Vous êtes sur la page 1sur 18

Repeated Doses of Antenatal

Corticosteroids
for Women at Risk of Preterm
Birth
Ahmed Alaa el din

Assistant Lecturer of OB/GYN


Cairo University

Introduction

Preterm birth is a leading cause of perinatal death and


disability and is an important public health problem
globally.

Administration of corticosteroids to mothers before


preterm
delivery
significantly
reduces
perinatal
morbidity and mortality.

Complications of preterm birth include:


-Respiratory distress.
-Intraventricular hemorrhage.
-Periventricular leukomalacia.
-Necrotizing enterocolitis.
-Need for mechanical ventilation & admission to NICU.

of Action of
Antenatal
Corticosteroi
ds

A. Respiratory Action

Antenatal corticosteroid therapy leads to architectural


and biochemical changes that improve both lung
mechanics and gas exchange. These changes are
primarily the result of accelerated morphologic
development of type 1 and type 2 pneumocytes. Type 1
pneumocytes are responsible for gas exchange in the
alveoli, while type 2 pneumocytes are responsible for
production and secretion of surfactant.

Antenatal corticosteroids also alter production of


surfactant binding proteins and enhance fetal lung
antioxidant enzymes.

However, for these changes to occur the lungs need to


have reached a stage of development that is biologically

B. Circulatory Action

Antenatal corticosteroid therapy improves circulatory


stability in preterm neonates, resulting in less
intraventricular
hemorrhage
and
necrotizing
enterocolitis.

Repeating
antenatal
corticosteroi
ds

Rationale for Repeating


antenatal corticosteroids

The
biologic
rationale
for
repeating
antenatal
corticosteroid therapy is based upon the observation
that biochemical stimulation of surfactant production
appears to be reversible in cell culture models i.e.
surfactant protein mRNA levels decline to control levels
after cortisol is removed.

However, other beneficial effects, such as cytostructural


maturation, persist after steroid exposure is withdrawn.

Effective
Antenatal
Corticosteroi
d Regimens

Corticosteroid Regimens

Corticosteroid regimens shown to be effective include:


betamethasone 12 mg intramuscularly, 2 doses 24 hours
apart; or dexamethasone 6 mg intramuscularly 4 doses
12 hourly.

Benefits were found when treatment was started


between
26 and 35 weeks of gestation, and for babies born 17
days after commencing treatment.

No
benefits
were
demonstrated
for
treatment
commenced, or infants born, before 26 weeks of
gestation, nor for those born more than seven days after
treatment.

Corticosteroid Regimens

Some studies showed that betamethasone is associated


with
lower
incidence
of
RDS
compared
to
dexamethasone.

Dexamethasone is associated with lower incidence of


intraventricular hemorrhage, but with higher incidence of
puerperal sepsis (especially if taken orally).

Repeated
Antenatal
Corticosteroi
ds

Advantages

Repeated doses are associated with better neonatal lung


function
than
single
course
of
corticosteroids,
particularly among infants delivered before 32 weeks of
gestation.

Also, less need for mechanical ventilation, continuous


positive airway pressure, and surfactant use. There was
also a reduction in the frequency of pneumothorax.

However, there is NO SIGNIFICANT BENEFIT in reduction


of severe respiratory distress syndrome, grade III or IV
intraventricular hemorrhage, chronic lung disease or
periventricular leukomalacia.

Disadvantages

Repeated doses are associated with lower birth weight


than the single course, and appear to cause IUGR.

However, it was found that repeating a SINGLE RESCUE


DOSE or COURSE, does not affect fetal growth.

Some studies reported increased incidence of cerebral


palsy.

Regarding late term effects, some studies showed


affection of neurological development in early childhood.

Disadvantages

In animals: studies have shown decreased brain size,


altered nerve growth, a delayed rate of myelination,
altered retinal development, a decrease in the number of
neurons and a dose-dependent degeneration of neurons
in the hippocampus.
Also it may be associated with increased incidence of
hypertension.

Recommend
ations

Recommendations

We recommend repeating a SINGLE RESCUE DOSE or


COURSE of antenatal corticosteroids only in cases who
have
passed
7 days since initial administration & are still at risk of
preterm labor.

Thank

you