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Recommendations for Use of Antenatal Corticosteroids [2]
" - The benefits of antenatal administration of corticosteroids to fetuses at
risk of preterm delivery vastly outweigh the potential risks. These benefits
include not only a reduction in the risk of RDS but also a substantial
reduction in mortality and IVH.
- All fetuses between 24 and 34 weeks' gestation at risk of preterm delivery
should be considered candidates for antenatal treatment with corticosteroids.
- The decision to use antenatal corticosteroids should not be altered by fetal
race or gender or by the availability of surfactant replacement therapy.
- Patients eligible for therapy with tocolytics should also be eligible for
treatment with antenatal corticosteroids.
- Treatment consists of two doses of 12 mg of betamethasone given
intramuscularly 24 hours apart or four doses of 6 mg of dexamethasone given
intramuscularly 12 hours apart. Optimal benefit begins 24 hours after
initiation of therapy and lasts 7 days.
- Because treatment with corticosteroids for less than 24 hours is still
associated with significant reductions in neonatal mortality, RDS, and IVH,
antenatal corticosteroids should be given unless immediate delivery is
anticipated.
- In preterm premature rupture of membranes at less than 30 to 32 weeks'
gestation in the absence of clinical chorioamnionitis, antenatal corticosteroid
use is recommended because of the high risk of IVH at these early gestational
ages.
- In complicated pregnancies where delivery prior to 34 weeks' gestation is
likely, antenatal corticosteroid use is recommended unless there is evidence
that corticosteroids will have an adverse effect on the mother or delivery is
imminent."
- Any actively tocolysed patient.[1]
- EGA > 34 weeks in the presence of an immature lung profile.[2]
Treatment:
-
Betamethasone 12 mg IM q 24 h X 2 doses OR
- Dexamethasone 6 mg IM q 12 h X 4 [2]
If betamethasone and dexamethasone are not available, hydrocortisone 500mg given IV q12h x 4 doses may help to reduce the incidence of repiratory distress syndrome [3,4].
REFERENCES:
1.ACOG Committee Opinion Committee on Obstetric Practice Number 210, October 1998 Antenatal Corticosteroid Therapy for Fetal Maturation
2.NIH
Consensus Statement Effect of Corticosteroids for Fetal
Maturation on Perinatal Outcomes1994 Feb 28-Mar 2;12(2):1-24
3. Morrison JC, Whybrew WD, Bucovaz ET, Schneider JM. Injection of corticosteroids into mother to prevent neonatal respiratory distress syndrome. Am J Obstet Gynecol 131:358,1978.
MEDLINE
4. Morrison JC, Schneider JM, Whybrew WD, Bucovaz ET. Effect of corticosteroids and Fetomaternal disorders on the L:S ratio. Obstet Gynecol 56:583, 1980
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