医学课件--双胎妊娠指南草稿

P.V Rajan and w.A. Grobman, es after physical examination- indicated cerclage in twin gestations. Am J Obstet Gynecol, 2014. 211(1):p. 46.e1-5 ) 问题 9:孕酮可以预防双胎妊娠的早产发生吗? 推荐孕酮制剂无论阴道给药或者肌肉注射均不能改变早产结局( B) ? 24-31 周宫颈长度< 25 mm 无症状双胎孕妇随机对照研究,用肌注孕激素治疗 2周,其用药至分娩时间两组间无统计学差异。(Senat MV, Porcher R, Winer N, et al. Prevention of preterm delivery by 17 alpha- hydroxyprogesterone caproate in asymptomatic twin pregnancies with a short cervix: a randomized controlled trial. Am J Obstet Gynecol. 2013 Mar;208(3):194.e1-8.) (Ⅱ a/Ⅲ) ? 671 名宫颈进行性缩短的双胎妊娠孕妇进行多中心研究, 使用孕酮组宫颈每周缩短 1.04 mm ,而对照组 1.11 mm ,两组比较无统计学差异,因此宫颈缩短与孕酮应用不显著关系。(Lim AC, Schuit E, Papatsonis D,et al. Effect of 17-alpha hydroxyprogesterone caproate on cervical length in twin pregnancies. Ultrasound Obstet Gynecol. 2012 Oct;40(4):426-30.) (Ⅱ a/Ⅲ)