Repeat Antenatal Glucocorticoids for Women at Risk of Preterm Birth

Abstract

Phase II included another 6-month period of data collection on cesarean births with emphasis on improving dialog between nurses and physicians. Each case was accompanied by a worksheet completed and signed by both the physicians and nurses. A second operating room (OR) was made available for emergency cases. Ongoing education regarding the 30-minute standard was available during this phase. The standard was met in 45% of the cases and the average time for DI dropped to 37 minutes.Phase III saw the implementation of a new work flow which simplified communication and emphasized teamwork. Two OR's and 2 anesthesiologists were made available specifically for cesarean deliveries. It was decided that all patients would be moved to the OR in 5-10 minutes without delaying for patient consent and that IV's, Foley's, and compression devices would be accomplished in the OR rather than in the labor area. This has proved to be a critical factor in obtaining the goals of the standard. The standard was met in 56% of cases and the length of time for DI decreased to 33 minutes.During phase IV, data collection and reporting were made more visible and times from decision to transport and DI were tracked. Monthly results were posted in the physicians' and nurses' lounges and graphic images displayed progress. Those cases which were >30 minutes were displayed with reasons for the delay. Medical personnel were not identified but the caregivers were contacted individually. The DI time decreased to 27 minutes and the standard was met in 65% of cases.The final phase began the initiation of "Code Green," which announced to all labor and delivery personnel the need for cesarean section for fetal intolerance to labor. Code Green announcement allowed for immediate attention and prioritization to emergency cases. With the initiation of Code Green, over 90% of the cases met the standard, the mean DI time dropped to <25 minutes, and 100% of the cases began within 40 minutes.This study shows that the implementation and achievement of the 30-minute standard is difficult. Efforts to improve timely delivery require continuous communication, data collection, analysis and discussion, and the willingness to change.Topics: Pharmacology, Neonatal Morbidity and Mortality, Maternal Morbidity and Mortality W omen with threatened or planned preterm birth (< 35-wk gestation) should be given a single course of antenatal glucocorticoids. This treatment has been shown to increase the effectiveness of postnatal surfactant therapy in the neonate, to reduce health care costs, and likely reduces the rate of child disability. Despite numerous studies showing their effectiveness, repeated antenatal glucocorticoid therapy remains controversial as there are concerns about the long-term effects of these treatments. The purpose of this study was to determine the safety and

The Role of the Placenta in Fetal Programming

“…Synthetic glucocorticoids, which largely by-pass the placental 11βHSD2 metabolic barrier, are administered to women presenting at risk of early preterm birth to promote fetal lung maturation (McKinlay et al 2012). As discussed above, this obvious benefit may be tempered by potential adverse effects on fetal growth, development, and postnatal responses (Murphy et al 2008;Davis et al 2009).…”