Use Of Antenatal Corticosteroids  For Fetal Maturation 

1. TITLE  :

Use Of Antenatal Corticosteroids  For Fetal Maturation

2. PURPOSE

To identify the indication, contraindications and complications of antenatal corticosteroids. This policy is regarding the use of antenatal corticosteroids ,reflects recommended guidelines for care. 

3. CONDITION/APPLICABILITY:

The attending physicians and all treating team members

Nursing staff in Labor and Delivery unit, Obstetrics and Gynecology Wards, emergency department and clinic

4. PATIENT GROUP

   1.  All pregnant women at high risk of preterm delivery between 23 and 34 weeks of gestation.

   2. All pregnant women going for elective caesarean section less than 38wk+6d

5. TARGET AREA

Labor and Delivery unit, Obstetrics and Gynecology wards, OPD and emergency department.

6. PROTOCOL

1. The indication for antenatal corticosteroid therapy in single and twin pregnancy 

   1. Antenatal Corticosteroids therapy should be indicated to all women at high risk of preterm delivery between 23 and 33+6 weeks of gestation.

   2. Consider antenatal Corticosteroids therapy (34-35+6) weeks of gestation when there is stablish preterm labor or plan delivery. 

   3. Antenatal Corticosteroids therapy can be considered at 37-38+6 weeks –before planned cesarean delivery to reduced neonatal respiratory morbidity patient should be council for cons prone for antenatal corticosteroid  

   4. A course of antenatal Corticosteroids is indicated in pregnant women with pre-gestational or gestational diabetes at risk of preterm delivery with close monitoring and treatment of hyperglycemia.

   5. Keep in consideration the changes of CTG “reduce variability “ up to 48hrs post administration of antenatal Corticosteroids.

2. Type and dose of antenatal Corticosteroids

   1. Dexamethasone to be given in a course of two doses of 12 mg administered intramuscularly 24 hours apart.

   2. An alternative regimen for diabetic patient GDM or DM would be four doses of 6 mg dexamethasone intramuscularly every 12 hours for four doses.

   3. A course of dexamethasone is still indicated in patients receiving treatment with hydrocortisone for other causes.

   4. Rescue course of antenatal Corticosteroids is consultant base decision  

3. Contraindications to the Administration of antenatal Corticosteroids

   1. maternal systemic infections &suspected chorioamnionitis 

7. RELATED REFERENCES

8.1   UpTO Date: Antenatal corticosteroid therapy for reduction of neonatal respiratory morbidity and mortality from preterm delivery Authors:Men-Jean Lee, MD,Debra Guinn, MD, FACOG

Literature review current through: Oct 2021

      8.2 McGoldrick E, Stewart F, Parker R, Dalziel SR. Antenatal corticosteroids for     accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2020; 12:CD004454.

      8.3   National Institute for Health and Care Excellence (NICE): Guideline on preterm labour and birth (2015, updated 2019

        8.4 Sotiriadis A, Makrydimas G, Papatheodorou S, et al. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database Syst Rev 2018; 8:CD006614.

        8.5 WHO recommendations on interventions to improve preterm birth outcomes Highlights and Key Messages from the World Health Organization’s 2015 Global Recommendations  

        8.6 Society for Maternal-Fetal Medicine (SMFM) Publications Committee. Implementation of the use of antenatal corticosteroids in the late preterm birth period in women at risk for preterm delivery. Am J Obstet Gynecol 2016; 215:B13.

       8.7 Amiya RM, Mlunde LB, Ota E, et al. Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of Women at Risk of Imminent Preterm Birth: A Systematic  Review and Meta-Analysis. PLoS One 2016; 11:e0147604.

      8.8 Ushida T, Kotani T, Sadachi R, et al. Antenatal Corticosteroids and Outcomes in Preterm Twins. Obstet Gynecol 2020; 135:1387.

8. It is review  Guideline and should be revised every two years

9. APPROVALS :