、单核细胞趋化蛋白 -1、γ干扰素诱导T细胞α趋化因子等,阐述各指标对早产的预测价值。以期找到更加稳定可靠的预测早产指标,提高围生质量。     

早产预测指标及其检查时机的研究

早产是围生儿并发症及死亡的主要原因之一。早产的预测是研究热点,大量文献分别从超声测量学角度,包括宫颈长度,胎儿某内脏的测量;宫颈阴道分泌物中多项指标,如胎儿纤维结合蛋白、磷酸化及脱磷酸化胰岛素样生长因子连接蛋白-1、白细胞介素的测定;血生化分析,如血清松弛肽、C反应蛋白、糖化血红蛋白含量的变化及羊水化验与感染有关的一些因子,如快速基质金属蛋白酶8、单核细胞趋化蛋白-1、γ干扰素诱导T细胞α趋化因子等,阐述各指标对早产的预测价值。以期找到更加稳定可靠的预测早产指标,提高围生质量。     

早产的预测

早产往往是隐藏在后面的病理情况的具体表现 ,如果只是用传统的方法 (临床表现或胎心监护仪记录子宫收缩 )来预测是否会发生早产 ,敏感性和特异性都比较差 ,不利于临床处理。近几年的研究显示 ,通过超声检查了解宫颈管的长度 ,以及测定某些生化指标的变化 ,都可以从某种程度上预测早产的发生 ,为临床的及时和正确处理提供比较可靠的证据。虽然这些年的研究取得了一些进展 ,预测的敏感性和特异性也有所提高 ,但是结果仍然不太令人满意 ,主要原因是造成早产的原因比较多 ,而且机制也各不相同。因此 ,试图用一种方法来预测所有的早产是一种不切…     

与早产临产相关的转录组学研究进展

早产是复杂的多因素综合征,是新生儿死亡的主要原因。早产一旦发生,并无切实有效的方法延长孕周。多年来研究人员一直致力于寻找早产的病理生理机制及有效的预测方法,但早产病理机制复杂,且需要母胎组织间的相互作用。母胎界面的转录组研究发现,妊娠期间过早的从抗炎状态转变为促炎状态,破坏母体先天性和适应性免疫平衡,从而发生早产。子宫肌层转录组研究也发现,分娩与炎症信号有关,包括与细胞因子、趋化因子和参与免疫反应的通路。而与妊娠相关组织的RNA通常会释放入母血,且RNA可直接反映来源组织的生理学信息。未来可以通过母体外周血中的细胞游离RNA来预测早产。但针对早产的研究仍存在一定的局限性,例如无法获得与胎龄相匹配的正常妊娠组织作为对照等问题,因而,寻找有效的能够预测早产的生物学标志物仍是未来一段时期的研究重点。     

早产的预测

早产是围产儿死亡和疾病的首要原因.但研究发现先兆早产孕妇很多没有治疗也没发生早产,如何鉴别"真正"的早产和"假的"早产即早产预测和早期诊断问题,是当前产科研究的热点之一.     

超声检查预测早产研究进展

<正>早产严重威胁新生儿及婴幼儿健康,它是仅次于肺炎引起5岁以下儿童死亡的第二大主要原因,2012年WHO公布全球早产率达11.1%,并整体呈上升趋势~([1])。此外,早产儿中胎儿畸形、胎儿合并症的发生率明显高于足月儿,给家庭及社会带来了沉重的经济负担~([1])。因此,早期预测早产采取预防性措施及治疗对于降低围产儿发病和死亡率至关重要。目前,临床预测早产主要根据患者临床症状、病史、Bishop评分、生化检查及超声检查。     

宫颈超声检查联合胎儿纤维连接蛋白检测对预测早产的临床价值

早产在我国是指妊娠满28周至不足37周（体重1000-2499g）分娩者。早产儿约占分娩总数的8%,但其占全部非畸形新生儿死亡的70%[1]。早产是导致围产儿死亡、患病及相关并发症的主要原因。因此,如何预测早产,以便积极采取相应的措施预防,是改善不良妊娠结局的关键。目前宫颈超声检查用于早产预测是国内外产科热点研究之一[2]。研究表明,孕24-35周孕妇宫颈分泌物胎儿纤维结合蛋白（fetal fibronectin,fFN）与早产具有一定的相关性[3]。我院现结合这两种方法用于预测早产,显著提高了早产预测的敏感性,现将结果报道如下。     

