Antenatal steroid

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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]

Current evidence suggests that giving antenatal corticosteroids reduces late miscarriages and baby deaths. The baby is also less likely to have respiratory distress syndrome (difficulty breathing), or need assistance breathing (mechanical ventilation).[3] They are also less likely to have (bleeding on the brain) intraventricular hemorrhage [4][5], NEC, or systemic infections (infections affecting the whole body) in the first two days of their life.[6] Steroids do not appear to increase the number of women who develop infection of the fetal membranes (chorioamnionitis) or of the womb (endometritis).[7] This research evidence is mostly from mid- to high-income countries. However, there is not a lot of research into giving antenatal corticosteroids to women in low-income countries where infections are more common. More research is needed to find out the effects of these steroids on women and babies in low-income countries.[8]

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[9] in spite of some counter-logic.[10] Betamethasone, on the other hand, is preferred over dexamethasone because it is thought to have better prophylaxis of brain softening of premature fetus.[11] They are used with the intention to help the lungs of a premature fetus develop before the fetus comes out.[12] 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.[13][14] Antenatal steroids are currently used up to 36 weeks in some parts of the world obstetric practice.[15]

The time between administration of steroids and delivery may alter the effectiveness of the steroids.[16]

References[edit]

  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 2845868Freely accessible. 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. ^ Roberts, D; Brown, J; Medley, N; Dalziel, SR (21 March 2017). "Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.". The Cochrane database of systematic reviews. 3: CD004454. PMID 28321847. 
  4. ^ 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. 
  5. ^ 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. 
  6. ^ Roberts, D; Brown, J; Medley, N; Dalziel, SR (21 March 2017). "Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.". The Cochrane database of systematic reviews. 3: CD004454. PMID 28321847. 
  7. ^ Roberts, D; Brown, J; Medley, N; Dalziel, SR (21 March 2017). "Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.". The Cochrane database of systematic reviews. 3: CD004454. PMID 28321847. 
  8. ^ Roberts, D; Brown, J; Medley, N; Dalziel, SR (21 March 2017). "Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.". The Cochrane database of systematic reviews. 3: CD004454. PMID 28321847. 
  9. ^ "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. 
  10. ^ 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. 
  11. ^ "Antenatal Steroid Video". 
  12. ^ 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. 
  13. ^ "Recommendations for Use of Antenatal Corticosteroids". perinatology.com. Retrieved 6 January 2014. 
  14. ^ "Medscape Obstetrics". (subscription required)
  15. ^ "UK National Health Service". 
  16. ^ 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[edit]