Antenatal Corticosteroids Overview

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Questions and Answers

What is the risk ratio (RR) reported for the reduction in proportion of teachers identified in the lower quartile of academic ability?

  • 1.00
  • 0.25
  • 0.75
  • 0.45 (correct)

What is the estimated number needed to treat (NNT) based on the provided data?

  • 50.4
  • 10.2
  • 35.7 (correct)
  • 25.1

Which potential complication is mentioned but not rigorously studied?

  • Hyperglycaemia
  • Anemia
  • Hypertension
  • Hypoglycaemia (correct)

What does the content suggest about the benefits of treatment if birth occurs more than 7 days after starting treatment?

<p>Benefits seem unlikely. (B)</p> Signup and view all the answers

What decrease in English proficiency is noted in the data?

<p>From 13% to 7% (A)</p> Signup and view all the answers

What was a significant finding in participants exposed to antenatal corticosteroids compared to those given placebo?

<p>Higher plasma insulin concentrations (D)</p> Signup and view all the answers

What long-term health concern is associated with young adults exposed to antenatal corticosteroids?

<p>Higher blood pressure (A)</p> Signup and view all the answers

According to the evidence, what was NOT significantly affected in children exposed to repeat antenatal corticosteroids?

<p>Growth patterns (B)</p> Signup and view all the answers

Which of the following effects has emerging evidence suggested might occur in term born infants exposed to antenatal corticosteroids?

<p>Diminished long-term development (B)</p> Signup and view all the answers

How did participants exposed to antenatal corticosteroids perform in terms of insulin resistance compared to those on placebo?

<p>Higher levels of insulin resistance (B)</p> Signup and view all the answers

What guideline does this document replace regarding antenatal corticosteroids?

<p>RCOG Green-top guideline No. 7 (C)</p> Signup and view all the answers

Which electronic database was NOT mentioned as part of the research for this guideline?

<p>Scopus (A)</p> Signup and view all the answers

Which term best reflects the focus of the guidelines on inclusivity in healthcare services?

<p>Gender identity sensitivity (C)</p> Signup and view all the answers

What hierarchy system is used to grade recommendations in this guideline?

<p>SIGN hierarchy of evidence (A)</p> Signup and view all the answers

Up to which date were the articles searched for this guideline published?

<p>January 2021 (D)</p> Signup and view all the answers

Which other RCOG guideline is related to the management of small-for-gestational-age fetuses?

<p>Green-top Guideline No. 31 (B)</p> Signup and view all the answers

Which of the following documents provides recommendations on twin and triplet pregnancies?

<p>NICE NG137 (C)</p> Signup and view all the answers

What is one key benefit of antenatal corticosteroids in preterm labor and birth?

<p>Reduced neonatal morbidity and mortality (D)</p> Signup and view all the answers

What is the main purpose of administering antenatal corticosteroids before a planned caesarean birth?

<p>To improve neonatal respiratory outcomes (B)</p> Signup and view all the answers

What was a limitation of the multicentre randomised controlled trial included in the Cochrane review?

<p>It was not placebo controlled. (B)</p> Signup and view all the answers

What evidence level was associated with the effect of antenatal corticosteroids on RDS and TTN?

<p>Low certainty evidence (D)</p> Signup and view all the answers

What was the observed absolute reduction in NNU admission for respiratory morbidity with antenatal corticosteroid administration?

<p>From 5.1 to 2.3% (D)</p> Signup and view all the answers

What conclusion did the authors of the Cochrane review draw regarding the current evidence for antenatal corticosteroids?

<p>More high-quality studies are needed. (A)</p> Signup and view all the answers

Which of the following complications did the Cochrane review find to likely be reduced by antenatal corticosteroids?

<p>Admission to NNU or NICU for respiratory morbidity (B)</p> Signup and view all the answers

What aspect of trials on antenatal corticosteroids is highlighted as lacking according to the content?

<p>A sufficient number of high-quality trials (D)</p> Signup and view all the answers

What does the term 'low certainty evidence' suggest about the findings regarding RDS risk reduction?

<p>There is considerable uncertainty about the effect. (B)</p> Signup and view all the answers

What is the ideal proportion of women undergoing planned caesarean birth who have a documented discussion about corticosteroids?

<p>100% (C)</p> Signup and view all the answers

What should ideally be the proportion of women at high risk of imminent preterm birth who are offered corticosteroids?

<p>100% (A)</p> Signup and view all the answers

In women with twin or triplet pregnancies, what is the ideal proportion that should receive untargeted courses of corticosteroids?

<p>0% (A)</p> Signup and view all the answers

What proportion of women who are deemed high risk of imminent preterm birth should give birth eight days or more after corticosteroid administration?

<p>0% (A)</p> Signup and view all the answers

What is the ideal percentage of women who receive antenatal corticosteroids unnecessarily by birthing at term after preterm administration?

<p>0% (B)</p> Signup and view all the answers

Which resource provides information about corticosteroids in pregnancy to reduce complications from premature birth?

<p>RCGO Information for you (B)</p> Signup and view all the answers

What type of information does the NICE NG25 guidance provide?

