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What is the risk ratio (RR) reported for the reduction in proportion of teachers identified in the lower quartile of academic ability?
What is the risk ratio (RR) reported for the reduction in proportion of teachers identified in the lower quartile of academic ability?
What is the estimated number needed to treat (NNT) based on the provided data?
What is the estimated number needed to treat (NNT) based on the provided data?
Which potential complication is mentioned but not rigorously studied?
Which potential complication is mentioned but not rigorously studied?
What does the content suggest about the benefits of treatment if birth occurs more than 7 days after starting treatment?
What does the content suggest about the benefits of treatment if birth occurs more than 7 days after starting treatment?
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What decrease in English proficiency is noted in the data?
What decrease in English proficiency is noted in the data?
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What was a significant finding in participants exposed to antenatal corticosteroids compared to those given placebo?
What was a significant finding in participants exposed to antenatal corticosteroids compared to those given placebo?
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What long-term health concern is associated with young adults exposed to antenatal corticosteroids?
What long-term health concern is associated with young adults exposed to antenatal corticosteroids?
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According to the evidence, what was NOT significantly affected in children exposed to repeat antenatal corticosteroids?
According to the evidence, what was NOT significantly affected in children exposed to repeat antenatal corticosteroids?
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Which of the following effects has emerging evidence suggested might occur in term born infants exposed to antenatal corticosteroids?
Which of the following effects has emerging evidence suggested might occur in term born infants exposed to antenatal corticosteroids?
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How did participants exposed to antenatal corticosteroids perform in terms of insulin resistance compared to those on placebo?
How did participants exposed to antenatal corticosteroids perform in terms of insulin resistance compared to those on placebo?
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What guideline does this document replace regarding antenatal corticosteroids?
What guideline does this document replace regarding antenatal corticosteroids?
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Which electronic database was NOT mentioned as part of the research for this guideline?
Which electronic database was NOT mentioned as part of the research for this guideline?
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Which term best reflects the focus of the guidelines on inclusivity in healthcare services?
Which term best reflects the focus of the guidelines on inclusivity in healthcare services?
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What hierarchy system is used to grade recommendations in this guideline?
What hierarchy system is used to grade recommendations in this guideline?
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Up to which date were the articles searched for this guideline published?
Up to which date were the articles searched for this guideline published?
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Which other RCOG guideline is related to the management of small-for-gestational-age fetuses?
Which other RCOG guideline is related to the management of small-for-gestational-age fetuses?
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Which of the following documents provides recommendations on twin and triplet pregnancies?
Which of the following documents provides recommendations on twin and triplet pregnancies?
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What is one key benefit of antenatal corticosteroids in preterm labor and birth?
What is one key benefit of antenatal corticosteroids in preterm labor and birth?
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What is the main purpose of administering antenatal corticosteroids before a planned caesarean birth?
What is the main purpose of administering antenatal corticosteroids before a planned caesarean birth?
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What was a limitation of the multicentre randomised controlled trial included in the Cochrane review?
What was a limitation of the multicentre randomised controlled trial included in the Cochrane review?
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What evidence level was associated with the effect of antenatal corticosteroids on RDS and TTN?
What evidence level was associated with the effect of antenatal corticosteroids on RDS and TTN?
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What was the observed absolute reduction in NNU admission for respiratory morbidity with antenatal corticosteroid administration?
What was the observed absolute reduction in NNU admission for respiratory morbidity with antenatal corticosteroid administration?
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What conclusion did the authors of the Cochrane review draw regarding the current evidence for antenatal corticosteroids?
What conclusion did the authors of the Cochrane review draw regarding the current evidence for antenatal corticosteroids?
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Which of the following complications did the Cochrane review find to likely be reduced by antenatal corticosteroids?
Which of the following complications did the Cochrane review find to likely be reduced by antenatal corticosteroids?
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What aspect of trials on antenatal corticosteroids is highlighted as lacking according to the content?
What aspect of trials on antenatal corticosteroids is highlighted as lacking according to the content?
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What does the term 'low certainty evidence' suggest about the findings regarding RDS risk reduction?
What does the term 'low certainty evidence' suggest about the findings regarding RDS risk reduction?
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What is the ideal proportion of women undergoing planned caesarean birth who have a documented discussion about corticosteroids?
What is the ideal proportion of women undergoing planned caesarean birth who have a documented discussion about corticosteroids?
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What should ideally be the proportion of women at high risk of imminent preterm birth who are offered corticosteroids?
What should ideally be the proportion of women at high risk of imminent preterm birth who are offered corticosteroids?
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In women with twin or triplet pregnancies, what is the ideal proportion that should receive untargeted courses of corticosteroids?
In women with twin or triplet pregnancies, what is the ideal proportion that should receive untargeted courses of corticosteroids?
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What proportion of women who are deemed high risk of imminent preterm birth should give birth eight days or more after corticosteroid administration?
What proportion of women who are deemed high risk of imminent preterm birth should give birth eight days or more after corticosteroid administration?
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What is the ideal percentage of women who receive antenatal corticosteroids unnecessarily by birthing at term after preterm administration?
What is the ideal percentage of women who receive antenatal corticosteroids unnecessarily by birthing at term after preterm administration?
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Which resource provides information about corticosteroids in pregnancy to reduce complications from premature birth?
Which resource provides information about corticosteroids in pregnancy to reduce complications from premature birth?
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What type of information does the NICE NG25 guidance provide?
What type of information does the NICE NG25 guidance provide?
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What is the focus of the Bliss organization?
What is the focus of the Bliss organization?
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What is the primary purpose of administering antenatal corticosteroids before preterm deliveries?
What is the primary purpose of administering antenatal corticosteroids before preterm deliveries?
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Which study specifically discussed the association of antenatal steroid exposure with survival rates among extremely preterm infants?
Which study specifically discussed the association of antenatal steroid exposure with survival rates among extremely preterm infants?
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What is a potential risk associated with the administration of multiple courses of antenatal corticosteroids?
What is a potential risk associated with the administration of multiple courses of antenatal corticosteroids?
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What is the recommended timing for antenatal corticosteroid administration in relation to preterm labor?
What is the recommended timing for antenatal corticosteroid administration in relation to preterm labor?
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Which of the following medications was part of a randomized controlled trial for preventing cerebral palsy in at-risk pregnancies?
Which of the following medications was part of a randomized controlled trial for preventing cerebral palsy in at-risk pregnancies?
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In the context of preterm premature rupture of membranes, what was the focus of the study by Soll et al.?
In the context of preterm premature rupture of membranes, what was the focus of the study by Soll et al.?
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What guideline outlines the management of diabetes in pregnancy and has been updated in 2020?
What guideline outlines the management of diabetes in pregnancy and has been updated in 2020?
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Which effect of antenatal betamethasone is specifically noted for women with preexisting health issues?
Which effect of antenatal betamethasone is specifically noted for women with preexisting health issues?
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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
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A course of antenatal corticosteroids given within seven days of preterm birth reduces perinatal and neonatal death, and respiratory distress syndrome. (Evidence level 1++).
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Antenatal corticosteroids can help to reduce neonatal death and respiratory distress syndrome. (Evidence level 1++)
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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.
Useful Links and Resources
- Links to relevant organizations (e.g., RCOG, NICE) providing details, resources, and support groups.
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Description
This quiz covers the essential aspects of antenatal corticosteroids, including their impact on perinatal outcomes, the timing of administration, and potential risks and benefits. It is crucial for healthcare providers to understand the guidelines surrounding corticosteroid use for expectant mothers facing preterm birth. Test your knowledge of the indications, administration timing, and potential complications associated with antenatal corticosteroids.
