双胎妊娠指南(草稿)PPT课件

善妊娠结局。? ? (Miller, E.S, 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)Р问题9: 孕酮可以预防双胎妊娠的早产发生吗?Р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.)(Ⅱa/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.) (Ⅱa/Ⅲ)