Objective To examine prospectively the effects of maternal betamethasone administration on fetal heart rate variation, body, breathing and eye movements and the rest‐activity cycle. Design Thirty‐one women on 38 occasions were at risk of premature delivery and received two doses of betamethasone 24 h apart. Gestational age ranged between 26 and 32 weeks. Fetal heart rate was monitored on each of five successive days (0–4) and fetal body, breathing and eye movements were recorded on days 0, 2 and 4. Results Compared with the control day before steroid administration (day 0), both long term and short term fetal heart rate variation were reduced on days 2 and 3 (P < 0.01). In one‐third of the cases, fetal heart rate variation fell transiently below the lower normal range for gestational age. Body movements were reduced on day 2 by 50% (P 0.01) due to prolonged periods of inactivity (P < 0.01). Breathing movements were largely absent on day 2 (P < 0.01), but the occurrence of eye movements remained unchanged after betamethasone administration. All values returned to baseline on day 4, indicating that no fetal deterioration had occurred during the course of the study period. Similar responses to betamethasone were observed in five fetuses when studied at re‐presentation two weeks later. Conclusions Maternal betamethasone administration causes a considerable but transient reduction in fetal body movements and activity periods, breathing and heart rate variation, without affecting fetal eye movements. Knowledge of this phenomenon is important when assessing the fetal condition. The effect may be due to a glucocorticoid receptor mediated process in the fetal brain.

Objectives To compare the effects of maternal betamethasone and dexamethasone administration on Design Aprospective randomised study of 60 women at increased risk of pretenn delivery.Outcome measures Fetal heart rate and its variation, the incidence of fetal body and breathing movements.Setting Obstetric unit, University Hospital, Utrecht, The Netherlands.Results Following maternal betamethasone administration (day 2), fetal heart rate variation was reduced by 19% and fetal body and breathing movements by 49% and 85%, respectively. After dexamethasone treatment there was a significant increase in short term fetal heart rate variation (24%) on day 1. All values returned to baseline on day 4, indicating that no fetal deterioration had occurred during the course of the study period.Conclusion Betamethasone, with probably the greater beneficial effect, has more effects on fetal behaviour and fetal heart rate variation than dexamethasone. When assessing fetal condition, due account needs to be taken of these effects.fetal behaviour and fetal heart rate variation.

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CONTRIBUTIONWhat are the novel findings of this work? This prospective longitudinal study showed that increased fetal intra-abdominal bowel diameter measured on at least three occasions can differentiate between simple and complex (atresia, volvulus, perforation or necrosis of the bowel) gastroschisis. What are the clinical implications of this work?Children born with complex gastroschisis have a higher morbidity than do children with simple gastroschisis. This study identifies ultrasound markers that may help to identify those fetuses that are at risk of a complicated neonatal period. ABSTRACT Objectives To identify antenatal ultrasound markers that can differentiate between simple and complex gastroschisis and assess their predictive value.Methods This was a prospective nationwide study of pregnancies with isolated fetal gastroschisis that underwent serial longitudinal ultrasound examination at regular specified intervals between 20 and 37 weeks' gestation. The primary outcome was simple or complex necrosis) gastroschisis at birth. Fetal biometry (abdominal circumference and estimated fetal weight), the occurrence of polyhydramnios, intra-and extra-abdominal bowel diameters and the pulsatility index (PI) of the superior mesenteric artery (SMA) were assessed. Linear mixed modeling was used to compare the individual trajectories of cases with simple and those with complex gastroschisis, and logistic regression analysis was used to estimate the strength of association between the ultrasound parameters and outcome. Results Of 104 pregnancies with isolated fetal gastroschisis included, four ended in intrauterine death. Eighty-one (81%) liveborn infants with simple and 19 (19%) with complex gastroschisis were included in the analysis. We found no relationship between fetal biometric variables and complex gastroschisis. The SMA-PI was significantly lower in fetuses with gastroschisis than in healthy controls, but did not differentiate between simple and complex gastroschisis. Both intra-and extra-abdominal bowel diameters were larger in cases with complex, compared to those with simple, gastroschisis (P < 0.001 and P < 0.005, respectively). The presence of intra-abdominal bowel diameter ≥ 97.7 th percentile on at least three occasions, not necessarily on successive examinations, was associated with an increased risk of the fetus having complex 777 gastroschisis (relative risk, 1.56 (95% CI, 1.02-2.10); P = 0.006; positive predictive value, 50.0%; negative predictive value, 81.4%).Conclusions This large prospective longitudinal study found that intra-abdominal bowel dilatation when present repeatedly during fetal development can differentiate between simple and complex gastroschisis; however, the positive predictive value is low, and therefore the clinical usefulness of this marker is limited.

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