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Antenatal steroids, also known as antenatal corticosteroids, are medications administered to pregnant women expecting a preterm birth.When administered, these steroids accelerate the maturation of the fetus' lungs, which reduces the likelihood of infant respiratory distress syndrome and infant mortality. [1]
Commonly used tocolytic medications include β 2 agonists, calcium channel blockers, NSAIDs, and magnesium sulfate. These can assist in delaying preterm delivery by suppressing uterine muscle contractions and their use is intended to reduce fetal morbidity and mortality associated with preterm birth. [2]
A Cochrane review from 2020 recommends the use of a single course of antenatal corticosteroids to accelerate fetal lung maturation in women at risk of preterm birth. Treatment with antenatal corticosteroids reduces the risk of perinatal death, neonatal death and respiratory distress syndrome and probably reduces the risk of IVH. [128]
The lecithin–sphingomyelin ratio is a marker of fetal lung maturity. The outward flow of pulmonary secretions from the fetal lungs into the amniotic fluid maintains the level of lecithin and sphingomyelin equally until 32–33 weeks gestation, when the lecithin concentration begins to increase significantly while sphingomyelin remains nearly the same.
This time can then be used to administer steroid injections to the mother which help fetal lung maturity and reduce complications of prematurity. [1] It should not be used to prevent preterm labor or delay labor more than 48–72 hours. In February 2011, the Food and Drug Administration began requiring a black box warning on the drug's label ...
The presence of PG usually indicates fetal lung maturity. For the S/A ratio, the result is given as milligrams of surfactant per gram of protein. A S/A ratio less than 35 indicates immature lungs, between 35 and 55 is indeterminate, and greater than 55 indicates mature surfactant production (correlating with an L/S ratio of 2.2 or greater).
Steroids - Steroids are sometimes given to the mother before IUTs and early delivery to mature the fetal lungs. [31] [32] Phenobarbital - Phenobarbital is sometimes given to the mother to help mature the fetal liver and reduce hyperbilirubinemia. [32] [33] Early Delivery - Delivery can occur anytime after the age of viability. [30]
Fetal lung maturity is associated with how much surfactant the fetus is producing. Reduced production of surfactant indicates decreased lung maturity and is a high risk factor for infant respiratory distress syndrome. [33] Typically a lecithin:sphingomyelin ratio greater than 1.5 is associated with increased lung maturity.