Betamethasone Administration Research Articles

A Complication of Percutaneous Sclerotherapy for Congenital Pulmonary Airway Malformation: Intravascular Injection and Cardiac Necrosis

ABSTRACTIntroduction: A congenital pulmonary airway malformation (CPAM) type III may become large enough to cause hydrops fetalis. In such circumstances, the fetus can be treated with open fetal resection, maternal betamethasone administration, or percutaneous sclerotherapy. Case report: A 24 week gestation fetus with a CPAM type III was treated by percutaneous sclerotherapy using ethanolamine oleate (EO). The EO inadvertently entered the left atrium and ventricle with subsequent fetal bradycardia and demise. Autopsy revealed myocardial necrosis. Conclusion: Percutaneous sclerotherapy has been previously described in the literature for the treatment of microcystic CPAMs with secondary hydrops. This is the first reported case of an adverse event after fetal sclerotherapy.

Current Strategy of Fetal Therapy I: Principles of In-utero Treatment, Pharmacologic Intervention, Stem Cell Transplantation and Gene Therapy

AbstractFetal conditions with high morbidity are amenable for prenatal intervention. It is important that the selective and investigative nature of most procedures needs to be clarified with the family during counseling session. Fetal therapy is fostered by accurate prenatal diagnosis with advanced fetal imaging, and molecular genetics technology. The treatments can be categorized into medical treatment, stem cell transplantation and gene therapy, minimally invasive intervention, endoscopic surgery, and open hysterotomy approach. Scientific validation of their genuine benefits has been a subject of ongoing researches. Prenatal administrations of pharmaceutical agents, for prophylactic or therapeutic purposes, have been broadly adopted. Transplacental administration of betamethasone to enhance the function of pneumocytes type II in premature fetus has been widely practiced for decades, and it might be the most common ‘fetal therapy’ being performed. However, the optimal dosage and interval of prenatal steroids administration was validated only recently. More invasive route of fetal administration, such as transamniotic, direct intramuscular, and intravenous injection, may be required for other pharmacologic agents. In this article, the authors selected to review common fetal conditions whose proposed prenatal pharmacologic treatments have undergone scientific validations. In-utero stem cell transplantation and gene therapy remain highly experimental. Informed choice and clinical experiment need to be balanced when prenatal treatment is offered.

EP04.33: Idiopathic intermittent dilated cardiomyopathy: in the fetal and the postnatal periods

Background: Transient fetal dilated cardiomyopathy (DCM) is associated to maternal chemotherapy treatment and fetal distress. We report here a case of transient intermittent fetal and neonatal cardiomyopathy unrelated to the above etiologies. Case description: A 28 y.o. G4P3 with gestational diabetes and chronic hypertension presented at 31 weeks gestation for a routine fetal growth scan. Maternal and fetal echocardiograms obtained at 24 weeks were both normal; however, fetal ultrasound at 31 weeks demonstrated marked cardiac dilation with ventricular wall thickening and globally depressed contractility. No hydrops was noted. The patient reported a viral illness two weeks prior to presentation, and serum Coxsackie B titers were elevated at 1:80. She was admitted to the inpatient service for betamethasone administration and monitoring, and discharged after serial echocardiograms demonstrated stable ventricular dilation with improved contractility. The patient underwent Caesarean delivery at term, with delivery of a vigorous 2860g female infant. Postnatal echocardiogram demonstrated only mild right-sided dilation and mildly decreased systolic function. On the fourth day of life, however, the infant was readmitted to the intensive care unit with heart failure. Labs were notable for NT pro-BNP of 614 and CK of 207, negative Coxsackie titers, and a negative workup for metabolic storage disease. Genetic testing demonstrated two heterozygous variants of uncertain significance in MYH7 and DSG2. The infant's cardiac status improved and she was subsequently discharged on digoxin and captopril. At 4 months, the infant was developing appropriately. Conclusion: To our knowledge, this is the first case of fetal DCM with antenatal improvement, followed by exacerbation in the postnatal period, which may be related to MYH7 and DSG2 variants or possible genetic susceptibility to viral cardiomyopathy.

EP04.30: Fetal dilated cardiomyopathy: genetic susceptibility?

