570: Antenatal corticosteroid administration for fetal lung maturation prior to elective caesarean section at term in women with pre-gestational diabetes - more harm than good?

Aim: To determine the efficacy of antenatal corticosteroid in the prevention of respiratory distress syndrome of the neonates in women undergoing elective cesarean section at term pregnancy. Study design: Descriptive case series Place and duration of study: Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar from 6th December 2018 to 6th May 2019. Methodology: One hundred and seventy five women were enrolled. The women after taking complete history with obstetrical examination and antenatal corticosteroid administration i.e. 12 mg dexamethasone IM (two doses 12 hours apart) were observed. The caesarean section was performed by experienced obstetrician having minimum of five years of experience after 24 hours and within seven days of the second dose of dexamethasone. All the neonates were carefully examined in NICU for the detection of respiratory distress syndrome. All these observations were done under supervision of an expert pediatrician having minimum of five years of experience. Results: The mean age was 28±11.34 years. Thirty five percent patients had POG range 37+ weeks while 65% patients had POG range 38+ weeks. Mean POG was 37±1.12 weeks. More over antenatal corticosteroid was effective in 97% patients and was not effective in 3% patients. Conclusion: The antenatal corticosteroid was 97% effective in the prevention of respiratory distress syndrome of the neonates, in women undergoing ELSC at term after elective caesarean section for term pregnancy. Keywords: Efficacy, Antenatal corticosteroid, Respiratory distress syndrome, Neonates, Elective C- section,

Download Full-text

Prenatal inflammation enhances antenatal corticosteroid–induced fetal lung maturation

JCI Insight ◽

10.1172/jci.insight.139452 ◽

2020 ◽

Vol 5 (24) ◽

Author(s):

Augusto F. Schmidt ◽

Paranthaman S. Kannan ◽

James Bridges ◽

Pietro Presicce ◽

Courtney M. Jackson ◽

...

Keyword(s):

Fetal Lung ◽

Antenatal Corticosteroid ◽

Lung Maturation ◽

Prenatal Inflammation ◽

Fetal Lung Maturation

Download Full-text

Antenatal corticosteroid administration before elective caesarean section at term to prevent neonatal respiratory morbidity: a randomized controlled trial

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2016.01.026 ◽

2016 ◽

Vol 199 ◽

pp. 88-91 ◽

Cited By ~ 27

Author(s):

A.M. Nada ◽

M.M. Shafeek ◽

M.A. El Maraghy ◽

A.H. Nageeb ◽

A.S. Salah El Din ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Caesarean Section ◽

Controlled Trial ◽

Elective Caesarean Section ◽

Respiratory Morbidity ◽

Antenatal Corticosteroid ◽

Corticosteroid Administration ◽

Randomized Controlled

Download Full-text

Antenatal Corticosteroids for Fetal Lung Maturity - Too Much of a Good Thing?

Current Pharmaceutical Design ◽

10.2174/1381612825666190326143814 ◽

2019 ◽

Vol 25 (5) ◽

pp. 593-600 ◽

Cited By ~ 5

Author(s):

Lenka Hrabalkova ◽

Tsukasa Takahashi ◽

Matthew W. Kemp ◽

Sarah J. Stock

Keyword(s):

Preterm Birth ◽

Fetal Lung ◽

Corticosteroid Treatment ◽

Antenatal Corticosteroid ◽

Clinical Practices ◽

Antenatal Corticosteroids ◽

Lung Maturation ◽

Corticosteroid Administration ◽

Fetal Organ

Background: Between 5-15% of babies are born prematurely worldwide, with preterm birth defined as delivery before 37 completed weeks of pregnancy (term is at 40 weeks of gestation). Women at risk of preterm birth receive antenatal corticosteroids as part of standard care to accelerate fetal lung maturation and thus improve neonatal outcomes in the event of delivery. As a consequence of this treatment, the entire fetal organ system is exposed to the administered corticosteroids. The implications of this exposure, particularly the long-term impacts on offspring health, are poorly understood. Aims: This review will consider the origins of antenatal corticosteroid treatment and variations in current clinical practices surrounding the treatment. The limitations in the evidence base supporting the use of antenatal corticosteroids and the evidence of potential harm to offspring are also summarised. Results: Little has been done to optimise the dose and formulation of antenatal corticosteroid treatment since the first clinical trial in 1972. International guidelines for the use of the treatment lack clarity regarding the recommended type of corticosteroid and the gestational window of treatment administration. Furthermore, clinical trials cited in the most recent Cochrane Review have limitations which should be taken into account when considering the use of antenatal corticosteroids in clinical practice. Lastly, there is limited evidence regarding the long-term effects on the different fetal organ systems exposed in utero, particularly when the timing of corticosteroid administration is sub-optimal. Conclusion: Further investigations are urgently needed to determine the most safe and effective treatment regimen for antenatal corticosteroids, particularly regarding the type of corticosteroid and optimal gestational window of administration. A clear consensus on the use of this common treatment could maximise the benefits and minimise potential harms to offspring.

Download Full-text

Anaplastic astrocytoma during pregnancy: the importance of an effective multidisciplinary approach

BMJ Case Reports ◽

10.1136/bcr-2021-242135 ◽

2021 ◽

Vol 14 (4) ◽

pp. e242135

Author(s):

Valeria Filippi ◽

Severina Maria Leu ◽

Luca Marengo ◽

Irene Hoesli

Keyword(s):

Multidisciplinary Approach ◽

Elective Caesarean Section ◽

Tumor Resection ◽

Fetal Lung ◽

Residual Tumor ◽

Diffuse Astrocytoma ◽

Lung Maturation ◽

Empathic Communication ◽

Maternal And Neonatal Outcomes ◽

Fetal Lung Maturation

A 34-year-old pregnant woman at 28 gestational weeks was diagnosed with a brain tumor after experiencing a generalised seizure. After completion of antenatal fetal lung maturation, she underwent an osteoplastic craniotomy parietal on the left side and a microsurgical partial tumor resection under general anaesthesia. With a histology of a diffuse astrocytoma and the postoperative stable amount of residual tumor on follow-up imaging, the pregnancy proceeded until 37 gestational weeks. A healthy baby boy was delivered by elective caesarean section. An awake craniotomy for removal of the residual tumor was planned two weeks later, followed by adjuvant treatment (combined radio-/chemotherapy). A multidisciplinary approach, combined with appropriate timing and a transparent and empathic communication, was able to create the most effective tailored management and optimise maternal and neonatal outcomes.

Download Full-text