Amanda Henry1,2,3, Aditi Mahajan1, Caroline A Crowther4, Anne Lainchbury5, Lynne Roberts2,6, Antonia W Shand3,7, Alec W Welsh1,3. 1. School of Women's and Children's Health, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia. 2. Department of Women's and Children's Health, St. George Hospital, Sydney, New South Wales, Australia. 3. Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia. 4. Liggins Institute, University of Auckland, Auckland, New Zealand. 5. Royal Hospital for Women, Sydney, New South Wales, Australia. 6. St. George and Sutherland Clinical School, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia. 7. Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
Abstract
INTRODUCTION: Maternal corticosteroid administration for anticipated preterm birth is common; however, the corticosteroid effect on fetal ultrasound and cardiotocograph (CTG) remains contested. This study aimed to evaluate short-term ultrasound and CTG impact of (a) dexamethasone versus betamethasone (b) pooled corticosteroid effect. METHODS: Substudy of blinded randomized trial of dexamethasone versus betamethasone (given <34 weeks). Umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV), and uterine artery Doppler, myocardial performance index (MPI), biophysical profile (BPP), and CTG measured pre-corticosteroid then 1, 2, 4, and 7 days post-corticosteroid. RESULTS: Of 47 fetuses (39 singleton; 4 dichorionic, diamniotic twins; and 4 monochorionic, diamniotic twins) in the February 2012-2013 period, 24 received dexamethasone and 23 betamethasone at average gestation 29.8 ± 2.9 weeks. Thirteen pregnancies (30%) had pre-corticosteroid fetal concerns (estimated weight <10th centile and/or abnormal UA/MCA Doppler). Few significant differences were seen post-corticosteroid: DV pulsatility index and right MPI initially decreased 15-20%, and average BPP decreased slightly on days 1-2. There were no major differential effects of dexamethasone versus betamethasone. DISCUSSION/ CONCLUSION: No substantive post-corticosteroid effects were seen for most ultrasound/CTG measures in fetuses with heightened preterm birth risk but predominantly normal pre-corticosteroid measures. Clinically, this suggests avoiding overreliance on individual measures for delivery decisions post-corticosteroid; equally, multiple/marked ultrasound changes suggest true pathology and not corticosteroid effect.
INTRODUCTION: Maternal corticosteroid administration for anticipated preterm birth is common; however, the corticosteroid effect on fetal ultrasound and cardiotocograph (CTG) remains contested. This study aimed to evaluate short-term ultrasound and CTG impact of (a) dexamethasone versus betamethasone (b) pooled corticosteroid effect. METHODS: Substudy of blinded randomized trial of dexamethasone versus betamethasone (given <34 weeks). Umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV), and uterine artery Doppler, myocardial performance index (MPI), biophysical profile (BPP), and CTG measured pre-corticosteroid then 1, 2, 4, and 7 days post-corticosteroid. RESULTS: Of 47 fetuses (39 singleton; 4 dichorionic, diamniotic twins; and 4 monochorionic, diamniotic twins) in the February 2012-2013 period, 24 received dexamethasone and 23 betamethasone at average gestation 29.8 ± 2.9 weeks. Thirteen pregnancies (30%) had pre-corticosteroid fetal concerns (estimated weight <10th centile and/or abnormal UA/MCA Doppler). Few significant differences were seen post-corticosteroid: DV pulsatility index and right MPI initially decreased 15-20%, and average BPP decreased slightly on days 1-2. There were no major differential effects of dexamethasone versus betamethasone. DISCUSSION/ CONCLUSION: No substantive post-corticosteroid effects were seen for most ultrasound/CTG measures in fetuses with heightened preterm birth risk but predominantly normal pre-corticosteroid measures. Clinically, this suggests avoiding overreliance on individual measures for delivery decisions post-corticosteroid; equally, multiple/marked ultrasound changes suggest true pathology and not corticosteroid effect.
Authors: Caroline A Crowther; Pat Ashwood; Chad C Andersen; Philippa F Middleton; Thach Tran; Lex W Doyle; Jeffrey S Robinson; Jane E Harding Journal: Lancet Child Adolesc Health Date: 2019-09-12
Authors: Caroline A Crowther; Jane E Harding; Philippa F Middleton; Chad C Andersen; Pat Ashwood; Jeffrey S Robinson Journal: BMC Pregnancy Childbirth Date: 2013-05-03 Impact factor: 3.007