scholarly journals Do Maternal Demographics and Prenatal History Impact the Efficacy of Betamethasone Therapy for Threatened Preterm Labor?

2020 ◽  
Vol 3 ◽  
Author(s):  
Mary Kinney ◽  
David Haas ◽  
Hayley Trussell ◽  
Larissa Silva ◽  
Sara Quinney
Keyword(s):  
Race And Ethnicity ◽  
Preterm Labor ◽  
Secondary Analysis ◽  
Fetal Lung ◽  
Time Frame ◽  
Lung Maturation ◽  
Maternal Characteristics ◽  
Gestational Age At Delivery ◽  
Threatened Preterm Labor ◽  
Individualization Of Therapy

Background/Objective: Betamethasone is used to accelerate fetal lung maturation in women with threatened preterm labor, but its efficacy is variable and limited by the lack of patient individualization in its dosing and administration. To determine sources of variability and potential opportunities for individualization of therapy, the objective of this study was to evaluate maternal factors associated with development of neonatal respiratory distress syndrome (RDS) in a cohort of women who received betamethasone.     Methods: This study prospectively enrolled women, gestational ages 23-34 weeks, who received betamethasone for threatened preterm labor (n=208). Maternal demographics, prenatal history, and neonatal outcomes were abstracted from Epic and Cerner records. RDS was the primary outcome. Associations between RDS diagnosis and factors such as maternal demographics, prenatal history, and betamethasone dosing were evaluated in a multivariable regression adjusted for gestational age at delivery. A secondary analysis limited the cohort to women who delivered within 2 weeks of betamethasone dosing (n=95).    Results: Of 208 deliveries, 44.1% resulted in neonatal RDS. Within the overall cohort, the only significant association with RDS was the type of delivery, with 61.3% of cesarean births resulting in RDS versus 28.7% of vaginal births (adjusted OR 1.17 [1.06-1.28]). Among deliveries within 14 days of betamethasone dosing, women who experienced preterm premature rupture of membranes (PPROM) had lower RDS outcome rates than those without PPROM (52.6% vs. 78.9%, adjusted OR 0.80 [0.65-0.98]). Maternal age, BMI, race, and ethnicity were not associated with RDS.    Conclusion: Maternal characteristics alone may not be useful biomarkers in predicting neonatal RDS. The association between PPROM and RDS may suggest the importance of the time frame between betamethasone dosing and delivery. The finding of higher risk for RDS among neonates born by cesarean is consistent with other studies and bears further exploration as betamethasone therapy may mediate the association. 

scholarly journals Do maternal demographics and prenatal history impact the efficacy of betamethasone therapy for threatened preterm labor?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mary T. Kinney ◽  
Sara K. Quinney ◽  
Hayley K. Trussell ◽  
Larissa L. Silva ◽  
Sherrine A. Ibrahim ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Race And Ethnicity ◽  
Fetal Lung ◽  
Control Analysis ◽  
Lung Maturation ◽  
Maternal Characteristics ◽  
Individualization Of Therapy ◽  
Gestational Age At Birth ◽  
Age At Birth

Abstract Background Betamethasone (BMZ) is used to accelerate fetal lung maturation in women with threatened preterm birth, but its efficacy is variable and limited by the lack of patient individualization in its dosing and administration. To determine sources of variability and potential opportunities for individualization of therapy, the objective of this study was to evaluate maternal factors associated with development of neonatal respiratory distress syndrome (RDS) in a cohort of women who received betamethasone. Methods This study prospectively enrolled women, gestational ages 23–34 weeks, who received betamethasone for threatened preterm birth. Maternal demographics, prenatal history, and neonatal outcomes were abstracted from hospital records. RDS was the primary outcome. Associations between RDS diagnosis and maternal demographics, prenatal history, and betamethasone dosing were evaluated in a case-control analysis and multivariable regression adjusted for gestational age at delivery. Secondary analyses limited the cohort to women who delivered within 1 or 2 weeks of betamethasone dosing. Results Of 209 deliveries, 90 (43 %) resulted in neonatal RDS. Within the overall cohort and controlling for gestational age at birth, RDS was only associated with cesarean births compared to vaginal births (adjusted OR 1.17 [1.06–1.29]). Route of delivery was also the only significant factor related to RDS in the 83 neonates delivered within 7 days of BMZ dosing. However, among 101 deliveries within 14 days of betamethasone dosing and controlling for gestational age at birth, women who experienced preterm premature rupture of membranes (PPROM) had lower RDS rates than those without PPROM (57.9 % vs. 80.2 %, adjusted OR 0.81 [0.67–0.99]). Maternal age, BMI, race, and ethnicity were not associated with RDS in the regression models. Conclusions Of maternal characteristics analyzed, only delivery by cesarean was associated with neonatal RDS after antenatal betamethasone use.

