Araştırma Makalesi
BibTex RIS Kaynak Göster

Use of corticosteroids for lung maturation in multiple pregnant at risk of preterm delivery; Perinatal outcomes

Yıl 2019, , 1206 - 1213, 15.04.2019
https://doi.org/10.30569/adiyamansaglik.490432

Öz

Objective:  Although
antenatal corticosteroid (ACS) treatment is widely used for prevention of
respiratory distress syndrome (RDS) in preterm infants the results of this
treatment is still controversial in multiple pregnancies. The aim of this study
is to evaluate the effect of antenatal corticosteroid on the mother and the
neonate in multiple pregnancies at risk of preterm birth.

Methods: Medical records of 68 women with twin or triplet
pregnancies at risk of preterm birth who delivered at a University Hospital in
two years period were analyzed. Sixty-seven of the women recruited had twin
pregnancy while the remaining one had triplets. The demographic
characteristics, obstetric history, gestational age, presence of maternal co-morbidities,
mode of delivery, maternal and fetal outcome were recorded.

Findings: The average age of the patients was 31.9±5.7. The
average week of pregnancy at admission to the hospital was 33.1±2.5 weeks.
48.5% of the patients had spontaneous pregnancy while 26.5% got pregnant after
controlled ovarian hyperstimulation and intrauterine insemination and 25% had
in vitro fertilization and embryo transfer. Out of 68 patients 45 (66.2%)
received single dose, 23 had (33.8%) multi doses of corticosteroids. The
average time between corticosteroid administration and delivery was 81±276
hours. One patient had facial paralysis and another one had surgical site
infection during the postpartum period. Out of 137 babies delivered, 70 (51.1%)  were not admitted to the Neonatal Intensive
Care Unit (NICU) while the indications for admission in the remaining 48.9%
were RDS, icterus and transient tachypnea of the neonate. Three neonates did
not survive (650, 750 and 875 gr).







Conclusion:  Preterm birth that is
encountered in 50% of the multiple pregnancies is a major risk factor for
neonatal morbidity and mortality. In order to prevent RDS and decrease the need
for admission to NICU it is important to administer ACS. In multiple
pregnancies complicated with preterm delivery, development of RDS has the
highest impact on survival. ACS use is important for prevention of RDS.

Kaynakça

  • 1. Kulkarni AD, Jamieson DJ, Jones Jr HW, Kissin DM, Gallo MF, Macaluso M, et al. Fertility treatments and multiple births in the United States. N Engl J Med 2013;369(23):2218–25.
  • 2. Ward RM, Beachy JC. Neonatal complications following preterm birth. BJOG 2003;110:8–16.
  • 3. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006;3, CD004454.
  • 4. Gyamfi C, