scholarly journals Steroids for All

2020 ◽  
Vol 3 ◽  
Author(s):  
Alexandra McKinzie ◽  
Ziyi Yang ◽  
Joanne Daggy ◽  
Robert Tepper ◽  
Sarah Quinney ◽  
...  
Keyword(s):  
Preterm Labor ◽  
Neonatal Intensive Care ◽  
Neonatal Outcomes ◽  
Hypertensive Disorder ◽  
Antenatal Corticosteroids ◽  
Maternal Characteristics ◽  
Admission Rates ◽  
Threatened Preterm Labor ◽  
The Mean ◽  
Nicu Admission

Background: Due to difficulties estimating the risk of preterm labor, many women diagnosed with threatened preterm delivery and given antenatal corticosteroids to improve neonatal outcomes do not deliver until term. Our objective was to compare the short-term outcomes of infants born at term to women who received betamethasone (BMZ) for threatened preterm labor to infants who were not exposed to BMZ in utero.     Methods: We performed a retrospective cohort study of infants born at or after 37 weeks’ gestational age (GA) to mothers diagnosed with threatened preterm labor during pregnancy. Controlling for covariates, the primary neonatal outcomes of interest, including transient tachypnea of the newborn (TTN), neonatal intensive care unit (NICU) admission, and birthweight, were evaluated for their association with BMZ exposure.     Results: Of 5330 women, 1459 (27.5%) women received BMZ at a mean GA of 32.2±3.3 weeks. The mean age of women was 27±5.9 years-old and the mean GA at delivery was 38.9±1.1 weeks. Women receiving BMZ had higher rates of maternal comorbidities (P<0.001 for diabetes, asthma, and hypertensive disorder) and were more likely to self-identify as white (P=0.022). BMZ-exposed neonates had lower birth weights and increased rates of oxygen usage, TTN, hyperbilirubinemia, hypoglycemia, and NICU admission rates (all P-values <0.05).  Controlling for maternal characteristics and GA at delivery, BMZ exposure was not significantly associated with diagnosis of TTN [OR 1.09 (95% CI 0.80-1.50)], though it was associated with more NICU admissions [1.49 (1.19-1.86)] and lower birthweight by 91.5 (-122.3 to -60.6) grams.      Conclusions: Compared to women evaluated for preterm labor that did not receive BMZ, women receiving BMZ had infants with higher rates of NICU admission and lower birthweights, though the rate of TTN diagnosis was similar between the two groups. While the benefits of BMZ to infants born preterm are clear, there may be negative impacts for infants delivered at term. 

scholarly journals Antenatal rescue corticosteroids and perinatal outcome

2021 ◽  
Vol 10 (6) ◽  
pp. 2312
Author(s):  
Nishat Ahtar ◽  
Parul Singh ◽  
Naghma Shahrukh ◽  
Aleena Haider
Keyword(s):  
Preterm Labor ◽  
Maternal Outcome ◽  
Transient Effects ◽  
Antenatal Corticosteroids ◽  
Group A ◽  
Preterm Babies ◽  
Threatened Preterm Labor ◽  
The Difference ◽  
Nicu Admission ◽  
Group B

Background: Antenatal corticosteroids (ACS) is one of the most effective intervention for prevention of neonatal complications in preterm babies. However, due to its transient effects, single repeat course is recommended. This rescue course of ACS is believed to improve feto-maternal outcome in women with preterm labor and was the subject matter of this study.Methods: Total 200 antenatal women who were admitted for threatened preterm labor, between 28 to 34 weeks of gestation, who had already received a single course of ACS within 7-14 days were allocated into group A and group B. Group A included 100 women, who were given rescue course of ACS. Group B included 100 women who rescue course was not given.Results: Out of 115 babies in group A and 114 babies in group B, 18 babies (16%) in group A and 30 babies (26%) in group B had NICU admission (p<0.05). Eight babies (6%) in group A and 23 babies (20%) in group B were diagnosed with respiratory distress syndrome (RDS) where the difference was statistically highly significant (p<0.001). Maternal outcome was similar among both the groups.Conclusions: A single repeat rescue course of ACS helps to improve neonatal outcome in preterm babies.

