Relationship between the time interval from antenatal corticosteroid administration until preterm birth and the occurrence of respiratory morbidity.

OBJECTIVE: The purpose of this study was to assess the relationship between neonatal respiratory morbidity and the interval between antenatal corticosteroids (ACS) administration and birth. STUDY DESIGN: We performed a retrospective cohort study among women who had received ACS and delivered at <34 weeks of gestation. We categorized these women in 4 groups: ACS-to-delivery interval of 0-7, 8-14, 15-21, and 22-28 days. Multivariable logistic regression analysis assessed the association between the ACS-to-delivery interval and neonatal respiratory morbidity. RESULTS: We included 254 neonates. Eighty-two neonates (32%) were intubated. In comparison with neonates with an ACS-to-delivery interval of 0-7 days, the risk for intubation was increased in all other groups (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.1-5.4; OR, 5.6; 95% CI, 1.8-18; and OR, 4.8; 95% CI, 0.71-32, not statistically significant, respectively). CONCLUSION: The effect of ACS decreases when the ACS-to-delivery interval exceeds 7 days. The first administration of ACS should be considered carefully.

Time to delivery after the first course of antenatal corticosteroids: a cohort study.

The optimal time interval between administration of antenatal corticosteroids and delivery is 1 to 7 days. This study evaluates the timing of the first course of antenatal corticosteroids in clinical practice. We performed a retrospective cohort study of consecutive women who had received antenatal corticosteroids and/or delivered between 24 and 34 weeks of gestation. Time between administration of corticosteroids and delivery was compared between women with different causes of anticipated preterm deliveries: symptomatic preterm labor with intact membranes; preterm premature rupture of the membranes; (pre)eclampsia; hemolysis, elevated liver enzymes, and low platelet count; intrauterine growth restriction; vaginal blood loss; and suspected fetal distress. We included 439 women of whom 348 (79%) completed the course of corticosteroids. In women with a complete course, 143 (41%) delivered within 7 days. The median interval between the course and delivery was 11 days and varied between 41 days in women with vaginal blood loss, 25 days in women with spontaneous preterm labor with intact membranes, and 8 days in women with preeclampsia ( P < 0.001). In women with spontaneous preterm labor with intact membranes and in women with vaginal blood loss, we can benefit substantially from a more accurate discrimination of women who need corticosteroids immediately and women who do not.

Measurement of cardiac output in normal pregnancy by a non-invasive two-dimensional independent Doppler device.

AIMS: To compose a normogram regarding cardiac output during pregnancy measured with ultrasonic cardiac output monitor (USCOM), a non-expensive simple continuous wave Doppler device and to investigate if this machine could be useful for haemodynamic monitoring during pregnancy. METHODS: Cardiac output was measured in 172 pregnant women with a gestational age < 21 weeks (n = 59), 21-32 weeks (n = 48), and > 32 weeks' gestation (n = 48). Interobserver differences were determined by measuring 24 patients and comparing results between three different observers. RESULTS: A good signal could be obtained in 155 (90.2%) pregnant women. Haemodynamic profiles were in line with data published in the literature. In 9.8 % of cases it was difficult to get a good result. Interobserver variations between the research officer (CK) and two clinicians were good (r = 0.9359 and r = 0.9609). CONCLUSION: USCOM appears to be a reliable and fast method to measure cardiac output compared with existing highly complex ultrasounds machines used in cardiology. It is easy to learn, cheap and quite reproducible between different observers. Further research is required to define its place in the management of hypertensive complications during pregnancy.