Estrategias de manejo en la amenaza de parto prematuro: evaluación de la eficacia de intervenciones farmacológicas (nifedipino y progesterona) y no farmacológicas (cerclaje cervical y pesario) para la prevención y tratamiento. Una revisión sistemática
Resumen
La prematuridad es la principal causa de mortalidad en menores de cinco años. Esta investigación evaluó la efectividad de intervenciones farmacológicas (nifedipino, progesterona) y no farmacológicas (cerclaje, pesario) para la prevención y manejo de la amenaza de parto pretérmino. Se realizó una revisión sistemática en PubMed (2020-2025) siguiendo las guías PRISMA y registro PROSPERO (CRD420251039893). Se incluyeron 32 estudios, entre ensayos clínicos aleatorizados y estudios de casos y controles, seleccionados de forma independiente mediante la herramienta Rayyan. Como principales resultados, el nifedipino es el tocolítico de elección para la fase aguda. La progesterona vaginal es fundamental en gestaciones únicas con cuello corto (<25 mm), mientras que el cerclaje demuestra superioridad en casos de alto riesgo o insuficiencia cervical. El pesario mostró resultados clínicos inconsistentes e inferiores. La terapia secuencial (nifedipino seguido de progesterona) prolongó significativamente la latencia gestacional. Como limitante existe una alta variabilidad en los protocolos y dosis de los estudios, además de disparidad en los recursos hospitalarios de los países analizados. En conclusión, el manejo debe ser personalizado según el riesgo individual y la longitud cervical. Se destaca el uso de probióticos como medida coadyuvante para proteger la integridad intraamniótica.
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Derechos de autor 2026 Nataly Susana Urgilez Gutiérrez, Jhomira Patricia Medina Cambizaca, María Elizabeth Heras Crespo
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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