A pregnant mother at 32 weeks gestation presents in preterm labour. Therapy with antenatal steroids to induce lung maturity in the fetus may be given in all of the following conditions except:
Correct Answer: Chorioamnionitis
Description: “Corticosteroids can be given even in presence of maternal hypertension or diabetes mellitus, but should preferably be avoided if PROM is associated with definitive evidence of chorioamnionitis”
Meherban Singh 5/e, p 227
“Steroid treatment is contraindicated in presence of overt infection.”
Fernando Arias 3/e, p 220
Steroid therapy in preterm labour:
Steroids are recommended for all women in preterm labour before 32 weeks with or without membrane ruptures in whom there is no evidence of chorioamnionitis. According to ACOG, single dose steroid injection is recommended between 24 to 32 weeks. There is no concensus regarding treatment between 32-34 weeks. Corticosteroid therapy is not recommended before 24 weeks.
Advantage:
Steroids reduce the rate of respiratory distress syndrome, intraventricular hemorrhage and necrotising enterocolitis in the newborn.
The effect of treatment is maximal between 24 hours of the first dose and uptil 7 days.
Earlier it was recommended to give repeated doses weekly till the patient delivers but this practice is associated with significant fetal and neonatal side effects like cerebral palsy and should be abandoned.
Betamethasone is the steroid of choice as it also prevents periventricular leukomalacia although dexamethasone can also be used.
Dose:
Betamethasone = 2 doses of 12 mg, 24 hours apart,
Dexamethosane: 4 doses of 6 mg, 12 hours apart.
Category:
Gynaecology & Obstetrics
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