Can the benefits of antepartum corticosteroid treatment be improved?
Although there is no doubt that antepartum corticosteroid treatment is effective in reducing the incidence of respiratory distress syndrome (RDS), the potential benefits cannot be fully realised for several reasons. Many patients deliver within 24 hours of the start of treatment because tocolytic treatment is withheld or ineffective. In other patients, contraindications to delayed delivery may exist. In addition, corticosteroids are relatively ineffective in the group of infants at greatest risk (less than 28 weeks). Marked improvements in benefit will be achieved by improved tocolytics (perhaps indomethacin and/or oxytocin analogues), by more precise methods of predicting and diagnosing preterm labour, and by methods that enhance the response to corticosteroids at very early gestational ages. In regard to the latter, there is encouragement from experimental work showing synergism of antepartum steroids with simultaneous TRH treatment and with neonatal instillation of surfactant.
Liggins
G C
GC
Postgraduate School of Obstetrics and Gynaecology, University of Auckland, New Zealand.
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D005260:Female; D005315:Fetal Diseases / Q000188:drug therapy*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy*
D000305:Adrenal Cortex Hormones