SARS-CoV-2: do corticosteroids for fetal lung maturation worsen maternal or fetal outcomes?

2021 ◽  
Vol 29 (2) ◽  
pp. 90-92
Author(s):  
Nashwa Eltaweel ◽  
Samuel Lockley ◽  
Irshad Ahmed ◽  
Bee K Tan
Keyword(s):  
Case Studies ◽  
Clinical Case ◽  
Intraventricular Haemorrhage ◽  
Fetal Lung ◽  
Premature Delivery ◽  
Lung Maturation ◽  
Antenatal Steroids ◽  
Clinical Case Studies ◽  
Inflammatory Processes ◽  
Fetal Lung Maturation

Immune system changes during pregnancy could make pregnant women more susceptible to SARS-Cov-2 infection. The use of corticosteroids within obstetrics has been shown to reduce the risks of respiratory distress syndrome, intraventricular haemorrhage, necrotizing enterocolitis and neonatal death in the baby associated with premature delivery. During the COVID-19 pandemic, corticosteroids have been trialled as a treatment to dampen the ‘cytokine storm’ and associated inflammatory processes. Corticosteroids have long been known to have immunosuppressive effects that could hinder the body's ability to mount a defence against COVID-19 and thereby delaying viral clearance. In this clinical case studies, antenatal steroids for fetal lung maturation appear to be of benefit and did not result in a deterioration of maternal disease. Our clinical case studies support the current recommendations from the Royal College of Obstetricians and Gynaecologists ie corticosteroids for fetal lung maturation is appropriate in patients who are suspected or have confirmed SARS-CoV-2 infection.

scholarly journals Amnioreduction in treatment of increased amniotic fluid volume

2004 ◽  
Vol 57 (11-12) ◽  
pp. 579-583 ◽  
Author(s):  
Sinisa Stojic ◽  
Aleksandra Novakov-Mikic ◽  
Mirjana Bogavac ◽  
Aljosa Mandic
Keyword(s):  
Amniotic Fluid ◽  
Placental Abruption ◽  
Fetal Lung ◽  
Symptomatic Treatment ◽  
Fluid Volume ◽  
Premature Delivery ◽  
Lung Maturation ◽  
Monochorionic Twins ◽  
Amniotic Fluid Volume ◽  
Fetal Lung Maturation

Introduction Increased amniotic fluid volume may significantly increase the risk for preterm delivery. Amniodrainage is a symptomatic treatment by which excess amniotic fluid is reduced to provide fetal lung maturation. The aim of this study is to estimate the efficacy and safety of this procedure, our results and give a literature review. Material and methods Sonografic criteria were used (AFI> 400 ml, or the biggest amniotic fluid pocket > 150 mm) to choose patients in whom 18G needle was used to allow leaking of excessive amniotic fluid. Results 10 patients underwent 26 procedures. The procedures were performed at 28.6th week gestation, on average and 6.25 weeks average gain or 1000 g. We had two sets of monochorionic twins with twin-to-twin transfusion syndrome (TTTS), where one child survived. One procedure was followed by premature placental abruption, and premature delivery in 28th week. The rest of procedures were uneventful. Conclusion In our series of 10 women, 26 procedures were performed to prolong pregnancies, enable fetal maturation and weight gain. In majority of cases amnioreduction was done without complications, so we could repeat the intervention and prolong the pregnancy. Survival of one child in two TTTS pregnancies should not be regarded unsuccessful in our conditions.

scholarly journals Histochemical Analyses of Altered Fetal Lung Development Following Single vs Multiple Courses of Antenatal Steroids

2005 ◽  
Vol 53 (12) ◽  
pp. 1469-1479 ◽  
Author(s):  
Zarah J. Pua ◽  
Barbara S. Stonestreet ◽  
Anne Cullen ◽  
Aliakbar Shahsafaei ◽  
Grazyna B. Sadowska ◽  
...  
Keyword(s):  
Cell Injury ◽  
Smooth Muscle Actin ◽  
Fetal Lung ◽  
Nuclear Antigen ◽  
Lung Maturation ◽  
Injury Death ◽  
Fetal Lung Development ◽  
Antenatal Steroids ◽  
Lung Histopathology ◽  
Fetal Lung Maturation

A single course of antenatal steroids is widely used during preterm labor to promote fetal lung maturation. However, little is known regarding efficacy and safety of multiple courses of antenatal steroids. In animal models and clinical trials, treatment with glucocorticoids can inhibit growth. The present study of single- vs multiple-course steroids in pregnant ewes analyzes the effects of steroids vs placebo on fetal lung histopathology. Single-course groups received dexamethasone (Dex) 6 mg or normal saline every 12 hr for 48 hr at 104-106 days of gestation (term = 150 days). Multiple-course groups received the first course at 76-78 days; this was repeated weekly for 5 weeks. At 108 days, lungs were analyzed using immunohistochemistry for α-smooth muscle actin, a myofibroblast marker and proliferating cell nuclear antigen. Cell injury/death was evaluated using TdT-mediated dUTP digoxigenin nick end labeling (TUNEL) analysis. Although fetal growth was restricted by either single or multiple courses of Dex, alveolar development was accelerated as measured by mean linear intercepts. Alveolar walls were thinner, developing septa were longer, and septal myofibroblasts were increased for both Dex groups compared with controls. Cell proliferation increased following multiple steroid courses, especially in the distal parenchyma, with a corresponding decrease in apoptosis. These observations suggest that Dex promotes alveolarization, whether given in single or multiple courses.

