17-Hydroxyprogesterone caproate in triplet pregnancy: an individual patient data meta-analysis.
17-Hydroxyprogesterone caproate in triplet pregnancy: an individual patient data meta-analysis.
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DOI：
10.1111/1471-0528.13779
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发表时间：
2016-04
期刊：
影响因子：
--
通讯作者：
Global Obstetrics Network (GONet) collaboration
中科院分区：
文献类型：
--
作者：
Combs CA;Schuit E;Caritis SN;Lim AC;Garite TJ;Maurel K;Rouse D;Thom E;Tita AT;Mol B;Global Obstetrics Network (GONet) collaboration
早产使几乎所有的三胞胎妊娠复杂化，没有预防策略被证明有效。使用个体患者数据（IPD）荟萃分析，确定三胎妊娠的结局是否受17-羟基孕酮己酸酯（17 OHPc）预防性给药的影响。我们检索了文献数据库、试验登记和已发表文章中的参考文献。孕激素与对照的随机对照试验（RCT），包括三胎妊娠的妇女。来自确定的RCT的研究者在方案上进行了合作，并贡献了他们的IPD。主要结局是不良围产期结局的复合指标。次要结局是妊娠32周前的出生率。其他预先规定的结局包括随机化至分娩间隔和妊娠< 24、< 28和< 34周的出生率。17 OHPc与安慰剂的3项RCT包括232名三胎妊娠母亲及其696名后代。偏差风险评分和研究间异质性较低。17 OHPc组和安慰剂组的基线特征相当。接受17 OHPc治疗的患者和接受安慰剂治疗的患者的围产期综合不良结局发生率相似（分别为34%和35%;风险比[RR] 0.98，95%置信区间[95%CI] 0.74-1.3）。两组中< 32周的出生率也相似（分别为35%和38%; RR 0.92，95% CI 0.55-1.56）。在围产期死亡率、随机化至分娩间隔或其他特定结局方面，两组间无显著差异。预防性给予三胎妊娠母亲17 OHPc对围产期结局或妊娠持续时间无显著影响。17-己酸羟孕酮对三胎妊娠的结局或持续时间没有显著影响。
Preterm birth complicates almost all triplet pregnancies and no preventive strategy has proven effective. To determine, using individual patient data (IPD) meta-analysis, whether the outcome of triplet pregnancy is affected by prophylactic administration of 17-hydroxyprogesterone caproate (17OHPc). We searched literature databases, trial registries and references in published articles. Randomised controlled trials (RCTs) of progestogens versus control that included women with triplet pregnancies. Investigators from identified RCTs collaborated on the protocol and contributed their IPD. The primary outcome was a composite measure of adverse perinatal outcome. The secondary outcome was the rate of birth before 32 weeks of gestation. Other pre-specified outcomes included randomisation-to-delivery interval and rates of birth at < 24, < 28 and < 34 weeks of gestation. Three RCTs of 17OHPc versus placebo included 232 mothers with triplet pregnancies and their 696 offspring. Risk-of-bias scores and between-study heterogeneity were low. Baseline characteristics were comparable between 17OHPc and placebo groups. The rate of the composite adverse perinatal outcome was similar among those treated with 17OHPc and those treated with placebo (34% and 35%, respectively; risk ratio [RR] 0.98, 95% confidence interval [95% CI] 0.74–1.3). The rate of birth at < 32 weeks was also similar in the two groups (35% and 38%, respectively; RR 0.92, 95% CI 0.55–1.56). There were no significant between-group differences in perinatal mortality rate, randomisation-to-delivery interval, or other specified outcomes. Prophylactic 17OHPc given to mothers with triplet pregnancies had no significant impact on perinatal outcome or pregnancy duration. 17-Hydroxyprogesterone caproate had no significant impact on the outcome or duration of triplet pregnancy.
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