Antenatal steroids timing

REFERENCES:
1. Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. American Journal of Obstetrics and Gynecology. 1997;177(1):210–214.
2. Placenta accreta. Committee Opinion No. 529. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012;120:207–11. PMID: 22914422 http:///Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Placenta_Accreta
3. Bowman ZS, et. al., Risk Factors for Placenta Accreta: A Large Prospective Cohort. Am J Perinatol. 2014 Oct;31(9):799-804. Epub 2013 Dec 12. PMID: 24338130
4. Clark SL, Koonings PP, Phelan JP. Placenta previa/accreta and prior cesarean section. Obstet Gynecol 1985 Jul;66(1):89-92
5 Ballas J, et . al., Identifying sonographic markers for placenta accreta in the first trimester. J Ultrasound Med. 2012 Nov;31(11):1835-41. PMID: 23091257
6 Hung TH, et. al., Risk factors for placenta accreta. Obstet Gynecol. 1999 Apr;93(4):545-50. PMID: 10214831
7. Royal College of Obstetricians and Gynaecologists . Green-top Guideline No. 27. Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and management.
London. January 2011 https:///globalassets/documents/guidelines/.
8. Medically indicated late-preterm and early-term deliveries. Committee Opinion No. 560. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:908–10. PMID:23635709
9 Bowman ZS, et al., Risk factors for unscheduled delivery in patients with placenta J Obstet Gynecol. 2014 Mar;210(3):-6. doi: /. Epub 2013 Oct 2. PMID: 24096181
10. Chantraine F, et. al., Individual decisions in placenta increta and percreta: a case Perinat Med. 2012 Jan 23;40(3):265-70. doi: /jpm-2011-:22505505
11. Fitzpatrick KE, et. al., The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG. 2014 Jan;121(1):62-70; discussion 70-1. PMID:23924326
12. Placenta accreta. Publications Committee, Society for Maternal-Fetal Medicine, Belfort MA. Am J Obstet Gynecol. 2010 Nov;203(5):430-9. PMID: 21055510
13. El-Messidi A, et. al. A multidisciplinary checklist for management of suspected placenta accreta. J Obstet Gynaecol Can. 2012 Apr;34(4):320-4. PMID: 22472330
14. Hull AD and Resnick R. Placenta Previa, Placenta Accreta, Abruptio Placenta, and Vasa Previa. In: Creasy RK, Resnik R, Iams JD, eds. Creasy and Resnik’s Maternal-Fetal Medicine: Principles and Practice. 7th ed. Philadelphia, Pa.: Saunders/Elsevier; 2014:736
15. Royal College of Obstetricians and Gynaecologists. Green–top Guideline : Antenatal corticosteroids to reduce neonatal morbidity and mortality. London: RCOG; 2010

Recent data also suggest that betamethasone can be beneficial in pregnant women at high risk of late preterm birth, between 34 0/7 weeks and 36 6/7 weeks of gestation who have not received a prior course of antenatal corticosteroids. The Maternal Fetal Medicine Units (MFMU) Network Antenatal Late Preterm Steroids trial ( 24 ) was a double-blind, placebo-controlled, randomized clinical trial designed to evaluate the use of antenatal betamethasone for pregnant women at high risk of delivery in the late preterm period. Women were identified to be at high risk if they presented in preterm labor, had preterm PROM, or if they had a planned delivery in the late preterm period, with the indication at the discretion of the obstetrician–gynecologist or other health care provider. Tocolysis was not employed as a part of this trial, and delivery was not delayed for obstetric or medical indications. The study found that the administration of betamethasone led to a significant decrease in the primary outcome, which was the need for respiratory support. A larger decrease was demonstrated for severe respiratory complications, from % in the placebo group to % in the betamethasone group (RR, ; 95% CI, –; P <.001). There were also significant decreases in the rates of transient tachypnea of the newborn; bronchopulmonary dysplasia; a composite of respiratory distress syndrome (RDS), transient tachypnea of the newborn and RDS; and the need for postnatal surfactant. Infants exposed to betamethasone were less likely to require immediate postnatal resuscitation. There was no increase in proven neonatal sepsis, chorioamnionitis, or endometritis with late preterm betamethasone. Hypoglycemia was more common in the infants exposed to betamethasone % versus % (RR, ; 95% CI, –); however, there were no reported adverse events related to hypoglycemia, which was not associated with an increased length of hospital stay. The rates of hypoglycemia found in the trial are similar to what is reported in the general population of late preterm infants ( 25 ). Although not studied in this trial, long-term adverse outcomes of prolonged and persistent neonatal hypoglycemia have been described ( 26 , 27 ). In order to reduce this risk and achieve the benefits of betamethasone therapy for fetal maturity in late preterm pregnancies, the American Academy of Pediatrics’ guidelines should be followed when employing this therapy (27). The American Academy of Pediatrics recommends the monitoring of neonatal blood sugars for late preterm infants because late preterm birth is a known risk factor for hypoglycemia. A single course of betamethasone is recommended for pregnant women between 34 0/7 weeks and 36 6/7 weeks of gestation at risk of preterm birth within 7 days, and who have not received a previous course of antenatal corticosteroids (24, 28 ).

In boys, testicular enlargement is the first physical manifestation of puberty (and is termed gonadarche ). [27] Testes in prepubertal boys change little in size from about 1 year of age to the onset of puberty, averaging about 2–3 cm in length and about –2 cm in width. The size of the testicles is among the parameters of the Tanner scale for male genitals , from stage I which represents a volume of less than ml, to stage V which represents a testicular volume of greater than 20 ml. Testicular size reaches maximal adult size about 6 years after the onset of puberty. After the boy's testicles have enlarged and developed for about one year, the length and then the breadth of the shaft of the penis will increase and the glans penis and corpora cavernosa will also start to enlarge to adult proportions. [28] While 18–20 cm 3 is an average adult size, there is wide variation in testicular size in the normal population. [29]

There is also data showing that antibiotics are helpful during preterm labor for women who carry bacteria called group B streptococcus (GBS). About one in five women will carry GBS, and babies who get infected during labor and delivery can become very sick. Antibiotics can treat GBS and reduce complications of a subsequent infection in the newborn, but carry risks for the mother ( Ohlssen & Shah, 2009 ). Most care providers test women for the bacteria about a month before their due date. The test involves taking swab samples from the lower vagina and rectum. Because it can take two or three days for test results to be returned, the general practice is to go ahead and begin treating a woman for GBS before confirmation of infection if a woman is in preterm labor. Most doctors think that this presumptive treatment is justified because as many as one in four women test positive for GBS. Ampicillin and penicillin are the antibiotics most commonly used for treatment.

Antenatal steroids timing

antenatal steroids timing

There is also data showing that antibiotics are helpful during preterm labor for women who carry bacteria called group B streptococcus (GBS). About one in five women will carry GBS, and babies who get infected during labor and delivery can become very sick. Antibiotics can treat GBS and reduce complications of a subsequent infection in the newborn, but carry risks for the mother ( Ohlssen & Shah, 2009 ). Most care providers test women for the bacteria about a month before their due date. The test involves taking swab samples from the lower vagina and rectum. Because it can take two or three days for test results to be returned, the general practice is to go ahead and begin treating a woman for GBS before confirmation of infection if a woman is in preterm labor. Most doctors think that this presumptive treatment is justified because as many as one in four women test positive for GBS. Ampicillin and penicillin are the antibiotics most commonly used for treatment.

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