Nonmedically Indicated Induction of Labor Compared with Expectant Management in Nulliparous Women Aged 35 Years or Older

2018 ◽  
Vol 36 (01) ◽  
pp. 045-052 ◽  
Author(s):  
Katherine Bowers ◽  
Jane Khoury ◽  
Tetsuya Kawakita
Keyword(s):  
Intensive Care Unit ◽  
Cesarean Delivery ◽  
Retrospective Cohort ◽  
Neonatal Intensive Care ◽  
Expectant Management ◽  
Induction Of Labor ◽  
Neonatal Outcomes ◽  
Nulliparous Women ◽  
Maternal And Neonatal Outcomes ◽  
Nicu Admission

Objective This article compares maternal and neonatal outcomes in women aged ≥ 35 years who experienced nonmedically indicated induction of labor (NMII) versus expectant management. Study Design This was a retrospective cohort study of nulliparas aged ≥ 35 years with a singleton and cephalic presentation who delivered at term. Outcomes were compared between women who underwent NMII at 37, 38, 39, and 40 weeks' gestation and those with expectant management that week. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) were calculated, controlling for predefined covariates. Results Of 3,819 nulliparas aged ≥ 35 years, 1,409 (36.9%) women underwent NMII. Overall at 39 weeks' gestation or later, maternal and neonatal outcomes were similar or improved with NMII. At 37, 38, and 39 weeks' gestation, NMII compared with expectant management was associated with decreased odds of cesarean delivery at 37, 38, and 39 weeks' gestation. At 40 weeks' gestation, NMII compared with expectant management was associated with an increased odds of operative vaginal delivery and a decreased odds of neonatal intensive care unit (NICU) admission. Conclusion In nulliparous women aged ≥ 35 years, NMII was associated with decreased odds of cesarean delivery at 37 to 39 weeks' gestation and decreased odds of NICU admission at 40 weeks' gestation compared with expectant management.

Implementation and Evaluation of the Early-Onset Sepsis Risk Calculator in a High-Risk University Nursery

2017 ◽  
Vol 57 (9) ◽  
pp. 1080-1085 ◽  
Author(s):  
Jessica B. Beavers ◽  
Shasha Bai ◽  
Jennifer Perry ◽  
Jordan Simpson ◽  
Sara Peeples
Keyword(s):  
Early Onset ◽  
Neonatal Intensive Care ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Risk Calculator ◽  
Admission Rates ◽  
Early Onset Sepsis ◽  
Sepsis Risk ◽  
Control And Prevention ◽  
Nicu Admission

There is growing interest in the Kaiser early-onset sepsis (EOS) risk calculator though institutions are hesitant to deviate from the Centers for Disease Control and Prevention guidelines and implement this in their hospitals. We describe the process of implementing routine use of the risk calculator in term and late preterm newborns delivered to mothers with chorioamnionitis in a level III neonatal intensive care unit (NICU). A retrospective chart review of infants delivered to mothers with chorioamnionitis from 2011 to 2014 was performed. Implementation of routine use of the calculator began in January 2015; preintervention and postintervention data were analyzed after a 9-month period of routine use. Following implementation, NICU admission rates, number of blood cultures drawn, and rates of antibiotic use dropped by 54%, 42%, and 59%, respectively ( P < .001). No negative outcomes were reported. In this article, we describe how the calculator was safely implemented in our NICU while decreasing the number of interventions.

