Steroid use in pregnancy

Question 1

What are the benefits of giving a single course of antenatal steroids to women at risk of preterm birth?

Answer 1

Significant reduction in neonatal mortality, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis WITHOUT increasing risk of maternal/neonatal morbidity/mortality

Question 2

At what gestational age do steroids work best?

Answer 2

24w0d to 33w6d

Question 3

What do corticosteroids do in the lungs?

Answer 3

Improve lung function and increase compliance by promoting surfactant production, narrow interalveolar septae, decrease vascular permeability, and enhance clearance of lung fluid

Question 4

What do corticosteroids do in the brain?

Answer 4

Make neuronal communication ore mature, stabilize synapses

But: also may inhibit growth factors and impair neural cell proliferation and myelination

Question 5

What are the ACOG recommendations for antenatal steroids?

Answer 5

Pregnant women who are at risk of delivery in the next 7d should get a single course of corticosteroids if GA between 24w-34w

Should get a single steroid course if PROM before 32w to reduce risk of respiratory distress, perinatal mortality, other morbidities

Question 6

Who is it appropriate to give a (second) rescue course of antenatal corticosteroids to?

Answer 6

Women with singleton or twin pregnancy with intact membranes at 25w0d-32w6d, judged to have threat of delivery within 7d, and who are got their first betamethasone course before 30w and at least 14d before the coming rescue course

Reduces ARDS, need for surfactant, and neonatal morbidity

More than 2 courses is NOT recommended because it may affect HPA axis

Question 7

What steroids do we give?

Answer 7

Betamethasone or dexamethasone - both cross placenta and have similar biologic activity

Decreased incidence of intraventricular hemorrhage observed in 1 report with dexamethasone; lower rate of adverse neurological outcomes at 18-22 months after infants born with betamethasone in another report

Question 8

A 24-year-old woman, gravida 4, para 0, at 29 weeks of gestation presents in preterm labor. Her cervix is 3 cm dilated and 80% effaced. Intact membranes are noted on speculum examination. The fetal heart rate tracing is Category I. You observe no evidence of chorioamnionitis. She was admitted 3 weeks ago for preterm labor and received a course of antenatal steroids. When she asks about further use of antenatal steroids, you tell her that the optimal number of additional courses of steroids is:

(A) 1
(B) 2
(C) 3
(D) 4

Answer 8

(A) 1