武功密笈

小黃藏書

Ÿ The greatest benefit is achieved if more than 24 hrs and less than 7 days.

Ÿ Infants born within 24 hrs or more than 7 days also show:

i mortality

i incidence or severity of respiratory distress syndrome

i intraventricular hemorrhage

i requirement for oxygen and ventilatory support

i neonatal costs and length of stay in NICU

Ÿ The most significant benefit is seen between 24 and 34 weeks of gestation

Ÿ All pregnant women between 24 and 34 weeks of gestation should be considered candidates for

corticosteroid therapy

Ÿ Any clinical suspicion or evidence of intrauterine infection

Ÿ Caution should be exercised in coexisting conditions maybe adversely affected:

- severe hypertensive disorders in pregnancy

- intrauterine growth restriction

- diabetes mellitus

- Rh isoimmunization

- peptic ulcer disease

Ÿ Betamethasone: 12mg given im. every 24 hrs ´ 2 doses

Ÿ Dexamethasone: 6mg given im. every 12 hrs ´ 4 doses

Ÿ Prenatal Corticosteroids should be administered even if delivery is expected to occur before

the second dose.

1. outweight the potential risk: reduction in the risk of RDS but also a substantial reduction in mortality and IVH
2. all fetus between 24 and 34 weeks gestation at risk
3. eligible for therapy with tocolytics should also be eligible for treatment with antenatal corticosteriods
4. treatment consists of two dose of 12 mg of betamethasone given intramuscularly 24 hours apart or four doses of 6 mg dexamethasone given intramuscularly 12 hours apart. Optimal benefit begins 24 hours after initiation of therapy and lasts 7 days.
5. Treatment for less 24 hours is still associated with significant reduction in neonatalmortaility, RDS, and IVH.
6. PPROM < 30-32 weeks’ gestation in the absence of clinical choriomamnionitis, corticosteriod is recommended because of the high risk of IVH at these early gestational ages.
7. In complicated pregnancies where delivery prior to 34 weeks’ gestation is likely, antenatal corticosteriod use is recommended unless there is evidence that corticosteriods will have an adverse effect on the mother or delivery is imminent.