Association between Uterine Tachysystole during the Last Hour of Labor and Cord Blood Lactate in Parturients at Term Gestation

2018 ◽  
Vol 36 (11) ◽  
pp. 1171-1178 ◽  
Author(s):  
Arvind Palanisamy ◽  
Julia Lopez ◽  
Antonina Frolova ◽  
George Macones ◽  
Alison G. Cahill
Keyword(s):  
Cord Blood ◽  
Blood Lactate ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Secondary Analysis ◽  
Base Deficit ◽  
Admission Rates ◽  
Tertiary Care Institution ◽  
Umbilical Arterial Ph ◽  
Nicu Admission

Objective To assess whether uterine tachysystole (UT) in labor causes an increase in cord blood lactate. Study Design Secondary analysis of a prospective cohort study of all consecutive singleton gestations ≥ 37 weeks admitted for labor to a single tertiary care institution with universal cord gas policy. Patients with UT in the last hour (“always”) were compared with those without UT (“never”). Primary outcome of interest was cord blood lactate ≥ 4 mmol/L. Secondary outcomes included pH ≤ 7.10, base deficit ≥ 8 mmol/L, and admission to the neonatal intensive care unit (NICU). Multivariable logistic regression was used to estimate the risk for elevated cord blood lactate after adjusting for maternal age and body mass index. Results Of the 8,580 patients included in the analysis, 513 experienced UT 1 hour before delivery (5.9%). UT was significantly associated with elevated cord blood lactate in the “always” (33.5%) compared with the “never” group (26%) (adjusted odds ratio 1.47 [1.17, 1.86]; p < 0.01). However, there were no differences in either umbilical arterial pH, base deficit, or NICU admission rates. Conclusion UT in the last hour preceding delivery increases arterial cord blood lactate suggesting that UT proximate to delivery should be considered as a variable when interpreting cord blood gas values.

Application of Plastic Wrap to Improve Temperatures in Infants Born Less Than 30 Weeks Gestation: A Randomized Controlled Trial

2013 ◽  
Vol 32 (4) ◽  
pp. 235-245 ◽  
Author(s):  
Jacqueline Smith ◽  
Kim Usher ◽  
Gary Alcock ◽  
Petra Buettner
Keyword(s):  
Randomized Controlled Trial ◽  
Neonatal Intensive Care ◽  
Controlled Trial ◽  
Intervention Group ◽  
Temperature Management ◽  
Outcome Variable ◽  
Control Group ◽  
Randomized Controlled ◽  
The Mean ◽  
Nicu Admission

Purpose: The primary aim of the study was to evaluate whether the application of a plastic wrap immediately after birth is more effective than the standard care of temperature management for improving admission temperatures to the neonatal intensive care unit (NICU) in infants <30 weeks gestation.Design: A randomized controlled trial was conducted. Infants in the intervention group were transferred to a prewarmed radiant heater immediately after birth and encased in NeoWrap from the neck down without being dried. The infant’s head was dried with a prewarmed towel and a hat added. The control group received usual care for the unit; the infant was transferred to the prewarmed radiant warmer and dried, and warm towels and a hat are then applied.Sample: A total of 92 infants were analyzed: 49 in the control group and 43 in the intervention group; 48 (52.2 percent) were <27 weeks gestation, and 44 (47.8 percent) were <30 weeks gestation. The infants’ temperatures were assessed for two hours following admission.Main Outcome Variable: The application of a plastic wrap and hat significantly increased NICU admission temperature in infants <30 weeks gestation.Results: Of the 92 infants, 43 (51.2 percent <27 weeks and 48.8 percent <30 weeks) were randomized to the experimental group and 49 (53.1 percent <27 weeks and 46.9 percent <30 weeks) to the control group. The mean first temperature was 36.15°C (SD = 0.85) for intervention and 35.81°C (SD = 0.91) for control infants (p=.074); whereas the respective admission temperatures were 36.26°C (SD = 0.68; n = 42) and 35.79°C (SD = 0.77; n = 44; p=.004). The mean temperature of the infants rose steadily from the time of birth to two hours follow-up in both the intervention (36.15°–37.03°C; SD = 0.49; n = 40) and control groups (35.81°–36.75°C; SD = 0.70; n = 47; p<.001, respectively).