Fetal dilated cardiomyopathy (DCM) may occur as the end result of both intrinsic and extrinsic cardiac disease. We present a novel case associated with two MYH7 and DSG2 gene variants in the setting of maternal Coxsackie seropositivity. A 28 year old G4P3 with chronic hypertension presented at 31 weeks gestation for a routine growth scan. Her fetal echocardiogram at 24 weeks gestation was normal; however, repeat ultrasound demonstrated biventricular dilation, wall thickening and poor contractility (figure 1), but no hydrops. The patient reported a viral illness two weeks prior to presentation, and serum Coxsackie B titers were highly positive at 1:80. She was admitted for betamethasone administration and discharged after serial echocardiograms demonstrated stable ventricular dilation and improved function. She underwent Caesarean delivery at term for a vigorous 2860g female infant. Postnatal echo demonstrated mild right-sided dilation and low normal systolic function; however, on the fourth day of life the infant was readmitted with heart failure. Labs were notable for NT pro-BNP 614, CK 207, negative Coxsackie titers, negative metabolic panel, and two heterozygous variants of uncertain significance in MYH7 and DSG2 on microarray. The infant was started on digoxin therapy and at 4 months was developing appropriately. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Committee Opinion No. 713 Summary: Antenatal Corticosteroid Therapy for Fetal Maturation.

Corticosteroid administration before anticipated preterm birth is one of the most important antenatal therapies available to improve newborn outcomes. A single course of corticosteroids is recommended for pregnant women between 24 0/7 weeks and 33 6/7 weeks of gestation who are at risk of preterm delivery within 7 days, including for those with ruptured membranes and multiple gestations. It also may be considered for pregnant women starting at 23 0/7 weeks of gestation who are at risk of preterm delivery within 7 days, based on a family's decision regarding resuscitation, irrespective of membrane rupture status and regardless of fetal number. Administration of betamethasone may be considered in pregnant women between 34 0/7 weeks and 36 6/7 weeks of gestation who are at risk of preterm birth within 7 days, and who have not received a previous course of antenatal corticosteroids. A single repeat course of antenatal corticosteroids should be considered in women who are less than 34 0/7 weeks of gestation who are at risk of preterm delivery within 7 days, and whose prior course of antenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario. Continued surveillance of long-term outcomes after in utero corticosteroid exposure should be supported. Quality improvement strategies to optimize appropriate and timely antenatal corticosteroid administration are encouraged.

Committee Opinion No. 713: Antenatal Corticosteroid Therapy for Fetal Maturation.

Corticosteroid administration before anticipated preterm birth is one of the most important antenatal therapies available to improve newborn outcomes. A single course of corticosteroids is recommended for pregnant women between 24 0/7 weeks and 33 6/7 weeks of gestation who are at risk of preterm delivery within 7 days, including for those with ruptured membranes and multiple gestations. It also may be considered for pregnant women starting at 23 0/7 weeks of gestation who are at risk of preterm delivery within 7 days, based on a family's decision regarding resuscitation, irrespective of membrane rupture status and regardless of fetal number. Administration of betamethasone may be considered in pregnant women between 34 0/7 weeks and 36 6/7 weeks of gestation who are at risk of preterm birth within 7 days, and who have not received a previous course of antenatal corticosteroids. A single repeat course of antenatal corticosteroids should be considered in women who are less than 34 0/7 weeks of gestation who are at risk of preterm delivery within 7 days, and whose prior course of antenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario. Continued surveillance of long-term outcomes after in utero corticosteroid exposure should be supported. Quality improvement strategies to optimize appropriate and timely antenatal corticosteroid administration are encouraged.

Reduced short-term variation following antenatal administration of betamethasone: Is reduced fetal size a predisposing factor?

ObjectiveTo assess the association between fetal size and the incidence of reduced short-term variability (STV) following bethametasone administration for fetal lung maturity. Study designThis was a retrospective, multicenter, cohort study conducted in two Tertiary University Units. Only uncomplicated singleton pregnancies admitted for threatened preterm labor between 26 and 34 weeks and submitted to betamethasone for fetal lung maturity were included. Delivery occurring within 72h from betamethasone administration represented criteria for exclusion. Computerized cardiotocography was carried out on a daily basis. Cases were identified by persistently reduced STV, defined as <5th percentile for gestational age and lasting for at least 72h after the first dose of betamethasone. The primary outcome was estimated fetal weight (EFW) at ultrasound in fetuses with normal and in those with persistently reduced STV. Pregnancy outcomes were also evaluated. ResultsPersistently reduced STV occurred in 33/405 of the included patients (8.1%). Compared to women with normal STV, those with persistently reduced STV had significantly lower EFW (1472±435 vs 1812±532g, p 0.04), lower birthweight (2353±635 vs 2857±796g, p<0.01) and earlier gestational age at delivery (35.1±4.2 vs 37.3±2.4weeks, p<0.01), whereas all the other variables including gestational age on admission were comparable. ConclusionsReduced STV following maternal betamethasone administration among appropriately grown fetuses seems to correlate with lower fetal size. Furthermore, fetuses with such abnormal response to steroids seem to carry a higher risk of perinatal complications, including lower birthweight and earlier gestational age at delivery.

