Scientific basis for the content of routine antenatal care .2. Power to eliminate or alleviate adverse newborn outcomes; Some special conditions and examinations
Scientific basis for the content of routine antenatal care .2. Power to eliminate or alleviate adverse newborn outcomes; Some special conditions and examinations
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DOI：
10.3109/00016349709047779
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发表时间：
1997-01-01
影响因子：
4.3
通讯作者：
Villar, J
中科院分区：
文献类型：
--
作者：
Bergsjo, P;Villar, J
背景产前保健能否作为消除或减轻新生儿不良后果的一种手段还存在不确定性。我们确定了先天性疾病、宫内感染、宫内发育迟缓、早产和母亲的一些特定传染病，以期采取预防和其他干预措施。一些特殊的诊断工具的价值也在讨论中。回顾近期文献，特别是随机对照试验和系统评价。结果和结论。遗传异常在受孕后无法预防，但其中许多和一些后天性疾病可以通过超声和生化诊断发现。筛查的可行性必须根据流行率、治疗方案和堕胎的法律的要求，在当地确定。吸烟、过量饮酒和严重的营养不良会导致胎儿发育迟缓。减少母亲吸烟的干预措施成效有限。补充蛋白质能量对出生体重的影响不大。子宫高度的常规测量是一个很好的预测严重的生长迟缓和在农村设置的围产期死亡。早产与上行感染和随后的胎膜破裂有关。根除局部感染的尝试已经显示出一些好处，但结果尚不令人信服。宫颈环扎术和β-兴奋剂几乎没有效果。应支持减轻工作时身体紧张（站立超过5小时）的主张。母亲的肺结核应该被发现和治疗。怀孕期间的疟疾预防将保护母亲，并可能有益于胎儿。对所有母亲进行适当的破伤风免疫接种是发展中国家的一项高度优先干预措施。在HIV阳性母亲中，产前和围产期使用齐多夫定可显著降低围产期HIV传播。风险评分可能有助于确定一些妇女转介到更高级别的护理。常规超声检查不能改善妊娠结局（活产率和发病率），但可能通过发现和流产重大畸形胎儿而影响死亡率。建议在怀孕期间进行一次阴道检查，但除非有医学指征，否则不要重复检查。
Background. There is uncertainty concerning antenatal care as a tool to eliminate or alleviate adverse outcomes in the newborn. We identified congenital conditions, intrauterine infections, intrauterine growth retardation, preterm birth and some specific infectious diseases in the mother with a view to prophylactic and other interventions. The value of some special diagnostic tools is also under discussion.Methods. Review of recent literature, especially randomized controlled trials and systematic reviews.Results and conclusions. Genetic abnormalities cannot be prevented after conception, but many of them, and a number of acquired conditions, can be discovered by ultrasonographic and biochemical diagnostics. The advisability of screening must be determined locally for each condition, based on prevalence, treatment options and the legal requirements for abortion. Smoking, excessive alcohol intake, and severe undernutrition cause fetal growth retardation. Interventions to reduce maternal smoking have had limited success. Protein-energy supplementation only modestly affects birthweight. Routine measurement of uterine height is a good predictor of severe growth retardation and in rural settings of perinatal death. Preterm birth has been linked to ascending infection and subsequent rupture of the membranes. Attempts to eradicate local infections have shown some benefit but results are not convincing yet. Cervical cerclage and betamimetic drugs have little, if any, effect. Claims for reduction of physical strain (standing >5 hours) at work should be supported. Tuberculosis in the mother should be discovered and treated. Malaria prophylaxis during pregnancy will protect the mother and possibly benefit the fetus. Adequate tetanus immunization of all mothers is a high priority intervention in developing countries. In HIV-positive mothers, Zidovudine ante- and perinatally will lower perinatal HIV-transmission significantly. Risk scoring may help identify some women for referral to higher level of care. Routine ultrasonography does not improve the outcome of pregnancy in terms of live births and morbidity, but may influence mortality through discovery and abortion of fetuses with major malformations. One vaginal examination during pregnancy is recommended but no repeat procedure unless medically indicated.