Antenatal steroids: multiple and "rescue" courses.

The huge potential of antenatal steroids was heralded by Liggins and Howie in 1972.

Obstetricians were slow to adopt their work, and it took until the 1990s before steroids were widely used.

Imagine the armies of babies who died or were harmed by our tardiness!

Another example of pioneering work that is  at first derided by the peer group.

The background is interesting and salutary.

We now accept that antenatal steroids will reduce:

        surfactant-deficiency respiratory disease of the newborn (see MCQ4, question 32),

        the need for neonatal ventilation,

        intra-ventricular haemorrhage,

        and necrotising enterocolitis.

But do not affect broncho-pulmonary dysplasia if a baby does get surfactant-deficient respiratory disease.

Steroids are most effective if the baby delivers

        more than 24 hours,

        but less than 7 days,

        from the time of treatment starting.

After 34 weeks the numbers you would need to treat for evidence of benefit is high.

So a decision about steroid use would be made on an individual basis.

The RCOG's Green-top guideline 7 dated February 2004 deals with this subject.

        or the subsequent development of the child.

It mentions that they are not licensed for this use in the UK.

MRCOG candidates need to know it.

The recommended treatment is two doses of betamethasone, 12 mg. given i.m. 24 hours apart.

Dexamethasone used to be the routine drug.

But is no longer used after being linked to an increased risk of cystic periventricular leucomalacia in babies born < 31 weeks.

I mention this as it is a fact likely to lurk in the database of MRCOG MCQs.

Even incomplete courses are beneficial, reducing the risk of death and intra-ventricular haemorrhage.

Debate continues about:

        repeat or multiple doses of steroids,

        steroid use in multiple pregnancy,

        potential negative effects of steroids on the developing fetus and child.

Repeat, multiple and "rescue" steroids.

Evidence continues to emerge to support the use of a "rescue" course of steroids.

This relates to women who have a dose of steroids as labour is thought imminent, but who don't go into labour.

A few weeks later labour really is imminent and a single, second, "rescue" dose is given.

Repeated doses are not favoured in the UK.