antenatal glucocorticoid treatment

1. ANTENATAL
CORTICOSTEROID
Osama
M
Warda
MD
Prof.
of
obstetrics
&
gynecology
Mansoura
University

2. BENEFITS
Antenatal
steroids
are
associated
with
a
significant
reducJon
in
rates
of:
-­‐
neonatal
death
by
31%,
-­‐
RDS
by
44%
-­‐
intra-­‐ventricular
hemorrhage
by
46%
.
Antenatal
corJcosteroid
use
is
also
associated
with
a
reducJon
in:
-­‐
necro>sing
enterocoli>s,
-­‐
respiratory
support,
-­‐
intensive
care
admissions
-­‐
systemic
infec>ons
in
the
first
48
hours.
Warda
O
2

3. WHEN
TO
GIVE?
• For
women
between
24+0
and
34+6
weeks
of
gesta>on
who
are
at
risk
of
preterm
birth.
•
can
be
considered
for
women
between
23+0
and
23+6
weeks
of
gesta>on
who
are
at
risk
of
preterm
birth.
•
Cor>costeroids
at
gesta>ons
less
than
24+0
weeks
should
be
made
at
a
senior
level.
Warda
O
3

4. WHEN
TO
GIVE?
•
Antenatal
cor>costeroids
should
be
given
to
all
women
with
elec3ve
CS
prior
to
38+6
weeks
of
gesta>on
to
reduce
the
risk
of
respiratory
morbidity.
•
There
is
no
evidence
to
support
prophylac>c
steroids
in
women
with
a
previous
history
of
preterm
delivery
or
mul>ple
pregnancy
who
show
no
signs
of
preterm
birth.
Warda
O
4

5. WHEN
TO
GIVE?
• A
retrospec>ve
cohort
study
showed
that
a
prophylac3c
cor3costeroids
every
2
weeks
from
24
to
32
weeks
of
gesta>on
was
not
associated
with
a
significant
reduc>on
in
RDS,
but
associated
with:
ý
reduced
birth
weight
in
term
by
129
g.
ý
reduced
head
circumference
ý
growth
delay
ý
brain
developmental
delay
ýlung
development
problems
ý necro>sing
enterocoli>s
ýmaternal
and
neonatal
sepsis
ý adrenal
gland
insufficiency
ý
placental
infarc>on
Warda
O
5

6. DURATION
OF
EFFECTIVENESS
•
most
effec>ve
in
reducing
RDS
if
delivery
occur
24
hours
a[er
and
up
to
7
days
a[er
administra>on
of
the
second
dose
of
antenatal
cor>costeroids.
• Before
that
for
neonatal
death
and
therefore
should
s>ll
be
given
even
if
delivery
is
expected
less
than
24
hrs.
Warda
O
6

7. SAFETY
• a
single
course
of
antenatal
cor>costeroids
is
not
associated
with
any
significant
short-­‐term
or
long
term
maternal
or
fetal
adverse
effects.
•
There
is
s>ll
insufficient
evidence
on
the
longer-­‐term
benefits
and
risks
of
mul>ple
courses.
Warda
O
7

8. Is
there
any
contraindica>on?
• Cau>on
should
be
taken
when
giving
cor>costeroid
to
women
with
systemic
infec3on
including
TB.
•
Senior
opinion
should
be
taken
to
delay
delivery
for
steroid
in
cases
of
chorioamnioni3s.
•
Clinical
chorioamnioni>s
is
significantly
associated
with
periventricular
leucomalacia
and
CP.
This
suggests
that
with
chorioamnioni>s,
cor>costeroids
may
be
started,
but
should
not
delay
delivery
if
indicated
by
maternal
or
fetal
condi>on.
Senior
opinion
should
be
taken
Warda
O
8

9. SPECIAL
CONDITIONS
• Mul>ple
pregnancy:
The
op>mal
dose
in
mul>ple
pregnancies
is
not
clearly
understood.
Evidence
suggests
that
mul>ple
pregnancy
abenuates
the
effect
of
steroids.
• Diabetes
mellitus:
Diabetes
mellitus
is
not
a
contraindica>on
to
antenatal
cor>costeroid.
Women
with
impaired
glucose
tolerance
or
diabetes
who
are
receiving
fetal
steroids
should
have
addi>onal
insulin.
Warda
O
9

10. SPECIAL
CONDITIONS
• Pregnancy
with
IUGR:
between
24+0
and
35+6
weeks
of
gesta>on
at
risk
of
delivery
should
receive
antenatal
cor>costeroids.

There
were
increase
in
the
survival
rate
without
disability
or
handicap
at
2
years
of
age,
but
there
were
more
children
with
physical
growth
problems
in
the
cor>costeroid
group.

The
benefits
from
antenatal
cor>costeroids
for
preterm
growth-­‐restricted
infants
appear
to
outweigh
the
possible
adverse
effects.
Warda
O
10

11. BEST
DOSAGE
• Betamethasone
12
mg
given
intramuscularly
in
two
doses
or
dexamethasone
6
mg
given
intramuscularly
in
four
doses.

Betamethasone
reduce
RDS
more
than
dexamethasone.
 Oral
administra>on
increase
the
incidence
of
neonatal
sepsis
only.
Warda
O
11

12. REPEATED
COURSE
• A
single
rescue
course
may
be
considered
with
cau>on
where
the
1st
course
was
given
less
than
26+0
weeks
and
another
indica>on
arises
later
in
pregnancy.
•
Senior
opinion
should
be
taken
if
a
rescue
course
is
to
be
considered.
Warda
O
12

13. Warda
O
13

14. Warda
O
14
THANK
YOU