Antenatal Corticosteroids in the Management of Preterm Birth: Are We Back Where We Started?

Bonanno, Clarissa; Wapner, Ronald J.

doi:10.1016/j.ogc.2011.12.006

Cited by 73 publications

(72 citation statements)

References 61 publications

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“…Similar delays result from the administration of antibiotics to women experiencing preterm premature rupture of membranes (PPROM) (21). While these approaches may provide time for the administration of glucocorticoids, which do reduce risk for respiratory distress, intraventricular hemorrhage, and necrotizing enterocolitis (22), they are ultimately not effective strategies to prevent PTB.…”

Section: Prediction and Preventionmentioning

confidence: 99%

A proposed bio-panel to predict risk for spontaneous preterm birth among African American women

2015

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Preterm birth (PTB), or birth prior to 37 weeks gestation, impacts 11.5% of U.S. deliveries. PTB results in significant morbidity and mortality among affected children and imposes a large societal financial burden. Racial disparities in PTB are alarming. African American women are at more than 1.5 times the risk for PTB than white women. Unfortunately, the medical community’s ability to predict who is at risk for PTB is extremely limited. History of a prior PTB remains the strongest predictor during a singleton gestation. Cervical length and fetal fibronectin measurement are helpful tools. However, usefulness is limited, particularly among the 95% of U.S. women currently pregnant and lacking a history of PTB. Therefore, preventive therapies do not reach a great number of women who may benefit from them. This manuscript, in response to the pressing need for predictors of PTB risk and elimination of racial disparities in PTB, presents a proposed bio-panel for use in predicting risk for spontaneous PTB among African American women. This bio-panel, measured each trimester, includes stimulated production of interleukin (IL)-1β, tumor necrosis factor (TNF)-α, IL-1 receptor antagonist (Ra), soluble(s) TNF receptor(R) 1, and sTNFR2, and cortisol responsiveness. We hypothesize that greater IL-1β and TNF-α production, decreased IL-1Ra, sTNFR1, and sTNFR2 production, and decreased cortisol responsiveness at each time point as well as a more expedient alignment with this unfavorable profile over time will be associated with PTB. The choice to focus on inflammatory parameters is supported by data highlighting a crucial role for inflammation in labor. Specific inflammatory mediators have been chosen due to their potential importance in preterm labor among African American women. The bio-panel also focuses on inflammatory regulation (i.e., cytokine production upon ex vivo stimulation), which is hypothesized to provide insight into potential in vivo leukocyte responses and potential for initiation of a preterm inflammatory cascade. Production of receptors antagonists is also considered, as pro-inflammatory mediator effects can be greatly influenced by their balance with respective antagonists. Finally, leukocyte responsiveness to cortisol is included as a measure of cortisol’s ability to convey anti-inflammatory signals. The development of a bio-panel predictive of risk for spontaneous PTB among African American women would represent a significant advancement. Available preventive therapies, namely progesterone supplementation, could be delivered to women deemed at risk. Further, the identification of biological predictors of PTB may uncover novel targets for preventive therapies.

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Section: Prediction and Preventionmentioning

confidence: 99%

A proposed bio-panel to predict risk for spontaneous preterm birth among African American women

2015

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“…It is well-known that clinical practice often lags behind both changes in primary evidence as well as clinical guidelines. 13–16 Reasons for failure to follow guidelines include knowledge gaps, disagreement with the guidelines, presence of external barriers, and the need to overcome inertia. 13 Studies of dissemination and implementation science have demonstrated a number of effective approaches to encourage uptake of new guidelines into clinical practice.…”

Section: Commentmentioning

confidence: 99%

“…13–15 For instance, within obstetrics, the delay between discovery of the beneficial effects of antenatal corticosteroids and their adoption into routine practice has been well documented. 16 …”

