臨床婦人科産科71巻1号

2017年01月発行

合併増大号　今月の臨床 性ステロイドホルモン研究の最前線と臨床応用

臨床各論 : 使い方の実際

切迫流早産

著者： 中井章人¹

所属機関： ¹日本医科大学多摩永山病院産婦人科

ページ範囲：P.83 - P.89

文献概要

●規則的な子宮収縮に加え，出血，破水，進行性の頸管変化を有する厳密な定義に従った切迫早産には，黄体ホルモン療法は奏効しない．

●早産既往妊婦では，妊娠16週以降の17-OHPCの筋肉内注射（250mg/週），頸管短縮例（≦25mm）では，天然型プロゲステロン腟錠（連日200mg）投与が効果的である．

●本邦では17-OHPCは125mg/週までが保険適応範囲で，天然型プロゲステロン腟錠は承認薬だが，薬価未収載，かつ切迫流早産は適応症外という問題がある．

参考文献

1）Meis PJ, et al : National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network : Prevention of recurrent preterm delivery by 17-alpha-hydroxyprogesterone caproate. N Engl J Med 348 : 2379─2385, 2003

2）Fonseca EB, et al : Fetal Medicine Foundation Second Trimester Screening Group : Progesterone and the risk of preterm birth among women with a short cervix. N Engl J Med 357 : 462─469, 2007

3）Johnson JW, et al : Efficacy of 17-alpha-hydroxyprogesterone caproate in the prevention of premature labor. N Engl J Med 293 : 675─680, 1975

4）Yemini M, et al : Prevention of premature labor by 17 alpha-hydroxyprogesterone caproate. Am J Obstet Gynecol 151 : 574─577, 1985

5）Saghafi N, et al : Efficacy of 17α-hydroxyprogesterone caproate in prevention of preterm delivery. J Obstet and Gynaecol Res 37 : 1342─1345, 2011

6）Majhi P, et al : Intravaginal use of natural micronised progesterone to prevent pre-term birth : a randomised trial in India. Am J Obstet Gynaecol 29 : 493─498, 2009

7）Cetingoz E, et al : Progesterone effects on preterm birth in high-risk pregnancies : a randomized placebo-controlled trial. Arch Gynecol Obstet 283 : 423─429, 2011

8）Fonseca EB, et al : Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk : a randomized placebo-controlled double-blind study. Am J Obstet Gynecol 188 : 419─424, 2003

9）O'Brien JM, et al : Progesterone vaginal gel for the reduction of recurrent preterm birth : primary results from a randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol 30 : 687─696, 2007

10）O'Brien JM, et al : Progesterone Vaginal Gel Study Group : Effect of progesterone on cervical shortening in women at risk for preterm birth : secondary analysis from a multinational, randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol 34 : 653─659, 2009

11）Maher MA, et al : Prevention of preterm birth : a randomized trial of vaginal compared with intramuscular progesterone. Acta Obstet Gynecol Scand 92 : 215─222, 2013

12）Grobman WA, et al : Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units（MFMU） Network : 17 Alpha-Hydroxyprogesterone caproate to prevent prematurity in nulliparas with cervical length less than 30mm. Am J Obstet Gynecol 207 : 390. e1─8, 2012

13）Winer N, et al : Groupe de Recherche en Obstétrique et Gynécologie : 17 alpha-hydroxyprogesterone caproate does not prolong pregnancy or reduce the rate of preterm birth in women at high risk for preterm delivery and a short cervix : a randomized controlled trial. Am J Obstet Gynecol 212 : 485. e1─10, 2015

14）Van Os MA, et al : Preventing preterm birth with progesterone in women with a short cervical length from a low-risk population : a multicenter double-blind placebo-controlled randomized trial. Am J Perinatol 32 : 993─1000, 2015

15）Hassan SS, et al : PREGNANT Trial : Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix : a multicenter, randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol 38 : 18─31, 2011

16）Tan PC, et al : Single dose 17 alpha-hydroxyprogesterone caproate in preterm labor : a randomized trial. Arch Gynecol Obstet 285 : 585─590, 2012

17）Nablot G, et al : The use of micronized progesterone in the treatment of menace of preterm delivery. Eur J Obstet Gynecol Reprod Biol 40 : 203─209, 1991

18）Facchinetti F, et al : Cervical length changes during preterm cervical ripening : effects of 17-α-hydroxyprogesterone caproate. Am J Obstet Gynecol 196 : 453. e1─4, 2007

19）Borna S, et al : Progesterone for maintenance tocolytic therapy after threatened preterm labour : A randomised controlled trial. Aust N Z J Obstet and Gynaecol 48 : 58─63, 2008

20）Fuchs F, et al : Treatment of threatened premature labor with large dose of progesterone. Am J Obstet Gynecol 79 : 172─176, 1960

21）Arikan I, et al : Effect of progesterone as a tocolytic and in maintenance therapy during preterm labor. Gynecol Obstet Invest 72 : 269─273, 2011

22）Aboulghar MM, et al : The use of vaginal natural progesterone for prevention of preterm birth in IVF/ICSI pregnancies. Reprod Biomed Online 25 : 133─138, 2012

23）中井章人 : 早産─ワンランク上の予防と管理，抗菌薬の選択．臨産婦65 : 1458─1463, 2011

24）中井章人 : 周産期診療指針2010，前回早産妊婦の診察．周産期医40 : 131─134, 2010