Influence of steroid prophylaxis on prenatal and postnatal parameters in fetuses with intrauterine growth restriction
 
More details
Hide details
1
Klinika Ginekologii i Położnictwa, Katedra Ginekologii i Położnictwa, Wydział Lekarski w Katowicach, Śląski Uniwersytet Medyczny w Katowicach
 
2
Klinika Neonatologii, Katedra Ginekologii i Położnictwa, Wydział Lekarski w Katowicach, Śląski Uniwersytet Medyczny w Katowicach
 
 
Corresponding author
Maksymilian Grzegórzko   

Klinika Ginekologii i Położnictwa, Katedra Ginekologii i Połoznictwa, Wydział Lekarski w Katowicach, Śląski Uniwersytet Medyczny w Katowicach, ul. Medyków 14, 40-752 Katowice
 
 
Ann. Acad. Med. Siles. 2018;72:6-11
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The administration of steroids during pregnancy up to 34 weeks accelerates the development of fetal lungs and stimulates surfactant production, therefore, it protects premature neonates against infant respiratory distress syndrome. It has been proven that the administration of steroids causes a temporary decrease in the fetal heart rate in fetuses appropriate for gestational age (AGA). How long does the temporary decrease in fetal heart rate (FHR) after steroid administration persist in intrauterine growth restriction fetuses (IUGR)?

Material and methods:
The study was conducted on 152 patients from the Clinic of Obstetrics and Gyneacology MUS in Katowice in 2013–2016, divided into two groups: AGA – 109 cases and IUGR – 43 cases. Steroid prophylaxis – betamethasone or dexamethasone was given in both groups. CTG and Monako records at admission and 24 and 48 hours after steroid administration were analysed with assessment of: FHR baseline, bradycardia episodes as well as LTV and STV parameters. All the results were analysed in the Statistica 12PL program.

Results:
Bradycardia after steroids occurred more frequently in AGA than in IUGR. After the first dose of steroids significantly lower bradycardia was noticed in the AGA group than IUGR (p = 0.0001). The FHR decrease after the first dose of steroids was bigger in the AGA group than in the IUGR group (p = 0.0001). The average STV value after the second dose of steroids was significantly lower in group the AGA group than in the IUGR group (p = 0.006). Oxygen partial pressure was higher in the IUGR group (p = 0.001).

Conclusions:
In the light of the results, it seems that fetuses with intrauterine growth restriction exhibit better tolerance to steroid administration in the form of a less frequent occurrence of bradycardia, higher STV values and smaller fluctuations in FHR.

 
REFERENCES (17)
1.
Liggins G.C. Premature delivery of fetal lambs infused with glucocorticoids. J. Endocrinol. 1969; 45(4): 515–523.
 
2.
Liggins G.C, Howie R.N. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 1972; 50: 515–525.
 
3.
Baillie P., Saunders M.C., Malan A.F., Davey D.A. The Active Management of Pre-term Labour and Its Effects on Fetal Outcome.  Australian and New Zealand Journal of Obstetrics and Gynaecology 1976; 16(2): 94–99.
 
4.
Crowther C.A., McKinlay C.J., Middleton P., Harding J.E. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. Cochrane Database Syst Rev. 2015; (7): CDOO3935. doi: 10.1002/14651858.CD003935.pub4.
 
5.
Saccone G., Berghella V. Antenatal corticosteroids for maturity of term or near term fetuses: systematic review and meta-analysis of randomized controlled trials. BMJ 2016; 355: i5044.
 
6.
Brownfoot F.C., Gagliardi D.I., Bain E., Middleton P., Crowther C.A. Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst. Rev. 2013; (8): CD006764.
 
7.
Markwitz W., Ropacka M., Breborowicz G.H. Analysis of selected parameters of maternal and fetal status during stimulation of fetal lung maturation. Ginekol. Pol. 2001; 72(4): 191–200.
 
8.
De Heus R., Mulder E.J., Derks J.B., Koenen S.V., Visser G.H. Differential effects of betamethasone on the fetus between morning and afternoon recordings. J. Matern. Fetal. Neonatal. Med. 2008; 21(8): 549–554.
 
9.
Roberts D., Brown J., Madley N., Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst. Rev. 2017; 3: CD004454.pub3.
 
10.
Crowther C.A., Haslam R.R., Hiller J.E., Doyle L.W., Robinson J.S. Neonatal respiratory distress syndrome after repeat exposure to antenatal corticosteroids: a randomized controlled trial. Lancet 2006, 367(9526); 1913––1919.
 
11.
Piazze J., Dillon K.C., Albana C. Full-term-pregnancy effects of antenatal betamethasone administration on short-term variation as assessed by com-puterized cardiotocography. J. Prenat. Med. 2012; 6(2): 18–21.
 
12.
Danesh A., Janghorbani M., Khalatbari S. Effects of antenatal corticosteroids on maternal serum indicators of infection in women at risk for pre-term delivery: A randomized trial comparing betamethasone and dexamethasone. J. Res. Med. Sci. 2012; 17(10): 911–917.
 
13.
Rotmensch S., Lev S., Kovo M., Efrat Z., Zahavi Z., Lev N., Celentano C., Ben-Rafael Z. Effect of betamethasone administration on fetal heart rate tracing: a blinded longitudinal study. Fetal Diagn. Ther. 2005; 20(5): 371–376.
 
14.
Frusca T., Soregaroli M., Valcamonico A., Scalvi L., Bonera R., Bianchi U. Effect of betamethasone on computerized cardiotocographic parameters in preterm growth-restricted fetuses with and without cerebral vasodilation. Gynecol. Obstet. Invest. 2001; 52(3): 194–197.
 
15.
Schneider U., Fiedler A., Schröder B., Jaekel S., Stacke A., Hoyer D., Schleussner E. Human fetal heart rate variability-characteristics of autonomic regulation in the third trimester of gestation. J. Perinat. Med. 2008; 36(5): 433–441.
 
16.
Van Iddekinge B., Hofmeyr G.J., Buchmann E.J. Visual interpretation of the effect of maternal betamethasone administration on the fetal heart rate pattern. van Iddekinge B., Hofmeyr G.J., Buchmann E. Obstet. Gynaecol. 2003; 23(4): 360–363.
 
17.
Shenhav S., Volodarsky M., Anteby E.Y., Gemer O. Fetal acid-base balance after betamethasone administration: relation to fetal heart rate variability. Arch. Gynecol. Obstet. 2008; 278(4): 333–336. 0582-y.
 
eISSN:1734-025X
Journals System - logo
Scroll to top