scholarly journals Maternal and neonatal outcomes of repeated antepartum bleeding in 493 placenta previa cases: a retrospective study

2020 ◽  
Author(s):  
Jiang ziyan ◽  
shiyun huang ◽  
qing zuo ◽  
zhiping ge ◽  
hongmei lu ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Elective Surgery ◽  
Placenta Previa ◽  
Late Pregnancy ◽  
Neonatal Outcomes ◽  
Maternal Characteristics ◽  
Increased Risk ◽  
History Of ◽  
Nicu Admission

Abstract Background Placenta previa (PP) is a serious complication of late pregnancy. Exploring the effect of antepartum bleeding caused by PP on pregnancy outcomes is very important.Methods We retrospectively analyzed 493 women complicated with PP. Patients were divided into antepartum repeated bleeding and non-bleeding groups. Maternal characteristics and pregnancy outcomes were compared.Results The risk of antepartum hemorrhage was 2.038 times higher when gravidity was 5 (95% CI 1.104 ~ 3.760, P = 0.023). Pregnant women with a history of more than three intrauterine procedures had a 1.968 times higher risk of antepartum hemorrhage (95% CI 1.135 ~ 3,412, P = 0.016) compared to pregnant women without any intrauterine procedures. The risk of antepartum bleeding was found to be decreasing with the pregnancy advancing; When the placenta edge was noted to be over cervival os, the risk of antepartum bleeding was 4.385-fold than the low-lying plcaenta cases (95%CI2.454ཞ8.372,P = 0.000). In the respect of maternal outcomes, the repeated bleeding group, the risk of emergency surgery was 7.213 times higher than elective surgery (95% CI 4.402ཞ11.817, P = 0.000). As for the neonatal outcomes, the risk of asphyxia was 2.970 times and the risk of NICU admission was 2.542-fold higher in repeated bleeding group compared to non-bleeding group, respectively.Conclusions Obstetricians should be aware of the increased risk of antepartum bleeding especially for ≤ 34 weeks and placenta edge over cervical os PP patients, they have a higher risk of antepartum bleeding. These women have higher possibility of emergency c-section and need preterm newborn resuscitation.

scholarly journals The effects of cervical cerclage practice on perinatal and neonatal outcomes according to the indications

2020 ◽  
Vol 28 (3) ◽  
pp. 164-169
Author(s):  
Serdar Kaya ◽  
Fatma Ceren Güner ◽  
Mehmet Şimşek ◽  
Selahattin Kumru
Keyword(s):  
Preterm Labor ◽  
Previous History ◽  
Cervical Length ◽  
Neonatal Outcomes ◽  
Cervical Insufficiency ◽  
Singleton Pregnancy ◽  
Cervical Cerclage ◽  
Significant Difference ◽  
Prophylactic Cerclage ◽  
The Mean