scholarly journals Our experience of nifedipine as a tocolytic agent in preterm labor (24 weeks to 36 weeks 6 days)

2017 ◽  
Vol 6 (2) ◽  
pp. 636
Author(s):  
Parag M. Hangekar ◽  
Anand Karale ◽  
Neelesh Risbud
Keyword(s):  
Side Effects ◽  
Preterm Labor ◽  
Mode Of Delivery ◽  
Previous History ◽  
Fetal Lung ◽  
Delivery Mode ◽  
Birth Complications ◽  
Gestational Age At Delivery ◽  
Nicu Admission ◽  
One Year

Background: Preterm birth is defined as birth between the age of viability and 37 completed weeks of gestation. The aim of this study is to evaluate the safety and efficacy of nifedipine, a calcium channel blocker, as a tocolytic in prolonging duration of pregnancy in case of preterm labor.Methods: This is a retrospective analytical study conducted in Department of Obstetrics and Gynaecology, SKNMC and GH, Pune, India conducted over a period of one year from June 2014 to May 2015. All uncomplicated, singleton preterm labor cases were given Cap. Nifedipine as tocolytic and Inj. Betamethasone for enhancing fetal lung maturity. Maternal parameters studied were Gravida and Parity, previous history of preterm labor, gestational age at delivery, mode of delivery, side effects. Neonatal parameters studied were weight at birth, APGAR score at birth, complications at birth, NICU admissions, mortality.Results: Out of total 4478 deliveries from June 2014 to May 2015, 252 women with preterm labor were treated with nifedipine. 214 out of 252 delivered at term with overall success rate of 84.92%. Out of remaining 38 cases, 36 cases delivered as preterm normal deliveries and 2 required Caesarean section. No major side effects observed in mothers receiving nifedipine. As regards neonatal outcome, 12 babies required NICU admission and mortality was of 2.Conclusions: Nifedipine is safe and effective in prolonging preterm labor and has minimal maternal and neonatal side effects. It eliminates the need for intensive maternal monitoring as required in case of betamimetics.

scholarly journals Steroids for All

2020 ◽  
Vol 3 ◽  
Author(s):  
Alexandra McKinzie ◽  
Ziyi Yang ◽  
Joanne Daggy ◽  
Robert Tepper ◽  
Sarah Quinney ◽  
...  
Keyword(s):  
Preterm Labor ◽  
Neonatal Intensive Care ◽  
Neonatal Outcomes ◽  
Hypertensive Disorder ◽  
Antenatal Corticosteroids ◽  
Maternal Characteristics ◽  
Admission Rates ◽  
Threatened Preterm Labor ◽  
The Mean ◽  
Nicu Admission

Background: Due to difficulties estimating the risk of preterm labor, many women diagnosed with threatened preterm delivery and given antenatal corticosteroids to improve neonatal outcomes do not deliver until term. Our objective was to compare the short-term outcomes of infants born at term to women who received betamethasone (BMZ) for threatened preterm labor to infants who were not exposed to BMZ in utero.     Methods: We performed a retrospective cohort study of infants born at or after 37 weeks’ gestational age (GA) to mothers diagnosed with threatened preterm labor during pregnancy. Controlling for covariates, the primary neonatal outcomes of interest, including transient tachypnea of the newborn (TTN), neonatal intensive care unit (NICU) admission, and birthweight, were evaluated for their association with BMZ exposure.     Results: Of 5330 women, 1459 (27.5%) women received BMZ at a mean GA of 32.2±3.3 weeks. The mean age of women was 27±5.9 years-old and the mean GA at delivery was 38.9±1.1 weeks. Women receiving BMZ had higher rates of maternal comorbidities (P<0.001 for diabetes, asthma, and hypertensive disorder) and were more likely to self-identify as white (P=0.022). BMZ-exposed neonates had lower birth weights and increased rates of oxygen usage, TTN, hyperbilirubinemia, hypoglycemia, and NICU admission rates (all P-values <0.05).  Controlling for maternal characteristics and GA at delivery, BMZ exposure was not significantly associated with diagnosis of TTN [OR 1.09 (95% CI 0.80-1.50)], though it was associated with more NICU admissions [1.49 (1.19-1.86)] and lower birthweight by 91.5 (-122.3 to -60.6) grams.      Conclusions: Compared to women evaluated for preterm labor that did not receive BMZ, women receiving BMZ had infants with higher rates of NICU admission and lower birthweights, though the rate of TTN diagnosis was similar between the two groups. While the benefits of BMZ to infants born preterm are clear, there may be negative impacts for infants delivered at term. 

