New evidence for preventive perinatal care

Abstract

care may benefit from prevention of cytomegalovirus infection during pregnancy. Frequent hand washing, wearing of gloves during nappy (diaper) changing, and avoidance of intimate contact of pregnant women with children under 36 months of age, who may be shedding the virus in their urine, were found to be effective in reducing infection in a randomised clinical trial (Pediatr Res 1995; 37: 168A). Continuous fetal monitoring with pulse oximetry may add to information from heart-rate monitoring without the risks of fetal-scalp blood sampling (Obstet Gynecol 1995; 85: 183). A potential tocolytic drug for the management or prevention of preterm labour and the treatment of intrapartum fetal distress caused by primary or iatrogenic uterine hypertonia may develop from basic research that confirms the specific and reversible effects on myometrial cells (in vitro) of oxytocin antagonists (Atosiban) (Am .7 Obstet Gynecol 1994; 171: 1627). The most important development during 1995 is the consensus on the benefit of antenatal steroids for the prevention of hyaline membrane disease. This was shown by a meta-analysis of 15 randomised controlled trials (RTCs) on antenatal corticosteroid therapy between 1972 and 1994, including 3560 neonates (Crowley), and observational evidence of effectiveness in more than 35 000 infants, provided by five perinatal databases in multicentre networks at 617 sites in USA, Canada, Australia, and Europe. It took 22 years since Liggins' first report to obtain a sufficiently firm body of evidence to reach consensus on this matter: the National Institutes of Child Health and Development Consensus Statement on Effects of Corticosteroids for Fetal Maturation on Perinatal Outcomes concludes Antenatal corticosteroid therapy is indicated for women at risk of premature delivery with few exceptions and will result in a substantial decrease in neonatal morbidity and mortality, as well as substantial savings in health care costs. Unfortunately, in 1995 a possible effect of thyrotropinreleasing hormone (TRH) potentiating antenatal steroids has been disproved. An Australian collaborative trial of antenatal T R H (ACTOBAT) for prevention of respiratory distress syndrome (RDS) showed adverse results. The study included 1234 women at 24-31 weeks of pregnancy at risk for preterm delivery, randomly assigned to 200 ptg T R H or placebo intravenously over 12 hours to a maximum of four doses. Surprisingly there was an increased risk of RDS, oxygen requirement at 28 days, and death in infants of the T R H group born more than 10 days after treatment. ¢(/-hilst use of exogenous surfactant has spread world