Objective: The aim was to investigate the perinatal and neonatal outcomes in the cases which underwent cervical cerclage, and to compare the elective and emergency cerclage cases. Methods: The cases that underwent cervical cerclage in the Hospital of the Faculty of Medicine at Akdeniz University between January 2014 and December 2019 were assessed retrospectively, and separated into 3 categories as the prophylactic, elective and emergency groups. The demographic characteristics and perinatal and neonatal outcomes were recorded and they were compared between the groups. Results: A total of 92 cases with singleton pregnancy between 12 and 24 weeks of gestation were included in the study. The prophylactic cerclage group consisted of 48 cases, the elective cerclage group consisted of 21 cases and the emergency cerclage group consisted of 23 cases. The rate of the cases delivered at term (≥37 weeks of gestation) was found significantly lower in the emergency cerclage group than the rates of the cases in the prophylactic and elective cerclage groups (26.1%, 70.8% and 66.7%; respectively). While there was no significant difference between the prophylactic and elective cerclage groups in terms of premature preterm labor (<32 weeks of gestation), the rate of premature preterm labor was significantly higher in the emergency cerclage group than two other groups (10.4%, 9.5% and 43.5%, respectively; p=0.005). The mean delivery week of the emergency cerclage cases was significantly higher than the prophylactic and elective cerclage groups (31.7, 36.7 and 36.5 weeks, respectively; p<0.001). The mean duration between the cerclage procedure and the delivery week was the highest in the prophylactic cerclage cases and the lowest in the emergency cerclage cases (22.8 and 9.7 weeks, respectively; p<0.001). The mortality rate of the newborns was higher in the emergency cerclage cases than the other groups, which was statistically significant (p=0.002). Conclusion: We concluded that the perinatal and neonatal outcomes of the emergency cerclage procedure carried out in the advanced stage of cervical changes in the cases with cervical insufficiency is less successful than the prophylactic and elective cerclage procedures. The early detection of cervical insufficiency by the previous history, the physical examination and the measurement of transvaginal cervical length and responding at the early weeks of gestation may improve the perinatal and neonatal outcomes.

scholarly journals Role of cervical ultrasound in prediction of preterm labor

1970 ◽  
Vol 2 (2) ◽  
pp. 20-23
Author(s):  
Samjhana Dhakal ◽  
Shripad Hebbar
Keyword(s):  
Preterm Labor ◽  
Preterm Labour ◽  
Cervical Length ◽  
Controlled Study ◽  
Control Group ◽  
Threatened Preterm Labor ◽  
The Mean ◽  
The Difference ◽  
Routine Antenatal Care

Aim: To compare the difference in the cervical length measured digitally or by transabdominal and transvaginal sonogram examination for prediction of preterm labour Method: This was a prospective randomized, controlled study in the Department of Obstetrics and Gynaecology at TMA Pai Hospital, Udupi from March 2001 to May 2002 where 200 women coming for routine antenatal care were recruited for the study. A total of 168 women were evaluated, out of which 145 were control group and 23 cases of threatened preterm labor formed study group. Results: The mean length of cervix measured by TVS at 20- 24wks of pregnancy was 3.87 cm. There after there was a slight decrease in the length mainly towards term and or 36 wks of pregnancy i.e. 3.27 cm. Cervical length measured on an average 0.8 cm more than TVS(4.9CM versus 3.52 cm) Similarly digital examination of cervix yielded shorter length, compared to TVS measurement (2.86 cm versus 3.5 cm). Conclusion: This study has shown TVS is a simple tool for prediction of preterm labour as decrease in cervical length was observed in women with threatened preterm labor (2.34 cm) and this decrease was statistically significant compared to that of the control (3.7 cm). Key words: Trans abdominal, transvaginal, preterm labour      doi:10.3126/njog.v2i2.1450 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 20 - 23

scholarly journals Do Maternal Demographics and Prenatal History Impact the Efficacy of Betamethasone Therapy for Threatened Preterm Labor?

2020 ◽  
Vol 3 ◽  
Author(s):  
Mary Kinney ◽  
David Haas ◽  
Hayley Trussell ◽  
Larissa Silva ◽  
Sara Quinney
Keyword(s):  
Race And Ethnicity ◽  
Preterm Labor ◽  
Secondary Analysis ◽  
Fetal Lung ◽  
Time Frame ◽  
Lung Maturation ◽  
Maternal Characteristics ◽  
Gestational Age At Delivery ◽  
Threatened Preterm Labor ◽  
Individualization Of Therapy

