无症状双胎妊娠产妇产前阴道孕酮管理与子宫动脉血流的临床相关性分析
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摘要
目的研究探讨无症状双胎妊娠产妇产前阴道孕酮管理对子宫动脉血流的影响。方法本研究共纳入125例基本特征相似的双胎妊娠孕妇,其中孕酮组64例,安慰剂组61例。对使用孕酮和安慰剂的双胎妊娠产妇进行随机、双盲及安慰剂对照的再分析。双胎妊娠产妇18-34+6孕周期间,通过超声检查对孕妇子宫动脉搏动指数进行评价,对孕酮组和安慰剂组孕妇的平均子宫动脉搏动指数进行比较。同时,研究开始后第3周、6周及第9周对孕酮组和安慰剂组孕妇的平均子宫动脉搏动指数进行比较。结果双胎妊娠产妇8-34+6孕周期间,孕酮组和安慰剂组孕妇的平均子宫动脉搏动指数(PI)值都为0.80±0.25(P=0.95),孕酮组和安慰剂组孕妇各孕周的平均子宫动脉血流没有显著差异(P>0.05);而且,在研究开始后的第3周、6周及第9周,孕酮组和安慰剂组孕妇的平均子宫动脉血流没有显著差异(P>0.05)。结论双胎妊娠产妇在妊娠后半期使用孕酮并不会影响到子宫血液循环。
Objective To evaluate the influence of vaginal progesterone on uterine circulation in asymptomatic twin gestations.Methods This study was a secondary analysis of a randomized,double-blind,placebo-controlled trial of 125 twin pregnancies with similar baseline characters exposed to vaginal progesterone or placebo.During 18-34+6 weeks,the uterine artery pulsatility index was evaluated based on ultrasound examination at the time of randomization,and the mean artery pulsatility index between the progesterone and placeto groups were prepared for each gestational age.Also,the mean uterine artery pulsatility index were analyzed and compared at three,six and nine weeks after randomization.Results During18-34+6 weeks,the mean uterine artery pulsatility index was 0.80±0.25(P=0.96)and no difference in the mean uterine artery pulsatility index was observed between the progesterone and placebo groups at each week of gestation(P>0.05);No difference in the mean uterine artery pulsatility index was observed between the progesterone and placebo groups at three,six and nine weeks after randomization throughout the gestation(P>0.05).Conclusion In twin pregnancies,the use of vaginal progesterone in the second half of pregnancy does not influence uterine circulation.
Objective To evaluate the influence of vaginal progesterone on uterine circulation in asymptomatic twin gestations.Methods This study was a secondary analysis of a randomized,double-blind,placebo-controlled trial of 125 twin pregnancies with similar baseline characters exposed to vaginal progesterone or placebo.During 18-34+6 weeks,the uterine artery pulsatility index was evaluated based on ultrasound examination at the time of randomization,and the mean artery pulsatility index between the progesterone and placeto groups were prepared for each gestational age.Also,the mean uterine artery pulsatility index were analyzed and compared at three,six and nine weeks after randomization.Results During18-34+6 weeks,the mean uterine artery pulsatility index was 0.80±0.25(P=0.96)and no difference in the mean uterine artery pulsatility index was observed between the progesterone and placebo groups at each week of gestation(P>0.05);No difference in the mean uterine artery pulsatility index was observed between the progesterone and placebo groups at three,six and nine weeks after randomization throughout the gestation(P>0.05).Conclusion In twin pregnancies,the use of vaginal progesterone in the second half of pregnancy does not influence uterine circulation.
引文
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[8]伍萍芝.地屈孕酮片联合保胎灵对复发性自然流产患者血管内皮生长因子及.Th1/Th2型细胞因子的影响[J].现代中西医结合杂志,2016,8:879.
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[10]Barda G,Ben-Haroush A,Barkat J,et al.Effect of vaginal progesterone,administered to prevent preterm birth,on impedance to bloodflow in fetaland uterine circulation[J].Ultrasound Obstet Gynecol,2010,36:743.
