Indian Journal of Obstetrics and Gynecology Research

Print ISSN: 2394-2746

Online ISSN: 2394-2754

CODEN : IJOGCS

Indian Journal of Obstetrics and Gynecology Research (IJOGR) open access, peer-reviewed quarterly journal publishing since 2014 and is published under auspices of the Innovative Education and Scientific Research Foundation (IESRF), aim to uplift researchers, scholars, academicians, and professionals in all academic and scientific disciplines. IESRF is dedicated to the transfer of technology and research by publishing scientific more...


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Pandya, Khandheriya, Trivedi, and Patel: Antenatal injection betamethasone- A fetal lung warrior


Introduction

Antenatal corticosteroids (ANS) are recommended in pregnant women between 24-34 weeks of gestation deemed at risk for preterm delivery for reducing the incidence rates of RDS in neonates.3, 4

Betamethasone enhances lung surfactant production and increasing lung maturity in newborns. 5, 6, 7 Betamethasone is commonly administered as a combined preparation of betamethasone phosphate and betamethasone acetate, 2 injections are given of 12 mg (2*12 mg) intramuscularly spaced by 24 hourly.8

A significant decrease in the rate of the respiratory distress syndrome (RDS) by 50% after administration of corticosteroids to mothers was shown first by Leggins and Haowie.5, 9

Prophylactic corticosteroid (betamethasone) in single tone pregnancies accelerates the fetal lung maturity, thereby reducing respiratory complications.10 Maternal administration of betamethasone is used for acceleration of the maturity of fetal lungs, reducing neonatal mortality, respiratory distress syndrome, intraventricular haemorrhage and necrotizing enterocolitis in pre-term infant and thereby reducing NICU admission rates of neonate.11 In comparision of vaginal delivery, babies born at or after 37 weeks (at term) by planned or elective caesarean section and before onset of labour are more likely to develop respiratory complications. Betamethasone injections given to mother have been shown to reduce the risk of new born babies having breathing difficulties in babies born before 34 weeks.12 They concluded that antenatal corticosteroid (betamethasone) and delaying delivery till 39 weeks, both reduce the rate of admissions to special care baby units with respiratory distress after elective caesarean section at term or prophylactic steroid administration to those who are at increased risk of pre-term labour.13

In severely growth- restricted fetuses the benefits of betamethasone treatment have been questioned.14 With betamethasone administration, some side effects like reduction in fetal body movements, fetal breathing movements and heart rate variation have been reported.15, 16 These changes are returned to normal values within 4 days following betamethasone treatment and these changes are transient. After repeated courses of steroids there might be increased risk of fetal growth restriction observed.17

The significant number of the women delivers outside of the putative one to seven days therapeutic window after betamethasone or antenatal corticosteroid treatment, and this delay may be associated with an increased risk of maternal and neonatal adverse outcomes. 18

Materials and Methods

This is a prospective study of pregnant women from November 2020 to March 2021. Pregnant women in age group of 19- 33 years visiting obstetrics and gynaecology Department of scientific research institute, Surendranagar, Gujarat, India. In this study 28-36 weeks of pregnant women are included. They were administered injection of 12 mg Betamethasone 24 hourly or a single dose of 24 mg IM as per obstetrician’s decision. Mothers with diabetes mellitus, other maternal medical illness (e.g. serious systemic infections, renal disease, trauma, SLE etc.,), those on prolonged steroid therapy were excluded.

Baseline demographic data of pregnant women included in this study like age of mothers, gestational age at time of presentation, gravid status, betamethasone administration, etc, were recorded from patient’s case file. Then up till delivery, they were followed.

New born babies of the enrolled mothers were observed for respiratory distress, diagnosis, need of ventilation, oxygen therapy, NICU admission and outcome at the time of discharge, etc. all things are noted.

Inclusion criteria

All pregnant women.

Exclusion criteria

  1. Fetal distress

  2. Emergency lscs

  3. Pre-term labour

  4. Mothers with diabetes mellitus

  5. Other maternal medical illness

  6. Other maternal medical illness

  7. Mothers on prolonged steroid therapy

Results

Table 1

Demographic details of antenatal women

Characteristics

Group (n=100)

1

Maternal age, years

19-33 years

2

Gestational Age in weeks

28 – 36 weeks

3

Gravid status (enrolled patients)

Primi

66(66%)

Multi

34(34%)

4

Pre- eclampsia

10 (10%)

Table 1 shows the demographic variables of the study group with regards to maternal age and parity. Among 100 pregnant women of age between 19-33 years, 66 women are primi and 34 are multiparae. In this study group involved pregnant women are of 28-36 weeks of gestational age. Among 100 pregnant women, 10 women are associated with pre-eclampsia.

