AN Steroids GTG

Question 1

When should you given AN steroids if imminent preterm birth anticipated according to GTG?

Extra point for NICE

Answer 1

24-34+6 (established preterm labour, PPROM, planned delivery)

NICE 2015 Discuss 22-23+6, Offer 24-33+6, Consider 34-35+6
Consider repeat <34 & ANS >7D, high risk delivery 48hr

Question 2

What are the benefits of AN steroids?

Answer 2

Reduce - perinatal mortality, neonatal death, RDS
Likely reduced: IVH and neurodevelopment delay, NEC

Question 3

What are the risk of of AN steroids if given with 7 days <35 weeks?

Answer 3

• Affects maternal glucose tolerance for 5 days.
• Reduction in birth weight
• Likely increase risk neonatal hypogylcaemia
• May increase risk of psychiatric and behavioural diagnosis if baby born at term (70000 children in Finland, 12% with ANS vs 6% in term-born children
• Exacerbate infection for women & baby

Question 4

What are the common regimes given?

Answer 4

Dexamethasone 12mg 24 hours apart
Betamethasone
12mg 24 hours apart
6mg 12 hours apart

Reaching total 24mg

Question 5

What is the medium latency between PPROM and birth

Answer 5

7 days, decreases as gestational age of PROM advances.

Question 6

What is the benefit of dexamethasone Vs Betamethasone

Answer 6

Reduced risk IVH
Lower risk CS

Question 7

What is the benefit of betamethasone vs dexamethasone

Answer 7

Reduced risk chore
Lower SBP at 2 years

Question 8

When is the maximum reduction of RDS following steroids

Answer 8

48hrs-7days

Question 9

What benefits begin within the first 48 hours?

Answer 9

Cerebroventricular haemorrhage, significant reduction fetal and neonatal death

Question 10

Are endogenous glucocorticoids from the mother cross the placenta?

Answer 10

No, the enzyme 11B-hydroxystreoid prevents this.

Synthetics glucocorticoids can bypass this enzyme.

Question 11

When is the greatest benefit of AN steroids?

Answer 11

24-48 hours - 50% reduction in mortality

Question 12

Repeat AN steroids? What are benefits and risks?

Answer 12

Repated course of steroids - Risk of mortality/morbidty are the same, no benefit
Lower birth weight

Question 13

According to NICE when should tocolysis and ANS be given based on clinical examination?

Answer 13

<30 weeks, if clinical assessment suspects PTL, give both

Question 14

According to NICE if > 30 weeks and suspected preterm labour what tests should be performed

Answer 14

If >30 weeks, consider cervical length USS. >15mm consider alternatives, <15mm steroids & toco

FFN
<50, alternative Dx
>50 steroids and tocolysis

Question 15

If using QUiPP app, what is the threshold to treatment within 7 days?

Answer 15

5%

Question 16

What percentage of babies given ACS are born at term?

Answer 16

40-50%

Question 17

What % of preterm birth and planned/indicated?

What is the most common indication for preterm birth?

Answer 17

30-35%

PET

Question 18

What did ASTECS trial find regarding ANS before ELCS?

Answer 18

Reduction in RDS and TTN (52%/55%) but lower quartile academically at 8-11years( 18% vs 8.5).

?Hypogylaecamia effect on Brian maturation