Section: Introductionmentioning

confidence: 99%

New labor management guidelines and changes in cesarean delivery patterns

Rosenbloom

Stout

Tuuli

et al. 2017

American Journal of Obstetrics and Gynecology

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Background In 2010 the Consortium on Safe Labor published labor curves. It was proposed that the rate of cesarean delivery (CD) could be lowered by avoiding the diagnosis of arrest of dilation before 6 cm. However, there is little information on the uptake of the guidelines and on changes in CD rates that may have occurred. Objective To test the hypotheses that: 1) among patients laboring at term, rates of arrest of dilation disorders have decreased leading to a decrease in the rate of CD; 2) in the second stage, pushing duration prior to diagnosis of arrest of descent has increased also leading to reduction in the rate of CD for this indication. As a secondary aim, we investigated changes in maternal and neonatal morbidity. Study Design This was a secondary analysis of a prospective cohort study of all patients presenting at ≥ 37 weeks’ gestation from 2010–2014 with a non-anomalous vertex singleton and no prior history of CD. Rates of CD, arrest of dilation, and changes in rates of maternal and neonatal morbidity were calculated in crude and adjusted models. Cervical dilation at diagnosis of arrest of dilation, time spent at the maximal dilation prior to diagnosis of arrest of dilation, and time in the second stage prior to diagnosis of arrest of descent were compared over the study period. Results There were 7845 eligible patients. The CD rate in 2010 was 15.8% and in 2014 17.7% (p-trend 0.51). In patients undergoing CD for arrest of dilation, the median cervical dilation at the time of CD was at 5.5 cm in 2010 and 6.0 cm in 2014 (p-trend 0.94). In these patients, there was an increase in the time spent at last dilation: 3.8h in 2010 to 5.2h in 2014 (p-trend 0.02). There was no change in the frequency of patients diagnosed with arrest of dilation at <6 cm: 51.4% in 2010 and 48.6% in 2014 (p-trend 0.56). However, in these patients, the median time spent at the last cervical dilation was 4.0h in 2010 and 6.7h in 2014 (p-trend 0.046). There were 206 CDs for arrest of descent. The median pushing time in these patients increased in multiparous patients from 1.1h in 2010 to 3.4h in 2014 (p-trend 0.009); in nulliparous patients these times were 2.7h in 2010 and 3.8h in 2014 (p-trend 0.09). There was a significant trend towards increasing adverse neonatal and maternal outcomes (p<0.001 for each). The aOR for adverse maternal outcome for 2014 compared to 2010 was 1.66 (95%CI 1.27, 2.17); however considering only transfusion, hemorrhage, or infection, there was no difference (p-trend 0.96). The aOR of adverse neonatal outcome in 2014 compared to 2010 was 1.80 (95%CI 1.36, 2.36). Conclusion Despite significant changes in labor management that have occurred over the initial years since publication of the new labor curves and associated guidelines, the primary CD rate was not reduced and there has been an increase in maternal and neonatal morbidity in our institution. A randomized controlled trial is needed.

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“…El índice de masa corporal no influencia el desenlace neonatal en mujeres que reciben corticoides; no hay un régimen alternativo para las pacientes obesas (42).…”

Section: Corticoidesunclassified

Guía fármacoterapeutica de amenaza de parto pretérmino

Osorio

Garcia

2015

Rev. Colomb. Enferm.

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RESUMENEl parto pretérmino representa un reto terapéutico ya que su tratamiento oportuno disminuye la morbilidad y mortalidad neonatal. Afecta de 5 a 11% de todos los partos en el mundo, entre 9 y 10% en países de bajos ingresos y de 6 a 11,9% en países con altos ingresos. Es el responsable de 70% de las muertes neonatales y 37% de las muertes en infantes así como el causante de 25 a 50% de los casos de falla en el desarrollo neurológico en niños. Por lo anterior, es importante realizar un adecuado tamizaje y tratamiento de las pacientes que se encuentran en riesgo de parto pretérmino. Para ello, se realizó una guía fármacoterapeutica basada en la mejor evidencia para su manejo.Palabras clave: parto pretérmino, magnesio, esteroides, progesterona, tocólisis. Artículo de RevisiónGuía fármacoterapeutica de amenaza de parto pretérmino ABSTRACT preterm labor represents a therapeutic challenge because opportune treatment decreases neonatal morbidity and mortality. It affects 5-11% of all worldwide births. Of these births 9-10% occurred in low-income countries and 6-11.9% in high-income countries. Preterm labor is responsible for 70% of neonatal deaths and 37% of infant deaths; it causes 25-50% of the cases of neurological development failure in children. Because of this, it is important to perform adequate screening and treatment of patients at risk for preterm delivery. A pharmaceutical guide based on the best evidence for its management was performed.Key words: premature birth, magnesium, steroids, progesterone, tocolysis. RESUMOO parto prematuro representa um desafio terapêutico, uma vez que seu tratamento oportuno diminui a morbidez e mortalidade neonatal. Afeta de 5 a 11% de todos os partos no mundo, sendo que, entre 9 e 10% ocorrem em países de baixa renda, e de 6 a 11,9%, em países de alta renda. É responsável por 70% das mortes neonatais e 37% das mortes em recém-nascidos, assim como é o causador de 25 a 50% dos casos de falha no desenvolvimento neurológico em crianças. Por este motivo, é importante realizar uma triagem e tratamento adequados das pacientes que se encontram em risco de parto prematuro. Portanto, foi elaborado um guia farmacoterapêutico com base na melhor evidência para seu manuseio.Palavras-chave: parto prematuro, magnésio, esteroides, progesterona, tocólise.

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Antenatal Corticosteroids in the Management of Preterm Birth: Are We Back Where We Started?

Cited by 73 publications

References 61 publications

A proposed bio-panel to predict risk for spontaneous preterm birth among African American women

A proposed bio-panel to predict risk for spontaneous preterm birth among African American women

New labor management guidelines and changes in cesarean delivery patterns

Guía fármacoterapeutica de amenaza de parto pretérmino

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