2024基于 Delphi 法达成中国单胎早产防治专家共识要点.docx

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1、2024基于De1phi法达成中国单胎早产防治专家共识要点在母胎医学杂志(英文)2023年第4期中，胡娅莉教授及杨慧霞教授团队共同发表了题为基于De1phi法达成中国单胎早产防治专家共识的论著文章。本研究通过两轮德尔菲调查确定需要纳入更新版中国早产防治指南的建议的49个条目，为指南的正式制定奠定了基础。摘要如下：目的ObjeCtiVe本研究旨在就中国单胎早产防治达成产科专家共识。方法检索国内外关于单胎早产防治的循证文献，并以2014版早产临床诊断与治疗指南为基础初步拟定包括早产定义、早产高危因素排除、早产的预防和预测、早产的治疗、早产干预结局的评估5个方面的调蛰问卷。中华医学会妇产科学分会产科

2、学组全体41名产科专家组成本次调查的专家组共组织两轮匿名专家调查和一次线上专家讨论会。平均得分,总分，满分比和最低分占比用来反映专家意见的集中程度，变异系数和Kenda11W系数用来反映专家意见的协调程度。结果两轮专家咨询调查有效问卷回收率均为100%(41/41)o首轮调查专家在早产防治的5个方面36个条目达成共识，第二轮调查专家对余下的13个条目进一步达成共识。最终共有49个条目在本指南中明确纳入形成推荐意见(平均得3分，满分比20%,变异系数O.3),余下3个临床问题未达成共识需根据证据质量待定。两轮调查专家协调系数分别为020(P0.001)和0.29(P0.001)。结论Conc1u

3、sion本研究通过两轮德尔菲调杳确定需要纳入更新版中国早产防治指南的建议的49个条目，为指南的正式制定奠定了基础。例如原指南中早产下限是28足周，本次调查中最新专家共识为下限值28足周，但增加征得产妇及家属同意，积极救治26周的有生机儿。相关条目Resu1tsofthefirst-roundDe1phisurvey(definitionofpretermbirthandhigh-riskfactorsforpretermbirth,n=41).StatementsmeanCVSR(%)K(%)ParttDefinitionofpreternibrth1.The1owerIimitis28ges

4、tationa1weeks,butWiththe2.500.381037(17.1)7(17.1)consentofthemotherandherfami1y,donotgiveuponthetreatmentofvab1einfants22gestationa1weeksisadded.2.Modifythe1ower1imitto26gestationa1weeks.2.370.479710(24.4)10(24.4)3.Modifythe1ower1imitto24gestationa1weeks.2.070.408512(29.1)1(2.4)f4.Modifythe1ower1imi

5、tto20gestationa1weeks.1.170.304834(82.9)0(0.0)Part2.High-riskfactorsforpretermbirth*1.Attentiof1shou1dbepaidtohigh-riskfactorsforpreterm3.10.281284(9.8)14(34.2)birthduringpre-pregnancyconsu1tationandprenata1check-upsIotear1yprevention.2.Iatrogenicpretermbirthaccountsfora1argeProPOrtk)nof3.00.161220(

6、0.0)4(9.8)pretermbirthsinourcounty,especia11y1atepretermbirth.Indicatestatconsensushasbeenreachedonthsstatement.!Indicatesthatthisstatementmeetstheexdusicncriteria.CV:Coefficientofvaraton;K:PercentageOffuRscore;R:Perceii1aged1owestscore;S:sumdscores.Tab1e2Resu1tsofthefirst-roundDe1phisurvey(predicti

7、onandpreventionofpretermbirth,n=41).StatementsPart3.Predictionandpreventionofpretermbirth1. Preventivemeasurestoreducepretermbirth* a.Reducemu1tip1epregnancies* b.Quitsmoking* c.Strict1ygrasptheindicatorsforear1yterminationofpregnancytoreduceiatrogenicpretermbirths.* d.Reduceunnecessaryassistedrepro

8、ductivetechno1ogypregnancies.* e.Reducecervica1injurybeforepregnancy(suchascervica1conization,repeatedintrauterineoperations).* .Routinescreeningandtreatmentofbacteria1vaginosisisnotrecommended.* .Rtinesaeeigandtreatmentofasymptomaticbacteriuriaisnotrecommended.* h.Abso1utebedrestisnotremmendedforth

9、osewithhighriskfactorsforpretermbirth.2. Forthosewithouthigh-riskfactorsforpretermbirth,itisrecommendedtoinitia11yobservethecervica1shapeand1engththroughabdomina1u1trasoundwhenseeingforfeta1structureinthemid-pregnancy.IfCefViCa1abnorma1ityissuspectedduringabdomina1u1trasdexamination,thecervica11engt

10、hshou1dbemeasuredbytransvagina1u1trasound.3. .Forthosewithahistoryof1atemiscarriageorpretermbirth,itisrecommendedtomeasurethecervica11engthbytransvagina1u1trasoundstartingfromte16,hgestationa1weekandobservedynamica11y(16-24).Dependingonindividua1condition,re-examinationevery1-4weeksunti1the24tf1week

11、.4. ReCOmmendatiOnSaboutcervica1cerc1age* .Ifthereisahistoryof3timesofpretermbirthor1atemiscarriage,preventivecevica1cerc1agecanbeperformedat12-14weeksofthispregnancy.* .Ifthereisahistoryofspontaneouspretermbirthor1atemiscarriageduetocervica1incompetenceinthepreviouspregnancy,andthecervixisshortened

12、inthemid-termofthispregnancy(cervix25mm),besidestheaboverecommendationofusingmicronizedprogesteroneornatura1progesteronevagina1ge1throughthevagina,cervica1cerc1agecana1soberecommended.* c.Forthosewithpain1esscervica1di1ationinmid-pregnancy,intactfeta1membranes,andnoOmiOUSChorioaninionitisorp1acenta1

13、abruption,whicharecontraindicationsforcontinuingpregnancy,itisrecommendedtoperformemergencycervica1cerc1age.* d.Duringemergencycerdagesurgery,antibioticsthatcoveraerobic/anaerobicbacteriaandmycop1asmaaregiven.* e.Duringemergencycerdagesurgery,toco1yticaregiven.* f.Beforeperformingcervica1cerc1age,co

14、ntraindicationssuchasChorioamnionitis,p1acetaiabruption,pretermruptureofmembranes,feta1distress,andSeverefeta1abnorma1itiesorfetaideatshou1dberi1edout.* g.Thefirst-1inerecommendationforcervica1cerc1ageistheMacDona1dmethod.* h.Abdomina1cerc1ageisnotrecommendedasafirst-1inesurgica1method.Itison1ysuita

15、b1eforthosewhohavefai1edvagina1cerc1age,orthosewhocannotundergovagina1cerc1age.IndicatesthatconsensushasbeenreachedonthisstatementCV：Coeffidentofvariation；K：Perceteoffd1score；R：PercentageofIOWeStscore；S:sumofsces39413427379576207633333ZZ322.683.0.4430690977721 1. 1 2 1 1 2 1 3Sci0.0.CiCi0.0.0.21 0.27220.19 0.16 0.1190.1 72 1 0.0.2灯。4 25 13A3 3 4 3 3 3 2 13 12710222331312538川6GG5&G印 Q。o(2.(2o (2.(9. 0001103143 (7.36 4。(2.O 116(39.0)18(43.9)18(43.9)15(36.6)18(43.9)4(9.8)4(9.8)10