Antenatal steroid

Antenatal steroids (or antenatal corticosteroids) are medications given to pregnant women expecting preterm delivery. They have been shown to reduce the morbidity and mortality of hyaline membrane disease.[1] They have also been shown to have definite beneficial effect even in conditions of preterm premature rupture of membranes (PPROM).[2] Dexamethasone and betamethasone are the corticosteroids used for the purpose although the former is recommended over the latter based on its efficacy, safety, wide availability, and low cost[3] in spite of some counter-logic.[4] Betamethasone, on the other hand, is preferred over dexamethasone because it is thought to have better prophylaxis of brain softening of premature fetus.[5] They are used with the intention to help the lungs of a premature fetus develop before the fetus comes out.[6] They are given when the fetus is expected to be delivered within 24 to 48 hours. Treatment consists of 2 doses of 12 mg of betamethasone given intramuscularly 24 hours apart or 4 doses of 6 mg of dexamethasone given intramuscularly 12 hours apart. Optimal benefit begins 24 hours after initiation of therapy and lasts 7 days.[7][8] Antenatal steroids are currently used up to 36 weeks in some parts of the world obstetric practice.[9]

It may also reduce risk of intraventricular hemorrhage.[10][11]

The time between administration of steroids and delivery may alter the effectiveness of the steroids.[12]

References

  1. ↑ Mwansa-Kambafwile, J.; Cousens, S.; Hansen, T.; Lawn, J. E. (26 March 2010). "Antenatal steroids in preterm labour for the prevention of neonatal deaths due to complications of preterm birth". International Journal of Epidemiology 39 (Supplement 1): i122–i133. doi:10.1093/ije/dyq029. PMC 2845868. PMID 20348115.
  2. ↑ Vidaeff, AC; Ramin, SM (Jun 2011). "Antenatal corticosteroids after preterm premature rupture of membranes". Clinical obstetrics and gynecology 54 (2): 337–43. doi:10.1097/GRF.0b013e318217d85b. PMID 21508704.
  3. ↑ "Dexamethasone versus betamethasone as an antenatal corticosteroid (ACS)" (PDF). UN Commission / Born Too soon Care Antenatal Corticosteroids Working Group. August 20, 2013. Retrieved 6 January 2014.
  4. ↑ Lee, BH (1 May 2006). "Adverse Neonatal Outcomes Associated With Antenatal Dexamethasone Versus Antenatal Betamethasone". Pediatrics 117 (5): 1503–1510. doi:10.1542/peds.2005-1749. PMID 16651303.
  5. ↑ "Antenatal Steroid Video".
  6. ↑ Engle WA (February 2008). "Surfactant-replacement therapy for respiratory distress in the preterm and term neonate". Pediatrics 121 (2): 419–32. doi:10.1542/peds.2007-3283. PMID 18245434.
  7. ↑ "Recommendations for Use of Antenatal Corticosteroids". perinatology.com. Retrieved 6 January 2014.
  8. ↑ "Medscape Obstetrics".(subscription required)
  9. ↑ "UK National Health Service".
  10. ↑ Abbasi S, Oxford C, Gerdes J, Sehdev H, Ludmir J (January 2010). "Antenatal Corticosteroids Prior to 24 Weeks' Gestation and Neonatal Outcome of Extremely Low Birth Weight Infants". Am J Perinatol 27 (1): 61–66. doi:10.1055/s-0029-1223269. PMID 19544249.
  11. ↑ Ment, LR; Oh, W; Ehrenkranz, RA; Philip, AG; Duncan, CC; Makuch, RW (Mar 1995). "Antenatal steroids, delivery mode, and intraventricular hemorrhage in preterm infants.". American Journal of Obstetrics and Gynecology 172 (3): 795–800. doi:10.1016/0002-9378(95)90001-2. PMID 7892866.
  12. ↑ McEvoy C, Schilling D, Spitale P, Peters D, O'Malley J, Durand M (May 2008). "Decreased respiratory compliance in infants less than or equal to 32 weeks' gestation, delivered more than 7 days after antenatal steroid therapy". Pediatrics 121 (5): e1032–8. doi:10.1542/peds.2007-2608. PMID 18450845.

Further reading


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