Preterm Delivery Corticosteroids

Last updated 20.09.12

 

Index

 

Definition

-  Administration of IM corticosteroids for potential preterm delivery during pregnancy

-  Single course x2 doses

-  Not currently recommended if multiple gestation

 

Features

-  Single course should be considered routine for preterm deliveries

-  Most units given routinely 23-34/40

-  Benefit between 28-35 (36) weeks

-  No improvement in <28/40 gestations

-  NO increased risk of

-  Maternal death

-  Chorioamnionitis

-  Puerperal sepsis

-  Childhood neurodevelopmental delay

-  Is associated w reduced

-  Neonatal death

-  Best effect if delivered prior to 48hrs after first dose

-  RDS

-  Accelerate foetal lung maturation

-  Preterm infants have quantitative & qualitative def of surfactant predisoposing to RDS

-  Best effect between 24hrs after first dose & 7/7

-  Interventricular haemorrhage

-  Major protective cerbral vasoconstrictive effects

-  NEC

-  Respiratory support: ventilation, CPAP, O2

-  Systemic infections in first 48/24 of life

-  NICU admissions

-  Women more likely to have glucose intolerance

-  Possbile increased insulin resistance in adulthood (of neonate)

-  Evidence less clear for repeat doses

-  Reduced RDS & morbidity

-  NO reduction in mortality

-  Decreased mean body size at birth but no difference on D/C from hospital & early childhood

-  Both Betamethasone & Dexamethasone have been used

-  Betamethasone better effect for reducing RDS

-  More puerperal sepsis but less intraventricular haemorrhage w Dexamethasone

 

Indications

-  Anticipated premature delivery

-  Effective in PPROM & pregnancy related HTN

 

Dose

-  Betamethasone 11.4mg IM x2 doses 24hrs apart

-  Reduces neonatal death even if delivered <24hrs after first dose

-  OR Dexamethasone 6mg IM 12/24 for x4 doses

-  Consult Obstetrician if considering repeat doses 1 week later if women remains at risk for preterm delivery <34/40

 

 

 

References

 

Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth, Cochrane Systematic review, Roberts et al, 2010

Repear doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes, Cochrane review, Crowther et al, 15/06/2011

3 Centres Collaboration, Preterm labour, 10/08/2011