corticosteroids

Question 1

dosage and administration of antenatal corticosteroids

Answer 1

administer one dose of betamethasone 11.4mg (ie. 2 ampoules) by IM injection and repet dose in 24 hours

Question 2

who should be offered a course of betamethasone

Answer 2

single dose of antenatal corticosteroid therapy should be offered to all women between 23 and 36+6 weeks gestation at risk of preterm delivery

Question 3

use of antenatal corticosteroids in women with diabetes at risk of late preterm birth

Answer 3

poor or no evidence of any benefit of corticosteroids for women with pre-existing diabetes at risk of later preterm birth (34-36+6)
evidence of benefit is not strong for women with gestational diabetes at risk of late preterm birth (34-36+6)

Question 4

when is tocolytic therapy used to allow for time to administer antenatal corticosteroids

Answer 4

for gestations under 34 weeks only

Question 5

women with systemic infection

Answer 5

antenatal corticosteroid therapy is contraindicated in women with systemic infection including tubrculosis
caution is required if chorioamnionitis is suspected

Question 6

women with preterm ROM

Answer 6

offer a course of corticosteroid therapy provided there are no clinical signs of infection

Question 7

when is antenatal corticosteroid administration most effective

Answer 7

for births that occur between 24 hours and 7 days after the second dose

Question 8

corticosteroid associated hyperglycaemia

Answer 8

betamethasone may induce hyperglycaemia due to increased insulin resistance
if the hyperglycaemia occurs close to delivery it may increase the risk of neonatal hypoglycaemia and hyper bilirubinaemia
the risk of these complications may be reduced by strict maternal glycaemic control during betamethasone admnistration

Question 9

DKA and corticosteroid use

Answer 9

the risk of DKA is especially raised in pregnant women with poorly controlled T1DM
Ideally, women with pre-existing diabetes should be admitted to hospital when steroids are to be given
low threshold of DKA is required

Question 10

risk factors for GDM

Answer 10

previous GDM
ethnicity: asain (including indian), aboriginal, pacific islander, Maori, middle eastern, non-white african
maternal age >40
family history DM
obesity
hypertension prior to 20 weeks
previous macrosomia
history of unexplained stillbirth
previous baby with congenital abnormalities
PCOS
medications: corticosteroids, antipsychotics