The case for tocolysis in threatened preterm labour
The case for tocolysis in threatened preterm labour
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DOI：
10.1016/s1470-0328(03)00052-1
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发表时间：
2003-04-01
影响因子：
5.8
通讯作者：
Chan, J
中科院分区：
文献类型：
--
作者：
Fisk, NM;Chan, J
在安慰剂对照试验中，抗早产药物未能改善新生儿结局，这被错误地解释为它们不起作用的证据。虽然分娩时间明显延长了24小时、48小时和7天，但所获得的时间并未被用于优化新生儿结局。这些试验通常研究孕龄相对较高的妇女，可预测预后良好，将她们纳入不能从宫内移植中获益的三级中心，并且皮质类固醇给药水平较低。没有研究能够检测到妊娠延长1-7天可能产生的有临床意义的差异。尽管如此，贝叶斯解释表明抗早产药物确实改善了新生儿结局。最大的安慰剂对照研究显示了胎儿更好的生存趋势
The failure of tocolytics to improve neonatal outcomes in placebo-controlled trials has wrongly been interpreted as evidence that they do not work. While delivery is unequivocally prolonged by 24 hours, 48 hours and 7 days, the time gained was not exploited to optimise neonatal outcome. These trials typically studied women at relatively advanced gestational ages with predictably good outcomes, enrolled them in tertiary centres where they could not benefit from in-utero transfer, and had low levels of corticosteroid administration. No study has been powered to detect clinically meaningful differences that might be expected to accrue from 1-7 days prolongation of gestation. Despite this, Bayesian interpretation suggests that tocolytics do improve neonatal outcome. The largest placebo-controlled study showed clear trends towards better survival in fetuses