Effect of Betamethasone on Fetal Pulmonary and Umbilical Artery Doppler Velocimetry and Relationship With Respiratory Distress Syndrome Development.

Respiratory distress syndrome (RDS) is a major cause of neonatal morbidity and mortality. It is primarily a disease of premature neonates. The aim of this study was to evaluate the impact of maternal betamethasone administration on the fetal pulmonary arteries (PAs) and umbilical arteries (UAs) and the correlation between RDS development and PA Doppler results. Forty singleton pregnancies between 24 and 34 gestational weeks with a diagnosis of preterm birth were included prospectively. They received corticosteroids to enhance fetal lung maturity. Fetal PA and UA Doppler parameters were evaluated before and 48 to 72 hours after steroid administration. Maternal records were matched to neonatal charts, and demographic and outcome data were abstracted. There were no differences between groups for maternal age, body mass index, mode of delivery, and mean GA at steroid administration. Apgar scores at 1 and 5 minutes were significantly lower for neonates who developed RDS (P < .05). There were no statistically significant differences in PA Doppler results between fetuses who developed RDS and those who did not, and there were no significant differences in PA Doppler results before and after steroid administration for both groups. The UA pulsatility and resistive indices were significantly lower after steroid administration for the neonates who developed RDS (P < .05). There were no significant differences in PA Doppler indices for fetuses with or without RDS after steroid administration.

INTRATHECAL BETAMETHASONE;

Objectives: The aim of our study to determine the use of intrathecal betamethasoneadministration as effective post-operative analgesic in gynecologic procedures. Study Design:Randomized control trial. Period: 6 months duration from April 2015 to end of September 2015.Setting: Tertiary Care Centre in Karachi, Pakistan. Method: The study population consisted ofn= 120 (divided into three groups using a random number generator) patients, who presentedto our setup either via emergency or through the outpatient. The patients belonged to ASAclass I and II, and underwent cesarean section. The group A was the control group, patientswho received 0.5ml normal saline IV with bupivacaine 0.5% in 3ml, with 0.5ml of normal salineintrathecally. Group B consisted of patients who received 0.5ml IV normal saline, with 0.5%in 3ml bupivacaine along with 0.5ml betamethasone as 4mg per ml. The last group, groupC consists of patients who received 0.5ml betamethasone IV (4ml/ml) along with 0.5% 3mlbupivacaine with 0.5ml of normal saline intrathecally. For the subjective measurement of painlevel a visual analog scale was used. Various time intervals as time of initial first analgesic effect,time between intrathecal injection and first administration of diclofenac as rescue analgesicand the total number of analgesics used in the first twenty four hour period were also recordedin the proforma. Various side effects such as nausea, vomiting and headache were noted.Data was analyzed using SPSS version 23. Results: The study population consisted of n=120 patients, divided into three groups using a random number generator, the demographicdata like age, whether the procedure performed was elective or emergency etc did not showany difference p value of &gt;0.05. The Visual analog scales scores at the 4 hour and 6 hourmark showed statistically significant difference, the values being lower in the medication groupsversus the control group. But no difference was found between the control and medicationgroups in the VAS score measured at 12 hour and 24 hours respectively. The requirement foruse of Diclofenac as rescue analgesia was also lower in the intrathecal and intravenous (groupB and C) as compared to the control group at the 24 hour mark post operatively, and thedose required was even lower in the intrathecal group as compared to the intravenous grouphaving a p value of 0.014. N= 27 patients suffered nausea and vomiting during the procedure,N= 40 patients reported headache following the 24 hour period post operatively. Conclusion:According to the results of our study intrathecal betamethasone administration is an effectivemethod of post-operative pain reduction in cesarean section surgeries and it also decreases theneed for rescue analgesia required.

