2022 43 Antenatal Corticosteroids

Question 1

** How long before preterm birth should antenatal corticosteroids be given? **

Answer 1

Within 7 days
Some benefit even within 24 hours

Question 2

** What are the benefits of corticosteroids? **

Answer 2

For baby, reduces:
Perinatal death
Neonatal death
Respiratory distress syndrome
For mother, no direct benefit

Question 3

** For planned CS between 37+0 & 38+6, what are the risks & benefits of steroids? **

Answer 3

Pro: may reduce NNU resp admission
Neut: uncertain if reduction in RDS, TTN, overall NNU admission
Con: hypoglycaemia, potential developmental delay

Question 4

** When should antenatal corticosteroids be offered? **

Answer 4

24+0 to 34+6
Established preterm labour
PPROM
Planned preterm birth

Question 5

** When should antenatal corticosteroids be offered for twins & triplets? **

Answer 5

Same as for singletons

Question 6

Benefits of antenatal steroids, if given at 22+0 to 34+6

Answer 6

Highly likely to reduce:
1. Perinatal mortality
2. Neonatal death
3. Neonatal RDS
Likely to reduce:
1. Intraventricular haemorrhage
2. Developmental delay in childhood

Question 7

Antenatal benefits of steroids, if given at 22+0 to 34+6

Answer 7

Highly likely to reduce:
1. Perinatal mortality
2. Neonatal death
3. Neonatal RDS
Likely to reduce:
1. Intraventricular haemorrhage
2. Developmental delay in childhood

Question 8

Harms of antenatal steroids, if given 22+0 to 34+6

Answer 8

Likely:
1. Maternal glucose tolerance disruption, particularly if mat DM
2. Reduced birth weight if birth >7 days after steroids
Possibly:
1. Increase in psychiatric or behavioural diagnosis if birth at term

Question 9

Benefits of antenatal steroids if given 35+0 to 36+6

Answer 9

Likely:
Reduce respiratory support

Question 10

Harms of antenatal steroids if given 35+0 to 36+6

Answer 10

1. Likely to increase neonatal hypoglycaemia
2. May increase psychiatric & behavioural diagnoses

Question 11

Risk/benefit analysis of antenatal steroids if given before ElCS at 37-39

Answer 11

May decrease NNU resp admission
May reduce educational attainment at school
Uncertain if any reduction in RDS, TTN, NNU overall

Question 12

Risk/benefit analysis of rescue course of steroids if Tx >7 days ago

Answer 12

Likely to reduce need for resp support
Likely to reduce birth weight, head circumference, length, neonatal BP

Question 13

What are the special considerations for antenatal steroids in women with diabetes?

Answer 13

1. Diabetes is not an absolute contraindication
2. Additional insulin should be given & closer monitoring
3. Increased rates of neonatal hypoglycaemia

Question 14

What is the optimum dosing for antenatal steroids

Answer 14

1. Dexamethasone phosphate 24mg:
   2 x 12mg, 24 hours apart, or
   4 x 6mg, 12 hours apart
2. Betamethasone sodium phosphate/acetate mix 24mg: 2 x 12mg, 24 hours
   NB NOT betamethasone phosphate

Question 15

How do the different antenatal corticosteroids compare?

Answer 15

1. Dexamethasone reduces risk of intraventricular haemorrhage
2. Dexamethasone cheaper
3. Betamethasone may reduce risk of chorioamnionitis
4. Betamethasone phosphate has different pharmacokinetics, dosing unclear