Antenatal steroid

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Antenatal steroid
SpecialtyOB/GYN

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]

The effectiveness of antenatal corticosteroids in preventing neonatal hyaline membrane disease and reducing mortality in premature infants was first demonstrated by Sir Graham Liggins and Ross Howie in 1972.[3]

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).[4] They are also less likely to have (bleeding on the brain) intraventricular hemorrhage,[5][6] NEC, or systemic infections (infections affecting the whole body) in the first two days of their life.[7] Steroids do not appear to increase the number of women who develop infection of the fetal membranes (chorioamnionitis) or of the womb (endometritis);[8] 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.[9]

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[10] in spite of some counter-logic.[11] Betamethasone, on the other hand, is preferred over dexamethasone because it is thought to have better prophylaxis of brain softening of premature fetus,[12] they are used with the intention to help the lungs of a premature fetus develop before the fetus comes out.[13] 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.[14][15] Antenatal steroids are currently used up to 36 weeks in some parts of the world obstetric practice.[16]

The time between administration of steroids and delivery may alter the effectiveness of the steroids.[17]

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 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. ^ Liggins, GC; Howie, RN (October 1972). "A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants". Pediatrics. 50 (4): 515–525. PMID 4561295.
  4. ^ 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. doi:10.1002/14651858.CD004454.pub3. PMC 6464568. PMID 28321847.
  5. ^ 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.
  6. ^ 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.
  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. doi:10.1002/14651858.CD004454.pub3. PMC 6464568. 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. doi:10.1002/14651858.CD004454.pub3. PMC 6464568. PMID 28321847.
  9. ^ 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. doi:10.1002/14651858.CD004454.pub3. PMC 6464568. PMID 28321847.
  10. ^ "Dexamethasone versus betamethasone as an antenatal corticosteroid (ACS)" (PDF). UN Commission / Born Too Soon Care Antenatal Corticosteroids Working Group. August 20, 2013. Archived from the original (PDF) on 6 January 2014. Retrieved 6 January 2014.
  11. ^ 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.
  12. ^ "Antenatal Steroid Video".
  13. ^ 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.
  14. ^ "Recommendations for Use of Antenatal Corticosteroids". Perinatology.com. Retrieved 6 January 2014.
  15. ^ "Medscape Obstetrics".(subscription required)
  16. ^ "UK National Health Service". Archived from the original on 2012-09-03.
  17. ^ 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]