Antenatal Corticosteroids Flashcards
What are the benefits of antenatal corticosteroids ?
Prior to preterm birth Reduces:
- perinatal & neonatal death
- respiratory distress syndrome
- intraventricular haemorrhage IVH
What are the benefits of antenatal Corticosteroids for women undergoing planned CS between 37- 39 w ( at term)?
NOT ROUTINELY
Discussion should take place about risks & benefits
⚠️ at term : steroids may reduce admission to the neonatal unit for respiratory morbidity
* uncertain about the reduction in RDS or transient tachypnoea
Antenatal Corticosteroids may result in harm to the neonate which includes what?
1- Hypoglycemia( at late preterm)
2- potential developmental delay
3- likely to reduce birthweight if birth > 7 days after steroids
At what gestation should antenatal Corticosteroids be discussed & offered?
📢 Should be offered:
All women between 24 - 35 w in whom imminent preterm birth is anticipated
🚩 discuss: before 24 w
🚩 discuss: 35 - 37 w
What are the maternal risks of antenatal Corticosteroids?
1-Likely to affect maternal glucose tolerance for up to 5 days after administration
2- no evidence that antenatal Corticosteroids increased rates of maternal infection
How long after administration is a course of antenatal Corticosteroids most effective?
If birth happens 24 - 48 h after starting treatment & within 7 days
⚠️ neonatal death: is reduced when the first dose is given within 48h prior to birth
Benefits are also seen when the first dose is given within 24h of birth
⚠️ RDS : is reduced if birth between 24h - 7days of the 2nd dose
Is there any recommendations about antenatal steroids in multiple pregnancy?
Routine courses should not be used in twin or triplet pregnancy
What are the recommendations about antenatal corticosteroid in women with diabetes?
📢 Diabetes is not an absolute contraindication
Additional insulin should be given +
Close monitor
ℹ Discuss: about the benefits of antenatal steroids in diabetic women between 37 -39w undergoing planned CS
What is the role of antenatal Corticosteroids in pregnancies complicated by P PROM?
Should be offered to women with P PROM who are at increased risk of preterm delivery
What is the optimum dose of administration for antenatal Corticosteroids?
📢 dexamethasone: 24 mg
2 doses each 12 mg
4 doses each 6 mg
📢 betamethazon 24 mg
2 doses each 12 mg
Dexamethasone compared with betamethazon as antenatal steroids?
Dexamethasone reduces the risk of IVH
Betamethazon reduces the risk of chorioamnionitis
In the presence of maternal infection, is antenatal Corticosteroids contraindicated?
Balance the risks & benefits
Corticosteroid may activate latent infection or exacerbate fungal infections
In what circumstances should an antenatal course of Corticosteroids be repeated?
No additional benefits or reduction in morbidity have been seen with repeat corticosteroid
⚠️ babies who receive repeated courses are smaller ( lower weight & reduced length)
What is the maximum number of Corticosteroids courses given in any one pregnancy?
Should not exceed 3