[11]Brizot ML,Hernandez W,Liao AW,et al.Vaginal progesterone for theprevention of preterm birth in twin gestations:a randomized placebocontrolleddouble-blind study[J].Am J Obstet Gynecol,2015,213:82e1.
[12]Schulman H,Fleischer A,Farmakides G,et al.Development of uterine artery compliance in pregnancy as detected by Doppler ultrasound[J].Am J Obstet Gynecol,1986,155:1031.
[13]Serra V,Perales A,Meseguer J,et al.Increased doses of vaginal progesterone forthe prevention of preterm birth in twin pregnancies:a randomised controlleddouble-blind multicentre trial[J].BJOG,2013,120:50.
[14]Yu CK,Papageorghiou AT,Boli A,et al.Screening for preeclampsiaand fetal growth restriction in twin pregnancies at 23weeks ofgestation by transvaginal uterine artery Doppler[J].Ultrasound Obstet Gynecol,2002,20:535.
[15]Lyall F,Bulmer JN,Kelly H,et al.Human trophoblast invasionand spiral artery transformation:the role of nitric oxide[J].Am J Pathol,1999,154:1105.
[2]韩国平.地屈孕酮治疗先兆流产的临床观察[J].中外女性健康研究,2016,24(6):170.
[3]Di Renzo GC,Mattei A,Gojnic M,et al.Progesterone and pregnancy[J].Curr Opin Obstet Gynecol,2005,17:598.
[4]Romero R.Prevention of spontaneous preterm birth:the role of sonographiccervical length in identifying patients who may benefit from progesteronetreatment[J].Ultrasound Obstet Gynecol,2007,30:675.
[5]Kumar P,Magon N.Hormones in pregnancy[J].Niger Med J,2012,53:179.
[6]Habara T,Nakatsuka M,Konishi H,et al.Elevated bloodflow resistance in uterine arteries of women with unexplained recurrentpregnancy loss[J].Hum Reprod,2002,17:190.
[7]余静,杨志军.阴道彩超联合血清β-HCG、孕酮检测在宫内妊娠与异位妊娠鉴别诊断中的价值[J].西南军医,2014,16(2):151.
[8]伍萍芝.地屈孕酮片联合保胎灵对复发性自然流产患者血管内皮生长因子及.Th1/Th2型细胞因子的影响[J].现代中西医结合杂志,2016,8:879.
[9]Czajkowski K,Sienko J,Mogilinski M,et al.Uteroplacental circulation in early pregnancy complicated by threatenedabortion supplemented with vaginal micronized progesterone or oraldydrogesterone[J].Fertil Steril,2007,87:613.
[10]Barda G,Ben-Haroush A,Barkat J,et al.Effect of vaginal progesterone,administered to prevent preterm birth,on impedance to bloodflow in fetaland uterine circulation[J].Ultrasound Obstet Gynecol,2010,36:743.
[11]Brizot ML,Hernandez W,Liao AW,et al.Vaginal progesterone for theprevention of preterm birth in twin gestations:a randomized placebocontrolleddouble-blind study[J].Am J Obstet Gynecol,2015,213:82e1.
[12]Schulman H,Fleischer A,Farmakides G,et al.Development of uterine artery compliance in pregnancy as detected by Doppler ultrasound[J].Am J Obstet Gynecol,1986,155:1031.
[13]Serra V,Perales A,Meseguer J,et al.Increased doses of vaginal progesterone forthe prevention of preterm birth in twin pregnancies:a randomised controlleddouble-blind multicentre trial[J].BJOG,2013,120:50.
[14]Yu CK,Papageorghiou AT,Boli A,et al.Screening for preeclampsiaand fetal growth restriction in twin pregnancies at 23weeks ofgestation by transvaginal uterine artery Doppler[J].Ultrasound Obstet Gynecol,2002,20:535.
[15]Lyall F,Bulmer JN,Kelly H,et al.Human trophoblast invasionand spiral artery transformation:the role of nitric oxide[J].Am J Pathol,1999,154:1105.