Table 2

Primary outcome variables

Mode of delivery

Vaginal delivery

58 (40+18)

Lscs

42

Instrumental delivery (vaccum/ outlet forceps)

18

Table 2 shows comparison of primary outcomes, among 100 antenatal women spontaneous vaginal delivery is 58% among which instrumental vaginal delivery is 18% and caesarean section 42%.

Table 3

Diagnosis in babies born within (n=18) and after (n=82 ) 24 hours of betamethasone administration

Diagnosis

<24 hours N(%)

>24 hours N(%)

Normal

08

76

RDS

08

05

NICU admission

10

06

Table 3 shows the diagnosis in babies born within (18 women) and after (82 women) 24 hours of betamethasone administration, among which total 16 NICU admission done. Among 16 NICU admissions, total 13 babies are affected with respiratory distress syndrome (RDS).

Table 4

Neonatal characteristics

Female gender

54 (54%)

Male gender

46 (46%)

Birth weight (gm)

1100 to 3900 gm

Table 4 shows characteristics neonates, among 100 babies, 54 were female and 46 were male. Birth weight of those ranges from 1100-3900 grams.

NICU admission: 16 (16%)

Need for ventilation: 1 (1%)

Need for oxygen therapy: 9 (9%)

Table 5

Neonatal outcome

Indications for NICU admission

Delayed cry

3

Fetal ss

13

Total

16

Table 5 shows neonatal outcome. Total 16 NICU admissions are done, among which 9 babies needed oxygen therapy and only 1 baby (1%) need ventilation. Various causes are also depicted for NICU admission like delayed cry, respiratory distress.

Table 6

Correlation of neonatal respiratory outcomes with maternal diagnosis.

Neonatal diagnosis(n)

Injection- delivery interval(n)

Maternal diagnosis

RDS

<24 hours (8)

Oligohydroamnios

Idiopathic pre-term pain followed by PIH

Anaemia

Premature rupture of membranes

Idiopathic

>24 hours (5)

Meconium stained liquor

Delayed progression of labour

Birth asphyxia

Idiopathic

Table 6 shows the correlation of neonatal respiratory outcomes with the maternal diagnosis in which causes according to injection – time delivery intervals are mentioned.

Discussion

In our private hospital, Scientific Research Institute, Surendranagar, Gujarat we did the study of 100 pregnant women by giving Betamethasone injection IM 24 hourly at 28-34 weeks of gestation of 19-33 age range to see the maternal and neonatal outcome after giving the injection.

Mean weeks of gestation in our study is 33.4. This is corresponding with the range of gestational age in weeks when Betamethasone corticosteroid administration is recommended to mothers in order to impart the maximum benefits to the neonates born.6, 17 Most common recorded diagnosis in our study was oligohydroamnios, idiopathic pre-term pain followed by PIH, anaemia, premature ruptures of membranes. In our study 18 patients delivered within 24 hours of drug administration. Majority of the neonates (8 out of 13) diagnosed with RDS were born in less than 24 hours. However, due to small number of subjects significance of this finding cannot be established.

According to Roberts D and Dalziel SR report, incidence of RDS was significantly reduced in babies born before 48 hours and between one and seven days of treatment of mothers with corticosteroid, but not in those born before 24 hours in corticosteroid treated mothers.6

In spite of this, we have tried in 18 antenatal women came to hospital with complain of labour pain in which injection-delivery time interval was less than 24 hours, result shows that 10 neonates which did not need any NICU admission (Antenatal injection betamethasone- a fetal lung warrior).

A study by Haowei G et al., preterm respiratory failure in advance can be predicted by the Silverman Anderson Score, as it will due to advance prediction of pre-term respiratory failure further aid clinicians in rapid assessment of severity and extent of the respiratory failure in such preterm babies.9

Conclusion

In our study we administered betamethasone corticosteroid in 100 antenatal women of age ranges between 19-33 years of age of gestation age ranges between 28-36 weeks. Our study showed that there was improvement in neonatal outcome and reduced incidence of neonatal respiratory distress syndrome (NRDS) and NICU admission rates in new-born babies. Betamethasone increases surfactant production and increases fetal lung maturity and thereby reducing RDS incidence.