The Effect of Betamethasone on Middle Cerebral Artery Doppler Flow in Fetuses With Elevated Peak Systolic Velocities [27Q

INTRODUCTION: Administration of betamethasone (BMZ) has been shown to decrease the morbidity and mortality associated with preterm birth, and is given to patients with a variety of complications such as preterm labor, PPROM, fetal growth restriction, and alloimmunization, among others. As middle cerebral artery (MCA) Dopplers are used to monitor fetal hemodynamics in patients with many of these conditions, we sought to determine if administration of betamethasone is associated with changes in MCA Doppler parameters in fetuses with an abnormally elevated MCA peak systolic velocity (PSV). METHODS: A retrospective longitudinal study was conducted including women with a fetal MCA PSV greater than 1.3 MoM that had an MCA Doppler assessment within one week before and one week after betamethasone administration. Pre- and post-BMZ MCA PSV were compared using a repeated measures t-test. RESULTS: 20 fetuses met inclusion criteria with diagnoses of alloimmunization (13), parvovirus infection (3), fetal growth restriction (2), and twin-twin transfusion (2). The pre-BMZ PSV of 1.60±0.16 MoM was significantly lower than the post-BMZ PSV of 1.41±0.16 MoM (p &lt; 0.0001). 13 of the 20 fetuses had a second post-BMZ MCA Doppler performed with a PSV of 1.5±0.24 MoM which was not significantly different from the initial post-BMZ MCA PSV (p=0.231). CONCLUSION: Our data suggest that maternal betamethasone administration lowers the MCA PSV in fetuses with an initially elevated MCA PSV. This should be taken into account when using MCA Dopplers to monitor fetal hemodynamics in patients receiving BMZ.

Influence of prenatal maternal corticosteroid therapy on clinical and metabolic features and pulmonary function of preterm newborn puppies

Although the effects of antenatal corticosteroid therapy in clinical improvement and pulmonary maturation in preterm have been described, little is known on premature newborn puppies. This study aimed to evaluate the effect of maternal administration of a single dose of prenatal betamethasone on lung function of preterm newborn puppies in the first hours of life, especially from the clinical point of view and acid-base balance. A prospective study was conducted involving 21 puppies allocated into three experimental groups: Term Group (63 days post-ovulation), Preterm-Treated Group (57 days post-ovulation and maternal administration of a single dose of 0.5 mg/kg of betamethasone) and Preterm-Control Group (57 days post-ovulation). Puppies were analyzed clinically through the Apgar score, heart rate, respiratory rate and neurological tests (muscular tone and irritability reflex) and for oximetry and blood acid-base balance in distinct experimental moments. Premature puppies had marked degree of prematurity, reversed by maternal administration of betamethasone. Prenatal corticosteroid therapy promoted better pulmonary and metabolic condition, with more efficient compensatory response to acid-base imbalance and better pulmonary gas exchange capacity. Therefore, prenatal treatment with betamethasone can be adopted as clinical lung maturation protocol for pregnancies at risk in order to prevent low vitality and increase neonatal survival.

The role of prenatal steroids at 34–36 weeks of gestation

A recent multicentre, double-blind, randomised, placebo-controlled trial has demonstrated that administration of betamethasone to women with threatened preterm delivery at 34–36 weeks of gestational age reduces the risk of neonatal...

Longitudinal progression of fetal short-term variation and average acceleration and deceleration capacity after antenatal maternal betamethasone application

ObjectiveTo analyze the effect of maternal betamethasone given for fetal lung maturation on fetal short-term variation (STV) and average acceleration and deceleration capacity (AAC/ADC). Both of these factors are calculated by phase-rectified signal averaging (PRSA) and represent new parameters to assess the fetal autonomic nervous system. Study designA longitudinal prospective study including 26 pregnant women at risk for preterm delivery was performed. Two injections of 12mg betamethasone were administered intramuscularly at a 24h interval for lung maturation. Cardiotocography recordings were performed at defined time intervals: day 0 (before the first injection) and days 1, 2, 4 after the first corticosteroid administration. AAC/ADC and STV were calculated. ResultsAn increase of all parameters (STV, AAC and ADC) was documented between day 0 and day 1. Between day 1 and day 2, all three indices were significantly reduced (p<0.05). STV declined by 19.8%, AAC by 10.1% and ADC by 14.8%. A normalization of these values was seen after 96h. ConclusionSimilar to STV, AAC/ADC shows significant changes after maternal betamethasone administration. The corticosteroid-induced transient decrease of the levels needs to be taken into account in the assessment of the fetal status to avoid misinterpretation of these parameters.