scholarly journals Nicardipine-Induced Acute Pulmonary Edema: A Rare but Severe Complication of Tocolysis

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Claire Serena ◽  
Emmanuelle Begot ◽  
Jérôme Cros ◽  
Charles Hodler ◽  
Anne Laure Fedou ◽  
...  
Keyword(s):  
Pulmonary Edema ◽  
Preterm Labor ◽  
Multiple Pregnancy ◽  
Fetal Lung ◽  
Clinical Severity ◽  
Acute Pulmonary Edema ◽  
Lung Maturation ◽  
Serious Adverse Event ◽  
Beta Agonists ◽  
Fetal Lung Maturation

We report four cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in pregnancy patients with no previous heart problems. Clinical severity justified hospitalization in intensive care unit (ICU) each time. Acute dyspnea has begun at an average of 63 hours after initiation of treatment. For all patients, the first diagnosis suspected was pulmonary embolism. The patients' condition improved rapidly with appropriate diuretic treatment and by modifying the tocolysis. The use of intravenous nicardipine is widely used for tocolysis in France even if its prescription does not have a marketing authorization. The pathophysiological mechanisms of this complication remain unclear. The main reported risk factors are spontaneous preterm labor, multiple pregnancy, concomitant obstetrical disease, association with beta-agonists, and fetal lung maturation corticotherapy. A better knowledge of this rare but serious adverse event should improve the management of patients. Nifedipine or atosiban, the efficiency of which tocolysis was also studied, could be an alternative.

scholarly journals Nicardipin Associated Pulmonary Edema : A Severe Complication of Tocolysis - A Case Report

2018 ◽  
Vol 5 ◽  
Author(s):  
Youssef Motiaa ◽  
Wafae El Otmani ◽  
Nezha El Oudghiri ◽  
Anas Saoud Tazi
Keyword(s):  
Pulmonary Edema ◽  
Preterm Labor ◽  
Channel Blocker ◽  
Fetal Lung ◽  
Pulmonary Angiography ◽  
Acute Pulmonary Edema ◽  
Lung Maturation ◽  
Computed Tomography Pulmonary Angiography ◽  
Uterine Contractions ◽  
Fetal Lung Maturation

In preterm labor, tocolytics are used to stop uterine contractions and to allow the administration of corticosteroids for fetal lung maturation, nicardipine is a calcium channel blocker increasingly used for this indication. Several adverse effects have been reported during tocolysis using nicardipine, one of the most serious complications is Acute Pulmonary Edema. We report a case of a parturient who was admitted at 28 weeks pregnancy for preterm labor and developed a respiratory failure two days following tocolysis with nicardipine. Echocardiography and Computed Tomography Pulmonary Angiography (CTPA) ruled out a pulmonary embolism and a decompensated heart disease. The patient received oxygen therapy and diuresis for Acute Pulmonary Edema with favorable outcome.The purpose of this paper is to discuss the risk factors for occurrence of pulmonary edema after tocolysis, importance of etiologic investigation to exclude differential diagnoses and therapeutic options for management of this complication.

scholarly journals Association Between Features of Spontaneous Late Preterm Labor and Late Preterm Birth

2019 ◽  
Vol 37 (04) ◽  
pp. 357-364
Author(s):  
Angelica V. Glover ◽  
Ashley N. Battarbee ◽  
Cynthia Gyamfi-Bannerman ◽  
Kim A. Boggess ◽  
Grecio Sandoval ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Preterm Labor ◽  
Secondary Analysis ◽  
Area Under The Curve ◽  
Late Preterm ◽  
P Value ◽  
Cervical Dilation ◽  
Late Preterm Birth ◽  
Gestational Age At Delivery

