Antenatal Steroids

[kpsanghvi]

Hi All

I have encountered stiff resistance from obstetricians when it comes to using antenatal steroids in mothers who are

1) preeclamptic or uncontrolled hypertensives because it may push up the BP further and

2) Diabetics it may increase the hyperglycemia

Would like to know your views

[Alexander Rakow]

The practice at our hospital is to give betaped (12mg tvice with at least 24 h intervall, if possible) even if there is preeklampsia or a history of diabetes in the mother to all mothers between GA 23-32 weeks.

We kind of put the priority on the baby

Alexaner Rakow

Karolinska Hospital

Stockholm, Sweden

[Guest nazarkandla]

Dear Sir

I think that baby of mother with preeclampsia and hypertension ,due to itrauterine distress have reduced incidence of hyaline membrane disease ,so if the mother having hypertension so better not to use steroid to ovoid increase in blood pressure in the mother.

Nice Regards

[kpsanghvi]

Dear Dr Nazarkandla

PIH does decrease the incidence of RDS but does not guarantee prevention of RDS. I generally ask the OBS to use an additional dose of antihypertensive or insulin as the case may be but I insist inspite of their resistance.

K P Sanghvi

[Guest 162761]

Is there any evidence that antenatal steroid therapy for only 24 hours will raise maternal blood pressure and blood sugar significantly/dangerously?

[Guest 162761]

Further, when considering an impending delivery of a micropremie, I think the advantages of antenatal steroids (for 24 hours) on fetal maturation outweigh maternal side effects.

Oussama Itani, MD;FAAP;FACN

Kalamazoo, MI

[Guest Rahmi]

What do you think about repeated doses of antenatal steroids? For example if obstetrician gives to mother at 24 weeks of gestational age. If birth does not occur and threat for preterm delivery continues, what is your policy? How many times may you give or repeat antenatal steroids? How is your practice?

Rahmi Örs,MD

Konya-Turkey

[hehady]

Point one: Neither hypertension nor diabetes are contraindications to antenatal steroids

PArt two: Repeated courses

please look at the NIH Consensus Statement Volume 17, Number 2

August 17–18, 2000

*The collective international data continue to support unequivocally the use and efficacy of a single course of antenatal corticosteroids using the dosage and interval of administration specified in the 1994 Consensus Development Conference report.

• The current benefit and risk data are insufficient to support routine use of repeat or rescue courses of antenatal corticosteroids in clinical practice.

• Clinical trials are in progress to assess potential benefits and risks of various regimens of repeat courses. Until data establish a favorable benefitto-

risk ratio, repeat courses of antenatal corticosteroids, including rescue therapy, should be reserved for patients enrolled in clinical trials.

[Guest 162761]

We do not use repeated courses of antenatal steroids anymore since the alarming reports of reduced brain growth came out. Although the culprit seems to be Dexamethasone rather than Betamethasone as far as brain growth, use of repeated antenatal courses should not be used outside the confines of a clinical trial with an informed consent.

Best regards

Oussama Itani, MD;FAAP;FACN

Clinical Associate Professor of Pediatrics and Human Development- Michigan State University & Kalamazoo Center for Medical Studies

Director of Neonatology

Borgess Medical Center

1521 Gull Road

Kalamazoo, MI 49048

Phone: (269)-226-5778

Fax: (269)-226-5998

email: oussama@pol.net

[Guest mbayari]

Hi all

I was interested about this field since the first question.

There is actually no reluctance about the interest af antenatal corticosteroids (surfactant synthesis, cell proliferation, differentiation of type II cells...)but,since the elegant demonstration of Murphy et al. of a 30% reduction of cerebral volume,there is a growing concern about their use. We have to keep in mind that we are dealing with more premature newborns and it is proven, beside the type of synthetic corticosteroids we use, that secondary septation can be inhibited according to the stage of development. This risk is sustained with multiple courses also. Some recent trials focus on the use of hydrocortione, in spite of DXM or Betamethasone, that seems less deleterious.

Best regards

[bashir51]

last trends :is to give betamethasone instead of hydrocortison for pregnant women in case of threatened delivery of premature baby... not twice.