Background/Objective: Betamethasone is used to accelerate fetal lung maturation in women with threatened preterm labor, but its efficacy is variable and limited by the lack of patient individualization in its dosing and administration. To determine sources of variability and potential opportunities for individualization of therapy, the objective of this study was to evaluate maternal factors associated with development of neonatal respiratory distress syndrome (RDS) in a cohort of women who received betamethasone.     Methods: This study prospectively enrolled women, gestational ages 23-34 weeks, who received betamethasone for threatened preterm labor (n=208). Maternal demographics, prenatal history, and neonatal outcomes were abstracted from Epic and Cerner records. RDS was the primary outcome. Associations between RDS diagnosis and factors such as maternal demographics, prenatal history, and betamethasone dosing were evaluated in a multivariable regression adjusted for gestational age at delivery. A secondary analysis limited the cohort to women who delivered within 2 weeks of betamethasone dosing (n=95).    Results: Of 208 deliveries, 44.1% resulted in neonatal RDS. Within the overall cohort, the only significant association with RDS was the type of delivery, with 61.3% of cesarean births resulting in RDS versus 28.7% of vaginal births (adjusted OR 1.17 [1.06-1.28]). Among deliveries within 14 days of betamethasone dosing, women who experienced preterm premature rupture of membranes (PPROM) had lower RDS outcome rates than those without PPROM (52.6% vs. 78.9%, adjusted OR 0.80 [0.65-0.98]). Maternal age, BMI, race, and ethnicity were not associated with RDS.    Conclusion: Maternal characteristics alone may not be useful biomarkers in predicting neonatal RDS. The association between PPROM and RDS may suggest the importance of the time frame between betamethasone dosing and delivery. The finding of higher risk for RDS among neonates born by cesarean is consistent with other studies and bears further exploration as betamethasone therapy may mediate the association. 

scholarly journals Optimized Clustering Algorithm for Comparative Analysis of Different Prenatal Corticosteroid Neurological Deficits in Premature Infants through Magnetic Reasoning Imaging (MRI)

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Shu Zhao
Keyword(s):  
Pregnant Women ◽  
Preterm Labor ◽  
Clustering Algorithm ◽  
Neurological Deficits ◽  
Antenatal Corticosteroids ◽  
Maternal Complications ◽  
Significant Difference ◽  
Group A ◽  
Threatened Preterm Labor ◽  
Group B

Objective. This study aimed to explore the application of different prenatal corticosteroids in the assessment of neurological deficits and prognosis in premature infants through Magnetic Reasoning Imaging (MRI) under optimized cluster algorithm. Methods. 100 pregnant women with threatened preterm labor were retrospectively analyzed, in which 38 pregnant women with lasting threatened preterm labor (group A) were treated with multiple courses of antenatal corticosteroids (dexamethasone treatment) and 62 cases of pregnant women with threatened preterm labor (group B) were treated with single course of dexamethasone treatment. Craniocerebral MRI images based on optimal clustering algorithm were used to examine neonates. Neonatal hypoxic-ischemic encephalopathy (HIE) rate, serum neuron-specific enolase (NSE) concentration, neonatal behavioral neurological score (NBNA), respiratory distress syndrome (RDS) rate, perinatal mortality, neonatal birth weight, and maternal complications rate of two groups were compared. Results. Compared with other traditional image segmentation algorithms, this algorithm had the best segmentation effect, the shortest running time (1.43 s), the least number of iterations (5 times), and the highest segmentation accuracy (97.98%). There was no significant difference in the HIE rate, serum NSE concentration, NBNA score, RDS score, and perinatal mortality in group A and group B ( P > 0.05 ). Compared with group B, neonates’ body weight in group A was decreased, while the maternal complication rate in group A was increased ( P < 0.05 ). Conclusion. MRI images based on optimized clustering algorithm can be used in the diagnosis of neonatal hypoxic-ischemic encephalopathy. There is no significant difference in the application of different antenatal corticosteroids affecting premature nerve function defect and prognosis, but multiple courses of antenatal corticosteroids can affect neonatal body mass and increased maternal complications to a certain extent; therefore, before threatened premature delivery treatment, the pros and cons of multiple courses of antenatal corticosteroids should fully be considered and in the treatment, measures should be actively taken to alleviate the side effect.

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