<p>Information on preterm labour and birth (C)</p> Signup and view all the answers

What is the focus of the Bliss organization?

<p>Support for families of premature and sick babies (A)</p> Signup and view all the answers

What is the primary purpose of administering antenatal corticosteroids before preterm deliveries?

<p>To prevent respiratory distress syndrome in premature infants (A)</p> Signup and view all the answers

Which study specifically discussed the association of antenatal steroid exposure with survival rates among extremely preterm infants?

<p>Ehret et al. 2018 (D)</p> Signup and view all the answers

What is a potential risk associated with the administration of multiple courses of antenatal corticosteroids?

<p>Increased likelihood of neonatal sepsis (A)</p> Signup and view all the answers

What is the recommended timing for antenatal corticosteroid administration in relation to preterm labor?

<p>Before 25 weeks' gestation (B)</p> Signup and view all the answers

Which of the following medications was part of a randomized controlled trial for preventing cerebral palsy in at-risk pregnancies?

<p>Magnesium sulfate (A)</p> Signup and view all the answers

In the context of preterm premature rupture of membranes, what was the focus of the study by Soll et al.?

<p>Comparison of single versus multiple courses of antenatal corticosteroids (C)</p> Signup and view all the answers

What guideline outlines the management of diabetes in pregnancy and has been updated in 2020?

<p>NICE guideline NG3 (D)</p> Signup and view all the answers

Which effect of antenatal betamethasone is specifically noted for women with preexisting health issues?

<p>Impact on maternal blood glucose levels (B)</p> Signup and view all the answers

Flashcards

Antenatal corticosteroids

Drugs given to a pregnant woman before labor begins to improve the baby's lung development if premature birth is expected.

Preterm labor

Labor that starts before 37 weeks of pregnancy.

Neonatal morbidity and mortality

Illness and death in newborns or babies.

Cochrane Library

A database of research reviews and summaries on many health topics.

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Evidence-based guidelines

Recommendations created based on the best available research and evidence.

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SIGN hierarchy of evidence

A system to rank the quality of research studies to determine how much trust should be placed in the findings.

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Preterm, prelabour rupture of membranes

When the amniotic sac breaks before labor begins, before 37 weeks of pregnancy.

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Small-for-gestational-age

A baby who is smaller or less developed than expected for its gestational age.

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Neonatal respiratory morbidity

Respiratory problems in newborns

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Planned Caesarean Birth

Scheduled surgical birth by C-section

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Cochrane Systematic Review

A review of research studies on a specific topic

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High risk of performance bias

Study design issue where participants/staff may bias results

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Respiratory Distress Syndrome (RDS)

Lung condition in newborns needing help breathing

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Transient Tachypnea of the Newborn (TTN)

Temporary breathing problem in newborns

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Insufficient evidence

Limited information to draw definite conclusions.

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Risk of Bias

The chance of errors or flaws in a study that could affect the results.

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Relative Risk (RR)

The ratio of the risk of an event in one group compared to another (e.g., risk with treatment/risk without treatment).

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Confidence Interval (CI)

A range of values that likely contains a true value of a measurement or estimate.

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Number Needed to Treat (NNT)

The average number of people who need to receive a treatment to see one additional beneficial outcome.

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Low Certainty

Indicates that the findings of a study have significant uncertainty.

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Antenatal corticosteroids & insulin resistance

Giving corticosteroids to pregnant women before labor may lead to increased insulin resistance in their children later in life.

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Long-term effects of antenatal corticosteroids

While short-term benefits exist, long-term effects on growth, blood pressure, and other health aspects in children exposed to antenatal corticosteroids are still being studied.

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Antenatal corticosteroids & brain development

Current research suggests that antenatal corticosteroids might have some impact on brain development, particularly in term-born infants.

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Repeat antenatal corticosteroids & neurodevelopment

Multiple doses of antenatal corticosteroids seem to have no detrimental effects on death or neurodevelopment in children, according to a meta-analysis.

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Aortic distensibility & corticosteroids

Young adults exposed to antenatal corticosteroids may have reduced aortic flexibility, a potential risk factor for cardiovascular disease.

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Auditable topics

Specific areas of care that are measured to track quality and improvement in healthcare.

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Corticosteroids in pregnancy

Medications given to pregnant women to help their baby's lungs mature if preterm birth is expected.

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High risk of imminent preterm birth

A situation where a woman is likely to give birth early, before 37 weeks of pregnancy.

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Twin or triplet pregnancy

Having more than one baby in the womb.

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Antenatal corticosteroids for twins/triplets

Routine use of corticosteroids is NOT recommended for twin or triplet pregnancies.

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Unnecessary corticosteroids

Giving corticosteroids to women who later deliver at term (full 40 weeks).

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RCOG

The Royal College of Obstetricians and Gynaecologists, a professional organization for doctors specializing in pregnancy and childbirth.

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Bliss

A charity that provides support for premature and sick babies and their families.

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Antenatal Corticosteroids for Premature Birth

These medications are given to pregnant women before labor begins when premature birth is expected. They help the baby's lungs develop better, reducing the risk of breathing problems after birth.

