Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes

Crowther, Caroline A; McKinlay, Christopher J.D.; Middleton, Philippa; Harding, Jane E.

doi:10.1002/14651858.cd003935.pub3

Cited by 164 publications

(107 citation statements)

References 89 publications

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“…The combined use of these two corticosteroids has not been tested. A single repeat rescue course of antenatal betamethasone, given after the first completion of the course to women with threatened preterm labour, reduces RDS and other shortterm health problems, however, these effected are paralleled by the reduced birth weight [122,123].…”

Section: Corticosteroidsmentioning

confidence: 99%

Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome

Tchirikov

Schlabritz‐Loutsevitch

Mäher

et al. 2017

Journal of Perinatal Medicine

188

153

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Mid-trimester preterm premature rupture of membranes (PPROM), defined as rupture of fetal membranes prior to 28 weeks of gestation, complicates approximately 0.4%-0.7% of all pregnancies. This condition is associated with a very high neonatal mortality rate as well as an increased risk of long-and short-term severe neonatal morbidity. The causes of the mid-trimester PPROM are multifactorial. Altered membrane morphology including marked swelling and disruption of the collagen network which is seen with PPROM can be triggered by bacterial products or/and pro-inflammatory cytokines. Activation of matrix metalloproteinases (MMP) have been implicated in the mechanism of PPROM. The propagation of bacteria is an important contributing factor not only in PPROM, but also in adverse neonatal and maternal outcomes after PPROM. Inflammatory mediators likely play a causative role in both disruption of fetal membrane integrity and activation of uterine contraction. The "classic PPROM" with oligo/anhydramnion is associated with a short latency period and worse neonatal outcome compared to similar gestational aged neonates delivered without antecedent PPROM. The "high PPROM" syndrome is defined as a defect of the chorio-amniotic membranes, which is not located over the internal cervical os. It may be associated with either a normal or reduced amount of amniotic fluid. It may explain why sensitive biochemical tests such as the Amniosure (PAMG-1) or IGFBP-1/alpha fetoprotein test can have a positive result without other signs of overt ROM such as fluid leakage with Valsalva. The membrane defect following fetoscopy also fulfils the criteria for "high PPROM" syndrome. In some cases, the rupture of only one membrane -either the chorionic or amniotic membrane, resulting in "pre-PPROM" could precede "classic PPROM" or "high PPROM". The diagnosis of PPROM is classically established by identification of nitrazine positive, fern positive watery leakage from the cervical canal observed during in specula investigation. Other more recent diagnostic tests include the vaginal swab assay for placental alpha macroglobulin-1 test or AFP and IGFBP1. In some rare cases amniocentesis and infusion of indigo carmine has been used to confirm the diagnosis of PPROM. The management of the PPROM requires balancing the potential neonatal benefits from prolongation of the pregnancy with the risk of intraamniotic infection and its consequences for the mother and infant. Close monitoring for signs of chorioamnionitis (e.g. body temperature, CTG, CRP, leucocytes, IL-6, procalcitonine, amniotic fluid examinations) is necessary to minimize the risk of neonatal and maternal complications. In addition to delayed delivery, broad spectrum antibiotics of penicillin or cephalosporin group and/or macrolide and corticosteroids have been show to improve neonatal outcome [reducing risk of chorioamnionitis (average risk ratio (RR) = 0.66), neonatal infections (RR = 0.67) and abnormal ultrasound scan of neonatal brain (RR = 0.67)]. The positive effect of continuo...

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Section: Corticosteroidsmentioning

confidence: 99%

Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome

Tchirikov

Schlabritz‐Loutsevitch

Mäher

et al. 2017

Journal of Perinatal Medicine

188

153

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“…59,60,61 The results of ten randomized controlled trials, involving 4730 women and 5650 neonates have been summarized recent in a Cochrane review. 62 Treatment of women who remained at risk of preterm birth seven or more days after an initial course of antenatal corticosteroids with repeat dose(s) compared with no repeat treatment reduced the risk of infant respiratory distress syndrome (RR 0.83, 95%CI 0.75–0.91). In addition, serious infant morbidity was reduced by repeat dose(s) (RR 0.84, 95%CI 0.75–0.94).…”

Section: Timing Of Administrationmentioning

confidence: 99%

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

Bonanno

Wapner

2012

Obstetrics and Gynecology Clinics of North America

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“…Likewise, the evidence for repeating treatment if delivery has not occurred within 7 days is mixed. Meta-analysis revealed that infants exposed to multiple steroid courses have lower risk of early respiratory morbidity, but tend to have reduced birth weight and head circumference 31. Current guidance advises against multiple courses, although a single additional rescue course may be appropriate when the first was before 26 weeks gestation 28…”

Section: Antenatal Interventionsmentioning

confidence: 99%

Protecting the premature brain: current evidence-based strategies for minimising perinatal brain injury in preterm infants

Lea

Smith-Collins

Luyt

2016

Arch Dis Child Fetal Neonatal Ed

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. INTRODUCTIONSurvival rates for preterm babies are increasing, 1 however severe neurological impairment remains a significant consequence of preterm birth.2 3 Research continues into potential treatments for reducing both the risk of initial brain injury and subsequent neurodevelopmental problems; 4 however, in the interim, these can be reduced by optimising currently approved and recommended practices.

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Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes

Cited by 164 publications

References 89 publications

Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome

Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome

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

Protecting the premature brain: current evidence-based strategies for minimising perinatal brain injury in preterm infants

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