The effects of perinatal steroid therapy on growth factor levels during different stages of the developing brain

Objective: Excess glucocorticoid (GC) exposure on the fetal brain during critical stages of development has considerable effects on the development of the central nervous system (CNS). This study thus aimed to evaluate the differential effects of GC exposure on critical growth factor levels during different stages of brain maturation.Methods: For this purpose, forty-two rat pups were divided into six groups based on the timing of betamethasone administration. Rats in the treatment groups were exposed to intraperitoneal betamethasone injections beginning at different time points (postnatal days 1, 2, and 3). Rats in the placebo group received the same volume of 0.9% saline via the same fashion. Pups were sacrificed at 24 h following the final injection for determining the neuronal density and immunohistochemical evaluation of critical growth factors.Results: In the groups treated with betamethasone on postnatal day 1 (P1) and P2, which correspond to 22–24 and 24–28 gestational weeks in humans, the neuronal count in the hippocampal regions was significantly lower than their control groups. However, if steroid therapy was administered on P3, corresponding to 28–32 weeks in humans, no difference was observed between the two groups. Growth factors were affected in different ways depending on the steroid administration time and evaluated region.Conclusions: The results suggest that the modulating effect of steroids on neuron count and growth factor response depends on the stage of brain development at the time of exposure. Therefore, this may be one of the key determinants affecting the deleterious and beneficial effects of GCs on the CNS.

Fetal and Neonatal Outcomes After Term and Preterm Delivery After Betamethasone Administration in Twin Pregnancies

(Abstracted from Int J Gynaecol Obstet 2016;134:329–335) Prenatal betamethasone administration in singleton pregnancies is associated with a dose-dependent decrease in birth weight. This study aimed to determine the effects of betamethasone overall, and at different doses on fetal growth and neonatal outcomes in twin pregnancies based on fetal sex, chorionicity, and severity of prematurity.

Predictors of the Usefulness of Corticosteroids for Cancer-Related Fatigue in End-of-Life Patients

Although some studies have examined the use of corticosteroids, their effectiveness in treating cancer-related fatigue (CRF) has yet to be established. Therefore, this retrospective study attempted to identify factors that would predict the usefulness of corticosteroids in treating CRF. We examined 87 hospitalized end-of-life cancer patients who were given betamethasone for relief of CRF at our hospital between January 2008 and January 2014. We evaluated the effect of betamethasone at 3days after administration and performed a multivariate logistic regression analysis designed to identify predictive factors for the usefulness of corticosteroids. Threshold measurements were examined using a receiver operating characteristic (ROC) curve. This analysis identified the initial daily dose of betamethasone [odds ratio (OR)=1.662], days from the start date of betamethasone administration to the date of death (OR=1.05), administration of fentanyl (OR=0.206) and age (OR=1.055) as significant factors related to the effect of betamethasone. ROC curve analysis of the effect of the betamethasone showed that the threshold for the initial daily dose of betamethasone was above 4mg, the threshold for the days from the start date of the betamethasone administration to the date of death was above 16days and the threshold for age was above 60years old. The initial daily dose of betamethasone, days from the start date of the betamethasone administration to the date of death, non-administration of fentanyl and advanced age were shown to be predictive factors for the usefulness of corticosteroids for CRF in end-of-life patients.

Effect of Single Dose Betamethasone Administration in Pregnancy on Maternal and Newborn Parameters.

Antenatal corticosteroids play an important role in preventing Respiratory Distress Syndrome (RDS) but benefits related to time between corticosteroid administration and delivery need to be explored. To observe the effect of betamethasone administration in pregnant women at risk of preterm delivery and on foetal parameters, in terms of development of RDS. It was a prospective observational study on pregnant women at risk of preterm delivery who were administered a single dose 24 mg injection betamethasone. Outcome of 111 newborns of enrolled mothers was observed in terms of respiratory distress, Downe's and Silverman Anderson score, need of NICU admission and ventilation. Paired t-test was used to compare means of maternal parameters before and after betamethasone. Independent sample t-test for comparison of scores for respiratory distress in neonates was used. There was a significant decrease in maternal haematological parameters like mean Red Blood Cell (RBC) and mean Platelet Count (PC) whereas increase in mean Total leucocyte Count (TC) after betamethasone administration. Out of 111 newborn babies, 71 were born within 24 hours and rest were born after 24 hours of betamethasone administration. Twelve out of 71 newborns who were born within 24 hours of betamethasone administration, developed RDS. Mean Downe's score and mean Silverman Anderson score in neonates born within 24 hours of injection administration were significantly higher than those born after 24 hours. Betamethasone administration affects the haematological parameters in mothers in antenatal period nearing term. A minimum of 24 hours have to elapse between corticosteroid administration and delivery of the preterm for benefits to occur.

