Antenatal steroids for preterm labor

When the diagnosis of IUGR has been established, it is helpful to determine a specific etiology. Therapy may be nonspecific but should try to address the underlying cause. Many infants thought to be growth-retarded are, in retrospect, found to be constitutionally small. The key management issues are the gestational age of the pregnancy at the time of diagnosis and the urgency to expedite delivery. Most fetal deaths involving IUGR occur after 36 weeks of gestation and before labor begins. 1 The clinician must balance the risk of delivering a premature infant against the potential for intrauterine demise.

Recent data also suggest that betamethasone can be beneficial in pregnant women at high risk of late preterm birth, between 34 0/7 weeks and 36 6/7 weeks of gestation who have not received a prior course of antenatal corticosteroids. The Maternal Fetal Medicine Units (MFMU) Network Antenatal Late Preterm Steroids trial ( 24 ) was a double-blind, placebo-controlled, randomized clinical trial designed to evaluate the use of antenatal betamethasone for pregnant women at high risk of delivery in the late preterm period. Women were identified to be at high risk if they presented in preterm labor, had preterm PROM, or if they had a planned delivery in the late preterm period, with the indication at the discretion of the obstetrician–gynecologist or other health care provider. Tocolysis was not employed as a part of this trial, and delivery was not delayed for obstetric or medical indications. The study found that the administration of betamethasone led to a significant decrease in the primary outcome, which was the need for respiratory support. A larger decrease was demonstrated for severe respiratory complications, from % in the placebo group to % in the betamethasone group (RR, ; 95% CI, –; P <.001). There were also significant decreases in the rates of transient tachypnea of the newborn; bronchopulmonary dysplasia; a composite of respiratory distress syndrome (RDS), transient tachypnea of the newborn and RDS; and the need for postnatal surfactant. Infants exposed to betamethasone were less likely to require immediate postnatal resuscitation. There was no increase in proven neonatal sepsis, chorioamnionitis, or endometritis with late preterm betamethasone. Hypoglycemia was more common in the infants exposed to betamethasone % versus % (RR, ; 95% CI, –); however, there were no reported adverse events related to hypoglycemia, which was not associated with an increased length of hospital stay. The rates of hypoglycemia found in the trial are similar to what is reported in the general population of late preterm infants ( 25 ). Although not studied in this trial, long-term adverse outcomes of prolonged and persistent neonatal hypoglycemia have been described ( 26 , 27 ). In order to reduce this risk and achieve the benefits of betamethasone therapy for fetal maturity in late preterm pregnancies, the American Academy of Pediatrics’ guidelines should be followed when employing this therapy (27). The American Academy of Pediatrics recommends the monitoring of neonatal blood sugars for late preterm infants because late preterm birth is a known risk factor for hypoglycemia. A single course of betamethasone is recommended for pregnant women between 34 0/7 weeks and 36 6/7 weeks of gestation at risk of preterm birth within 7 days, and who have not received a previous course of antenatal corticosteroids (24, 28 ).

There is also data showing that antibiotics are helpful during preterm labor for women who carry bacteria called group B streptococcus (GBS). About one in five women will carry GBS, and babies who get infected during labor and delivery can become very sick. Antibiotics can treat GBS and reduce complications of a subsequent infection in the newborn, but carry risks for the mother ( Ohlssen & Shah, 2009 ). Most care providers test women for the bacteria about a month before their due date. The test involves taking swab samples from the lower vagina and rectum. Because it can take two or three days for test results to be returned, the general practice is to go ahead and begin treating a woman for GBS before confirmation of infection if a woman is in preterm labor. Most doctors think that this presumptive treatment is justified because as many as one in four women test positive for GBS. Ampicillin and penicillin are the antibiotics most commonly used for treatment.

Antenatal steroids for preterm labor

antenatal steroids for preterm labor

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