Maternal Steroids on Fetal Doppler Indices, in Growth-Restricted Fetuses with Abnormal Umbilical Flow from Pregnancies Complicated with Early-Onset Severe Preeclampsia

Abstract

Corticoids are largely used for fetal interest in expected preterm deliveries. This study went further, evaluating the effect of maternal administration of dexamethasone (Dex) on the umbilical artery (UA), middle cerebral artery (MCA), and ductus venous (DV) spectrum, in growth-restricted fetuses, with the absent end-diastolic flow (AEDF) in UA, from singleton early-onset severe preeclamptic pregnancies. Supplementary, the impact on both uterine arteries (UTAs) flow was also evaluated. In 68.7% of cases, the EDF was transiently restored (trAEDF group), in the rest of 31.2% remained persistent absent (prAEDF group). UA-PI significantly decreased in the first day after Dex (day 1/0; p < 0.05), reaching its minimum during day 2 (day 2/1; p > 0.05), revealing a significant recovery to day 4 (day 4/2; p < 0.05), in both groups. The MCA-PI decreased from day 1 until day 3 in both groups, but significantly only in the trAEDF group (p = 0.030 vs. p = 0.227. The DV-PI’s decrease (during day 1) and the CPR’s increase (between days 0 and 2) were not significant in both groups. UTAs-PIs did not vary. The prAEDF group had a significantly increased rate of antenatal worsening Doppler and a poorer perinatal outcome compared with the trAEDF group. In conclusion, Dex transiently restored the AEDF in UA in the majority of cases, a “positive” effect being a useful marker for better perinatal prognosis. UA-PI significantly decreased in all cases. The improvement in umbilical circulation probably was responsible for the short but not significant DV-PI reduction. MCA-PI decreased only in sensitive cases, probably due to an already cerebral “full” vasodilation in the prAEDF group. Furthermore, the CPR’s nonsignificant improvement was the result of a stronger effect of Dex on UA-PI than on MCA-PI. Finally, despite the same etiology, it was only a weak correlation between the severity of the umbilical and uterine abnormal spectrum.

The value of lung ultrasound score in neonatal respiratory distress syndrome: a prospective diagnostic cohort study

“…Noticeable changes in the fluid-to-gas ratio across different lung tissue types represent varying degrees of lung tissue aeration loss. Severe involvement results in contiguous and fused B-lines, while moderate involvement is characterized by multiple well defined B-lines ( 37 ). Pearson correlation analysis revealed a negative correlation between LUS and OI, and positive correlations between LUS and RI, OI, and SOFA scores (all p < 0.01), indicating that LUS accurately reflects NRDS progression.…”

Targeting Neutrophil Extracellular Trap Formation: Exploring Promising Pharmacological Strategies for the Treatment of Preeclampsia

“…It has been proposed that single doses after week 24 (2 doses of 12 mg betamethasone 24 h apart or 6 mg dexamethasone 12 h apart before delivery) help foetal lung maturation in PE [147,148]. Dexamethasone has been shown to transiently restore absent end-diastolic flow in the umbilical artery in early-onset preeclampsia [149]. However, dexamethasone treatment for PE should be carefully considered, as the use of high doses and repeated doses should be avoided for fear of possible long-term adverse effects on the foetal brain [150].…”