The Effect of Antenatal Steroids on Fetal Lung Maturation between the 34th and 36th Week of Pregnancy

2010 ◽  
Vol 70 (2) ◽  
pp. 95-99 ◽  
Author(s):  
Osman Balci ◽  
Suna Ozdemir ◽  
Alaa S. Mahmoud ◽  
Ali Acar ◽  
Mehmet C. Colakoglu
Keyword(s):  
Fetal Lung ◽  
Lung Maturation ◽  
Antenatal Steroids ◽  
Fetal Lung Maturation

scholarly journals Antenatal steroids for fetal lung maturity: Time to target more frequent doses to fewer women?

2015 ◽  
Vol 8 (4) ◽  
pp. 172-176 ◽  
Author(s):  
Carolyn I Freeman ◽  
Natasha L Hezelgrave ◽  
Andrew H Shennan
Keyword(s):  
High Risk ◽  
Day Treatment ◽  
Fetal Lung ◽  
Optimal Timing ◽  
Antenatal Corticosteroids ◽  
Lung Maturation ◽  
Targeting Therapy ◽  
Antenatal Steroids ◽  
Maximum Benefit ◽  
Fetal Lung Maturation

Antenatal corticosteroids for fetal lung maturation have become mainstay treatment in women thought to be at high-risk of premature birth. To ensure treatment efficacy before delivery, the current practice is to administer steroids early to a woman considered at risk; however, neonatal benefit is lost after the seven-day treatment-to-delivery window. Over half of women who deliver before 34 weeks’ gestation do not receive antenatal corticosteroids within this timeframe, but many still deliver prematurely; however, clinicians are reluctant to administer repeated courses of steroids due to concerns, among others, of impaired fetal growth. However, evidence is mounting regarding the optimal timing for steroids, including substantive benefits close to delivery, and the benefits of repeated courses if delivery has not occurred. Better targeted treatment is required to allow for maximum benefit; reducing unnecessary treatment in low-risk women, while targeting therapy in the high-risk cohort and offering repeat courses if the seven-day window is exceeded. Novel tools to aid prediction may help implement this strategy.

scholarly journals Antenatal PPAR-γ agonist pioglitazone stimulates fetal lung maturation equally in males and females

2020 ◽  
Vol 319 (3) ◽  
pp. L435-L443
Author(s):  
Cindy Lee ◽  
Reiko Sakurai ◽  
Eugene Shin ◽  
Ying Wang ◽  
Jie Liu ◽  
...  
Keyword(s):  
Fetal Lung ◽  
Peroxisome Proliferator ◽  
Sprague Dawley ◽  
Lung Maturation ◽  
Peroxisome Proliferator Activated Receptor ◽  
Alveolar Epithelial ◽  
Ppar Γ ◽  
Antenatal Steroids ◽  
Males And Females ◽  
Fetal Lung Maturation

Antenatal steroids (ANS) accelerate fetal lung maturation and reduce the incidence of respiratory distress syndrome. However, sex specificity, i.e., being less effective in males, and potential long-term neurodevelopmental sequelae, particularly with repeated courses, remain significant limitations. The differential sex response to ANS is likely mediated via the inhibitory effect of fetal androgens on steroid’s stimulatory effect on alveolar epithelial-mesenchymal interactions. Since peroxisome proliferator-activated receptor-γ (PPAR-γ) agonists accelerate lung maturation by stimulating alveolar epithelial-mesenchymal interactions, independent of fetal sex, we hypothesized that the effect of PPAR-γ agonist pioglitazone (PGZ) would be sex-independent. Pregnant Sprague-Dawley rat dams were intraperitoneally administered dexamethasone (DEX) or PGZ on embryonic day (e) 18 and e19. At e20, pups were delivered by cesarean section, and fetal lungs and brains were examined for markers of lung maturation and apoptosis, respectively. Mixed epithelial-fibroblast cell cultures were examined to gain mechanistic insights. Antenatal PGZ increased alveolar epithelial and mesenchymal maturation markers equally in males and females; in contrast, antenatal DEX had sex-specific effects. Additionally, unlike DEX, antenatal PGZ did not increase hippocampal apoptosis. We conclude that PPAR-γ agonist administration is an effective, and probably even a superior, alternative to ANS for accelerating fetal lung maturity equally in both males and females.

Clinical Case Studies in Renal Transplantation

2013 ◽  
Vol 12 (2) ◽  
pp. 75-75
Keyword(s):  
Risk Assessment ◽  
Chronic Kidney Disease ◽  
Pulmonary Hypertension ◽  
Renal Transplantation ◽  
Kidney Disease ◽  
Case Studies ◽  
Clinical Case ◽  
Hemodynamic Evaluation ◽  
Clinical Case Studies

The case studies below are referred to in the articles “Pulmonary Hypertension in Patients with Chronic Kidney Disease: Noninvasive Strategies for Patient Phenotyping and Risk Assessment” by Amresh Raina, MD, and “Hemodynamic Evaluation of Pulmonary Hypertension in Chronic Kidney Disease” by Ryan Tedford, MD, and Paul Forfia, MD, on the following pages.

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