Comparing neonatal respiratory morbidity in neonates delivered after 34 weeks of gestation with and without antenatal corticosteroid.

Objective:To investigate the effect of antenatal corticosteroid prophylaxis on neonatal respiratory morbidity between 34 and 37 weeks of gestation.Methods:This retrospective study evaluated the neonatal respiratory complications of 683 low risk singleton pregnancies delivered at 34-37 weeks of gestation in a tertiary care center between Jan 2012 and Sept 2015. Group-I (n=294) comprised data of woman who did not receive betamethasone and Group-II(n=396) comprised those who received betamethasone after 34 weeks of gestation for cases at risk of preterm birth. Primary outcome was neonatal respiratory morbidity (NRM). NRM was defined as any respiratory disease that required medical support including supplemental oxygen, nasal continuous positive airway pressure, endotracheal intubation, or exogenous surfactant, with more than 25% oxygen for > 10 minute to maintain neonate oxygen saturation >90% Demographic characteristics, mode of delivery, fetal birth weight and neonatal respiratory complications was compared between the two groups.Results:There was no statistically significant difference for neonatal respiratory morbidity development rate between patients who received betamethasone or those who did not receive it. The incidence of neonatal respiratory morbidity was similar (15.3% in the control group and 14.9% in the intervention group; p=0.88).Conclusion:We found no improvement with betamethasone administration empirically in late preterm birth as regards prevention of Neonatal Respiratory Morbidity(NRM).

Committee Opinion No.677: Antenatal Corticosteroid Therapy for Fetal Maturation.

Corticosteroid administration before anticipated preterm birth is one of the most important antenatal therapies available to improve newborn outcomes. A single course of corticosteroids is recommended for pregnant women between 24 0/7 weeks and 33 6/7 weeks of gestation, including for those with ruptured membranes and multiple gestations. It also may be considered for pregnant women starting at 23 0/7 weeks of gestation who are at risk of preterm delivery within 7 days, based on a family's decision regarding resuscitation, irrespective of membrane rupture status and regardless of fetal number. Administration of betamethasone may be considered in pregnant women between 34 0/7 weeks and 36 6/7 weeks of gestation at imminent risk of preterm birth within 7 days, and who have not received a previous course of antenatal corticosteroids. A single repeat course of antenatal corticosteroids should be considered in women who are less than 34 0/7 weeks of gestation who have an imminent risk of preterm delivery within the next 7 days, and whose prior course of antenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario. Continued surveillance of long-term outcomes after in utero corticosteroid exposure should be supported. Quality improvement strategies to optimize appropriate and timely antenatal corticosteroid administration are encouraged.

Committee Opinion No. 677 Summary: Antenatal Corticosteroid Therapy for Fetal Maturation

Corticosteroid administration before anticipated preterm birth is one of the most important antenatal therapies available to improve newborn outcomes. A single course of corticosteroids is recommended for pregnant women between 24 0/7 weeks and 33 6/7 weeks of gestation, including for those with ruptured membranes and multiple gestations. It also may be considered for pregnant women starting at 23 0/7 weeks of gestation who are at risk of preterm delivery within 7 days, based on a family's decision regarding resuscitation, irrespective of membrane rupture status and regardless of fetal number. Administration of betamethasone may be considered in pregnant women between 34 0/7 weeks and 36 6/7 weeks of gestation at imminent risk of preterm birth within 7 days, and who have not received a previous course of antenatal corticosteroids. A single repeat course of antenatal corticosteroids should be considered in women who are less than 34 0/7 weeks of gestation who have an imminent risk of preterm delivery within the next 7 days, and whose prior course of antenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario. Continued surveillance of long-term outcomes after in utero corticosteroid exposure should be supported. Quality improvement strategies to optimize appropriate and timely antenatal corticosteroid administration are encouraged.