Abstract Objective This study aimed to evaluate the association between clinical and examination features at admission and late preterm birth. Study Design The present study is a secondary analysis of a randomized trial of singleton pregnancies at 340/7 to 365/7 weeks' gestation. We included women in spontaneous preterm labor with intact membranes and compared them by gestational age at delivery (preterm vs. term). We calculated a statistical cut-point optimizing the sensitivity and specificity of initial cervical dilation and effacement at predicting preterm birth and used multivariable regression to identify factors associated with late preterm delivery. Results A total of 431 out of 732 (59%) women delivered preterm. Cervical dilation ≥ 4 cm was 60% sensitive and 68% specific for late preterm birth. Cervical effacement ≥ 75% was 59% sensitive and 65% specific for late preterm birth. Earlier gestational age at randomization, nulliparity, and fetal malpresentation were associated with late preterm birth. The final regression model including clinical and examination features significantly improved late preterm birth prediction (81% sensitivity, 48% specificity, area under the curve = 0.72, 95% confidence interval [CI]: 0.68–0.75, and p-value < 0.01). Conclusion Four in 10 women in late-preterm labor subsequently delivered at term. Combination of examination and clinical features (including parity and gestational age) improved late-preterm birth prediction.

The Effect of Intramuscular 17α-Hydroxyprogesterone in Women Screened for Shortened Cervical Length

2019 ◽  
Vol 37 (07) ◽  
pp. 659-665
Author(s):  
S. Lindsay Wood ◽  
Bria N. Williams ◽  
Jeff M. Szychowski ◽  
John Owen
Keyword(s):  
Gestational Age ◽  
Preterm Labor ◽  
Secondary Analysis ◽  
Cervical Length ◽  
Spontaneous Preterm Birth ◽  
Short Cervix ◽  
Hydroxyprogesterone Caproate ◽  
Gestational Age At Delivery ◽  
Risk Patients ◽  
Multivariable Regression

Abstract Objective This article assesses the effect of weekly intramuscular 17α-hydroxyprogesterone caproate (17P) on midtrimester cervical length (CL) in patients with prior spontaneous preterm birth. Study Design Retrospective cohort study of all singletons that underwent CL screening at a single institution from 2011 to 2016. The timing of 17P exposure was assessed. The primary outcome was shortest midtrimester CL. Secondary outcomes included gestational age at delivery, rate of short cervix, cerclage, preterm labor admission, and preterm premature rupture of the membranes (PROM). Multivariable regression analysis was used to model the relationship between 17P exposure and shortest CL, controlling for selected covariates. Results Of 409 women who underwent screening, 211 received and 198 did not receive 17P prior to the last CL. Rates of short cervix and cerclage were similar between groups. After adjusting for covariates, the shortest CL was significantly shorter in the 17P group. In a secondary analysis, those who received any 17P (n = 293) versus those who did not (n = 116) had higher rates of preterm PROM, preterm labor admission, and cerclage. After controlling for covariates, gestational age at delivery was significantly lower in those receiving 17P. Conclusion In high-risk patients undergoing CL screening for ultrasound-indicated cerclage, 17P did not prevent midtrimester cervical shortening or prolong gestation.

Effect of prenatal isoxsuprine on pulmonary oxygen toxicity in the newborn rat

1980 ◽  
Vol 48 (3) ◽  
pp. 505-510 ◽  
Author(s):  
L. Frank ◽  
J. Summerville ◽  
D. Massaro
Keyword(s):  
Enzyme Activities ◽  
Oxygen Toxicity ◽  
Fetal Lung ◽  
Antioxidant Enzyme Activities ◽  
Newborn Rats ◽  
Lung Maturation ◽  
Lung Weight ◽  
Pregnant Rats ◽  
Rat Pups ◽  
Hyperoxic Exposure

Isoxsuprine, a beta-sympathomimetic agent used clinically to delay premature parturition and to possibly accelerate fetal lung maturation, was administered to pregnant rats at 48 and 24 h prior to delivery. Newborn rats were placed in 96-98% O2 (or room air) to determine if the prenatal isoxsuprine treatment compromised their tolerance to prolonged hyperoxic exposure. (Exogenous catecholamines are known to exacerbate O2 toxicity in adult animals). Survival of the isoxsuprine-treated pups in O2 (52%) was no different than for control neonates exposed to hyperoxia for 7 days (57%) (P = 0.22). Body weight, lung weight, lung protein, and DNA content of the newborns were also not altered by the prenatal isoxsuprine treatment. Lung antioxidant enzyme activities for superoxide dismutase, catalase, and glutathione peroxidase were the same at birth in the isoxsuprine-treated and control rat pups, and the enzyme activities increased in response to hyperoxic exposure in each group to an equivalent degree. Thus, in utero treatment with isoxsuprine had no apparent adverse effect on newborn rats exposed to a prolonged O2 challenge.

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