早产的诊治现状和面临的问题

近20年来,我国为降低早产发病率,改善早产儿结局不懈努力,取得了令人瞩目的成就,但由于中国人口基数庞大,早产的数量仍不容小觑。加之早产和分娩启动的机制至今仍未完全阐明,区域内早产诊疗水平和早产儿救治水平存在较大差异,在一定程度上制约了早产诊治水平的提高。对我国围产医学工作者而言,进一步降低早产率,改善早产儿远、近期结局,依旧任重而道远。     

早产的诊治现状和面临的问题

近20年来,我国为降低早产发病率,改善早产儿结局不懈努力,取得了令人瞩目的成就,但由于中国人口基数庞大,早产的数量仍不容小觑。加之早产和分娩启动的机制至今仍未完全阐明,区域内早产诊疗水平和早产儿救治水平存在较大差异,在一定程度上制约了早产诊治水平的提高。对我国围产医学工作者而言,进一步降低早产率,改善早产儿远、近期结局,依旧任重而道远。     

Tocolysis for preterm labor: Expert opinion

Tocolysis is an important treatment in the improvement of outcome in preterm labor and preterm birth, provided that its use follows clear evidence-based recommendations. In this expert opinion, the most recent evidence about efficacy and side effects of different tocolytics is being reviewed and evidence-based recommendation about diagnosis and treatment of preterm labor is given. Further aspects such as progesterone administration or antibiotic treatment for the prevention of preterm birth are included. Our review demonstrates that an individualized choice of different tocolytics and additional treatments is necessary to improve short- and long-term neonatal outcome in preterm labor and preterm birth.     

The role of inflammation in preterm birth—focus on periodontitis

It is universally accepted that acute inflammation is responsible for a substantial fraction of preterm births, particularly early cases. Much of this inflammation is caused by intrauterine infection. There is also evidence that infection and perhaps inflammation remote from the genitourinary tract can trigger preterm labour. Several studies have suggested that periodontitis during pregnancy increases the risk of preterm birth. Periodontitis may cause preterm birth by causing low-grade bacteraemia, which lodges in the decidua, chorion and amnion or by releasing endotoxin into the maternal circulation, which triggers intrauterine inflammation and preterm birth. Alternatively, it may release cytokines and other inflammatory products, which then trigger preterm labour. It is also conceivable that periodontitis might serve as a marker for other unhealthy behaviours, or immune hyperresponsiveness and that hyperresponsiveness to low-grade intrauterine infection itself might cause preterm birth. Currently, there are few data available to distinguish these possibilities. Such distinctions are important since they have clear implications for whether treatment of periodontitis might reduce the incidence of preterm birth. Several clinical trials of treatment of periodontitis are continuing, but until their results are known there is currently little evidence that treatment of periodontitis during pregnancy reduces the incidence of preterm birth.     

Pathophysiology of preterm birth: emerging concepts of maternal infection

Preterm birth remains a significant health concern. Maternal reproductive infections such as bacterial vaginosis pose increased risk for preterm birth, although treatment of bacterial vaginosis has not proven to be universally effective in preterm birth prevention. Maternal oral infection such as clinical periodontal disease has also been identified as a risk factor for preterm birth, and pilot data suggest that oral treatment interventions undertaken during pregnancy may reduce preterm birth risk.     

Controversies in diagnosis of preterm labour

Despite scientific advances, efforts to prevent preterm birth can be disappointing. Obstetric care must focus on strategies to improve the outcome of preterm infants. The major goal is to delay preterm birth long enough to allow the transfer of women about to deliver preterm to a facility with a neonatal intensive care unit and to administer corticosteroids to enhance fetal lung maturation. A prerequisite for the success of this strategy is the reliable identification of women who will give birth preterm. Although symptoms of preterm labour strongly suggest preterm birth, contractions—even if combined with cervical effacement and dilation—do not reliably predict preterm birth. The diagnosis of true preterm labour that will eventually lead to preterm birth has been facilitated by the use of transvaginal cervical ultrasonography and by the detection of fetal fibronectin (FFN) in cervicovaginal secretions. The main clinical value of these tests is that preterm birth is very unlikely if the results of both tests are negative. This may help to avoid unnecessary transfer, hospitalisation and treatment of women with false preterm labour. The detection of phosphorylated insulin-like growth factor binding protein-1 in cervicovaginal secretions, or elevated levels of inflammatory markers, like interleukin-6, interleukin-8 and tumour necrosis factor-α (TNF-α), also predict preterm birth in symptomatic women. These markers, however, are not routinely used to predict preterm birth in women with symptoms of preterm labour.     

