Timing of Indicated Delivery After Antenatal Steroids in Preterm Pregnancies with Severe Hypertension

Abstract

The rates of most adverse maternal and neonatal outcomes in preterm pregnancies with severe hypertension delivered at 26 to 34 weeks are not affected by timing from steroid administration to delivery. These data support the decision for delivery based mainly on obstetrical indications.

Relevance of the Antenatal Corticosteroids-to-Delivery Interval in the Prevention of Neonatal Respiratory Distress Syndrome Through the Eyes of Causal Inference: A Review and Target Trial

“…Literature on the ACS-to-birth interval is summarised in Table S1. 1,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Two RCTs on ACS reported on the ACS-to-birth interval: the initial rst RCT 1 , and the RCT of Schutte et al 26 Schutte et al performed a study (partially RCT (ACS vs placebo), partially observational (all women who received betamethasone)) to analyse the incidence of RDS in groups of preterm born children at different time intervals after admission of the mother. Although the goal was to investigate the relevance of time factors, the randomisation was for ACS or placebo.…”

“…Finally, the focus was less on the ACS-to-birth interval, but mainly on the admission-to-birth interval. 26 All remaining 19 studies that focused on the neonatal outcome according to the ACS-to-birth interval were observational (17 in retrospective [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]44,45 and two in prospective cohorts 42,43 ). Four studies [27][28][29][30] postulated no superiority of a certain interval, three studies 35,38,42 concluded that an interval of 0-7d was superior compared to other intervals, and eight studies 31,34,36,37,41,[43][44][45] con rmed the optimal interval of one or 2 to 7 days.…”

“…Four studies [27][28][29][30] postulated no superiority of a certain interval, three studies 35,38,42 concluded that an interval of 0-7d was superior compared to other intervals, and eight studies 31,34,36,37,41,[43][44][45] con rmed the optimal interval of one or 2 to 7 days. The remaining four studies 32,33,39,40 suggested a different interval (Table S1).…”

One life ends, another begins: Management of a brain-dead pregnant mother-A systematic review-

“…In addition, laboratory tests including complete blood cell count, electrolytes such as Na + , Ca 2+ , K + , creatinine, urea, liver enzymes, retinol-binding proteins, albumin, prealbumin, transferrin and urine analysis should be periodically performed. After 24 weeks of gestation, glucocorticoids should be administered for fetal lung maturation and prophylaxis of fetal respiratory distress syndrome [38,39]. To prevent preterm uterine contractions, in particular in the early weeks of gestation when no fetal lung maturation is yet provided, tocolytic interventions may be needed.…”

“…The majority of studies reported routine and complex fetal monitoring such as daily fetal heart rate monitoring using cardiotocography and nonstress testing. Serial ultrasound examinations to evaluate the fetoplacental unit, including biometric estimations as well as morphologic studies on the placental structure and the amnion fluid, should be performed weekly to assess intrauterine fetal growth [39,42-44]. …”