Source of Funding

None.

Conflict of Interest

None.

References

1 

J Chatterjee J Gullam M Vatish S Thornton The management of preterm labourArch Dis Child2007922F88F9310.1136/adc.2005.082289

2 

CL Hermansen Respiratory distress in the new-bornAm Fam Physician200776798794

3 

Impact of Antenatal Betamethasone on Plasma Glucose Levels2010https://clinicaltrials.gov/ct2/show/NCT00585676

4 

C McEvoy D Schilling P Spitale D Peters J O'Malley M Durand Decreased Respiratory Compliance in Infants Less Than or Equal to 32 Weeks' Gestation, Delivered More Than 7 Days After Antenatal Steroid TherapyPaediatrics20081215e1032810.1542/peds.2007-2608

5 

GC Liggins RN Howie A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infantsPaediatrics19725051525

6 

D Roberts S Dalziel antenatal corticosteroids for accelerating fetal lung maturation for women at risk for pre-term birthCochrane Database Syst Rev2006344544454

7 

X Miracle GC Di Renzo A Stark A Fanaroff X Carbonell-Estrany ES (Coordinators of WAPM Premat Guideline for the use of antenatal corticosteroids for fetal maturationJ Perinat Med2008363191610.1515/jpm.2008.032

8 

MW Kemp JP Newnham JG Challis AH Jobe SJ Stock The clinical use of corticosteroids in pregnancyHum Reprod Update201522dmv04710.1093/humupd/dmv047

9 

G Haowei H Jinhui Z Hongli L Yanguan Z Li W Rong The diagnostic cut-off value of Silverman Anderson predicting pre-term children with respiratory failureChin Diagn Electron J2104214951

10 

PL Ballard RA Ballard Scientific basis and therapeutic regimens for use of antenatal glucocorticoidsAm J Obstet Gynecol199517312546210.1016/0002-9378(95)90210-4

11 

A Sotiriadis G Makrydiams S Papatheodorou Jpa Ioannidis 2018 Aug 3;8(8):CD006614. Corticosteroids for preventing of neonatal respiratory morbidity after elective caesarean section at termCochrane Database Syst Rev20094CD006614doi: 10.1002/14651858.CD006614.pub2

12 

Caesarean delivery on maternal request. Committee Opinion No. 559. American College of Obstetricians and GynaecologistsAm Coll Obstet Gynaecol20131219047

13 

PR Stutchfield R Whitaker I Russell Antenatal steroids for elective Caesarean SectionBMJ20063316624

14 

GV Stralen JD Bos E Lopripre ABT Pas KW Bloemenkamp FJ Walther No short term benefits of antenatal corticosteroid treatment in severely preterm growth restricted fetuses: A case - control studyEarly Hum Dev2009852537

15 

EJH Mulder JB Derks MF Zonneveld HW Bruinse GHA Visser Transient reduction in fetal activity and heart rate variation after maternal betamethasone administrationEarly Hum Dev1994361496010.1016/0378-3782(94)90032-9

16 

JB Derks EJH Mulder GHA Visser The effects of maternal betamethasone administration on the fetusInt J Obstet Gynaecol199510214061470-0328, 1471-052810.1111/j.1471-0528.1995.tb09024.xWiley

17 

C Bonanno RJ Wapner Antenatal Corticosteroids in the Management of Preterm Birth: Are We Back Where We Started?Obstet Gynecol Clin N Am201239476310.1016/j.ogc.2011.12.006

18 

KJ McLaughlin CA Crowther N Walker JE Harding Effects of a single course of corticosteroids given more than 7 days before birth: A systematic reviewAust New Zealand J Obstet Gynaecol2003432101610.1046/j.0004-8666.2003.00052.x



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Article type

Original Article


Article page

255-258


Authors Details

Manish R Pandya, Kalpana Khandheriya, Vinay Trivedi, Khushbu Patel


Article History

Received : 25-05-2021

Accepted : 05-06-2021

Available online : 11-06-2021


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