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Multiple Courses of Antenatal Corticosteroids

Sometimes, pregnant women with preterm premature rupture of membranes (PROM) receive more than one dose of corticosteroids. This is done to improve the baby's lung development, even though the membranes have ruptured.

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Magnesium Sulfate for Cerebral Palsy Prevention

Magnesium sulfate is a medication given to pregnant women who are at risk of delivering prematurely. It helps to protect the baby's brain from damage and may reduce the chance of cerebral palsy.

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Neonatal Sepsis after Antenatal Corticosteroids

Even though corticosteroids help premature babies, some still develop sepsis (infection) after birth. This is an important risk to consider.

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Preterm Premature Rupture of Membranes (PROM)

When the amniotic sac breaks before labor begins, and before 37 weeks of pregnancy. This increases the risk of premature birth.

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Antenatal Corticosteroids and Gestational Age

The benefits of antenatal corticosteroids for premature babies depend on the gestational age at which they are born. The earlier the baby is born, the greater the benefit.

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Single vs. Weekly Courses of Antenatal Corticosteroids

There are different ways to give antenatal corticosteroids. Some women receive a single course, while others receive weekly courses. The best approach depends on the individual situation.

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Antenatal Corticosteroids and Survival

Antenatal corticosteroids are linked to improved survival rates among premature infants, especially those born very early (between 22 and 25 weeks).

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Study Notes

Antenatal Corticosteroids

  • Antenatal corticosteroids given within seven days before preterm birth reduce perinatal and neonatal death and respiratory distress syndrome. (Grade A)
  • For women with planned cesarean delivery between 37+0 and 38+6 weeks, a discussion about the risks and benefits of corticosteroid use is essential. (Grade B)
  • Antenatal corticosteroids may reduce neonatal unit admissions for respiratory morbidity, but the effect on respiratory distress syndrome, transient tachypnoea of the newborn, or overall neonatal unit admissions is uncertain. (Grade B)
  • Potential harms of antenatal corticosteroids include hypoglycemia and possible developmental delay in the neonate.
  • Immediate preterm birth is anticipated either from established preterm labor, Preterm Premature Rupture of Membranes (PPROM), or planned preterm delivery, corticosteroids should be given between 24+0 and 34+6 weeks. (Grade A)
  • Women with twins and triplets should be offered targeted antenatal corticosteroids for early birth. (Grade D)
  • Delaying birth for antenatal corticosteroids should not happen if birth is required to protect the health of the woman or her baby. (Grade GPP)
  • Corticosteroids should be offered to women presenting with PPROM. (Grade A)
  • Antenatal corticosteroids reduce neonatal death when the first dose is within 48 hours of birth. (Grade D)
  • Benefits are also seen when the first dose is given within 24 hours of birth. (Grade D)
  • Treatment should still be administered if birth is expected within 24 hours. (Grade D)

Background and Scope

  • Antenatal corticosteroids significantly improve neonatal outcomes by reducing respiratory morbidity and other complications of prematurity.
  • This guideline provides evidence-based recommendations for the use of antenatal steroids for women at risk of preterm birth or undergoing planned cesarean.
  • It replaces/updates previous guidelines and supplements NICE guideline NG25.

Identification and Assessment of Evidence

  • The Cochrane Library and electronic databases (DARE, EMBASE, Trip, MEDLINE, PubMed) searched for relevant publications.
  • Search criteria included keywords like corticosteroids, pregnancy, and obstetrics.
  • Articles published until January 2021 were included.
  • A standard methodology was used to develop the guideline.
  • Recommendation grades follow the SIGN hierarchy.

Benefits of Antenatal Corticosteroids

  • A course of antenatal corticosteroids given within seven days of preterm birth reduces perinatal and neonatal death, and respiratory distress syndrome. (Evidence level 1++).

  • Antenatal corticosteroids can help to reduce neonatal death and respiratory distress syndrome. (Evidence level 1++)

  • Giving corticosteroids within a certain timeframe (typically 24 to 48 hours before birth) is essential.

Discussion and offering corticosteroid use

  • Women with twins or other multiple gestations (e.g. triplets) should be offered targeted antenatal corticosteroids.

Gestational Age for Antenatal Corticosteroids

  • Corticosteroids are effective when given in women presenting with imminent preterm birth (established preterm labor, PPROM, or planned preterm birth) prior to 24+0 to 34+6 weeks.
  • Risks/benefits are discussed, considering individual situations.

Contraindications to Antenatal Corticosteroids

  • Birth should not be delayed if maternal/fetal condition requires immediate delivery.
  • Systemic infection is a contraindication.

Repeating the treatment

  • Repeated corticosteroid courses have not been shown to provide additional benefits to the mother or baby.
  • The maximum number of courses shouldn't exceed three per pregnancy.

Future Research Recommendations

  • Studies should investigate antenatal corticosteroids' effectiveness in reducing neonatal morbidity in planned cesarean birth at term.
  • Determining the optimal timing/dose of corticosteroids for women of certain risk profiles or pregnancy conditions.
  • Links to relevant organizations (e.g., RCOG, NICE) providing details, resources, and support groups.

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