PubMed · 5787354
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G K Steigleder. 1969-06-27. [Periocically occurring aphthae].. https://pubmed.ncbi.nlm.nih.gov/5787354/
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OBJECTIVE: To develop a consensus on the use of antenatal corticosteroids for fetal maturation in preterm infants. PARTICIPANTS: A nonfederal, nonadvocate, 16-member consensus panel including representatives from neonatology, obstetrics, family medicine, behavioral medicine, psychology, biostatistics, and the public; 19 experts in neonatology, obstetrics, and pharmacology presented data to the consensus panel and a conference audience of approximately 500. EVIDENCE: An extensive bibliography of references was produced for the consensus panel and the conference audience using a variety of on-line databases including MEDLINE. The consensus panel met several times prior to the conference to review the literature. It also commissioned an updated meta-analysis, a neonatal registry review, and an economic analysis that were presented at the conference. The experts prepared abstracts for distribution at the conference, presented data, and answered questions from the panel and audience. The panel evaluated the strength of the scientific evidence using the grading system developed by the Canadian Task Force on the Periodic Health Examination and adapted by the US Preventive Services Task Force. CONSENSUS: The consensus panel, answering predefined consensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. CONSENSUS STATEMENT: The consensus panel composed a draft statement that was read in its entirety at the conference for comment. The panel released a revised statement at the end of the conference and finalized the revisions a few weeks after the conference. CONCLUSIONS: Antenatal corticosteroid therapy is indicated for women at risk of premature delivery with few exceptions and will result in a substantial decrease in neonatal morbidity and mortality, as well as substantial savings in health care costs. The use of antenatal corticosteroids for fetal maturation is a rare example of a technology that yields substantial cost savings in addition to improving health.
OBJECTIVE: Our purpose was to determine whether maternal preeclampsia per se has a beneficial effect on neonatal outcome after delivery before 35 weeks. STUDY DESIGN: A matched cohort study design was used. Two hundred twenty-three infants of strictly defined preeclamptic women were matched for gestational age, race, gender, and mode of delivery with infants of normotensive women with preterm labor and delivery. Pregnancies with multiple gestation, premature rupture of membranes, known fetal anomalies, diabetes, or maternal medical disease were excluded. Information was obtained by review of maternal and neonatal charts. Paired categoric and continuous data were compared by McNemar's test and the Wilcoxon signed-rank test, respectively. RESULTS: There was no difference in the incidence of neonatal death (4.5% vs 4.5%, p = 0.82), respiratory distress syndrome (22.0% vs 22.0%, p = 0.88), grades 3 and 4 intraventricular hemorrhage (2.2% vs 2.2%, p = 0.72), grades 2 and 3 necrotizing enterocolitis (5.8% vs 4.0%, p = 0.48), and culture-proved sepsis (9.0% vs 9.0%, p = 0.85). Results were similar when analysis was limited to infants born at < or = 32 weeks, infants born to mothers with severe preeclampsia, and infants with intrauterine growth restriction. CONCLUSION: Maternal preeclampsia per se does not have a beneficial effect on the postnatal course of infants born at 24 to 35 weeks' gestation.
OBJECTIVE: To determine if corticosteroid administration causes increased contractions or labor in high-order multiple gestations. METHODS: Medical records of all triplet and quadruplet pregnancies cared for by Phoenix Perinatal Associates from August 1988 to January 1992 were reviewed retrospectively. Twenty-one women were identified; 17 of them received at least one dose of corticosteroids for fetal lung maturation. Fifteen of the 17 had complete contraction data (2 hours per day before and after steroids) available for analysis. The mean number of contractions in the 48 hours before steroids was compared to the mean number of contractions in the 48 hours after the first steroid injection. RESULTS: There was a significant increase in contractions during the first monitoring session (8-16 hours after injection, P = .002), and the second monitoring session. There was also a statistically increased chance of both labor with cervical change and the need for tocolytic intervention if the basal contraction rate was at least 3.5 contractions per hour than if it was less than 3.5 contractions per hour (P < .02). CONCLUSION: Betamethasone administration in triplet and quadruplet births is associated with increased uterine contractions, preterm labor with cervical change, and preterm labor requiring tocolysis. There should be fewer than 3.5 contractions per hour to minimize the steroid effect on uterine activity.