Impact of metronidazole therapy on preterm birth in women with bacterial vaginosis flora (Gardnerella vaginalis): a randomised, placebo controlled trial

Objective To ascertain whether metronidazole treatment of women with a heavy growth of Gardnerella vaginalis during mid-pregnancy would reduce the risk of spontaneous preterm birth.
Design A multicentre, randomised, placebo-controlled trial
Setting Four metropolitan hospitals.
Participants Eight hundred and seventy-nine singleton women with a heavy growth of G. vaginalis or Gram stain indicative of bacterial vaginosis at 19 weeks of gestation.
Interventions Oral metronidazole (400 mg) or placebo twice daily for two days at 24 weeks of gestation, and at 29 weeks if G. vaginalis found in test-of-cure swab four weeks after treatment.
Main outcome measures Spontaneous preterm birth less than 37 weeks.
Results Intention-to-treat analysis showed no difference between metronidazole and placebo groups in overall preterm birth (31/429 [7.2%] vs 32/428 [7.5%]) or spontaneous preterm birth (20/429 [4.7%] vs 24/428 [5.6%]). Among the 480 women with bacterial vaginosis, treatment had no effect on spontaneous preterm birth (11/242 [4.5%] vs 15/238 [6.3%]). In the subset of 46 women with a previous preterm birth, women in the metronidazole group showed a significant reduction in spontaneous preterm birth (2/22 [9.1%] vs 10/24 [41.7%], OR 0.14, 95%CI 0.01–0.84). A treatment effect was also found in compliant women with a previous preterm birth and bacterial vaginosis (0/14 [0%] vs 6/17 [35.3%], OR 0.0,95%CI 0.0–0.94).
Conclusion Metronidazole treatment of women with a heavy growth of G. vaginalis or bacterial vaginosis did not reduce the preterm birth rate. Among women with a previous preterm birth, treatment reduced the risk of spontaneous preterm birth. Further studies are required to confirm these findings.     

胎盘疾病与早产

全球早产发生率呈逐年攀升趋势,且由多方面因素造成,是现今各国产科面临的重要难题。文章主要就早产发生的胎盘因素进行讨论,并进一步阐述减少早产发生的预测和预防方式,及改善围产期结局的最新临床诊治进展。     

Periodontal disease and preterm birth

Preterm birth (delivery at fewer than 37 weeks’ gestation) is the most common cause of infant morbidity and mortality among nonanomalous infants in the United States. Increasing evidence has focused on associations between clinical infection, inflammation, and preterm birth. Maternal periodontal disease, which is associated with systemic inflammation, has been associated with preterm birth. Intervention trails for treatment of periodontal disease during pregnancy, however have not consistently shown a reduction in preterm birth rates. Despite the lack of reduction in preterm birth, oral health maintenance is an important part of preventive care and should be supported during pregnancy.     

Effect of vaginal metronidazole + miconazole treatment during pregnancy for gestational age and birth weight in a population-based study

The objective of the study was to check the effect of the combination of metronidazole and miconazole (M+M) for the prevention of sexually transmitted infections/disorders related preterm delivery/birth. Antiprotozoal vaginal metronidazole was not able to prevent preterm birth, while the antifungal topical miconazole use showed some reduction in preterm birth in our previous studies. The population-based large control (without any defects) data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities was used for the evaluation of the combination of M+M for birth outcomes. Of 38,151 controls, 846 (2.2%) had treatment with vaginal tablet of M+M for vaginal infections. The prevalence of preterm birth was 9.5% after this treatment compared with the 9.2% of preterm birth in the untreated group. Thus the combination of M+M was not able to reduce the preterm birth associated with vulvovaginal infections/disorders.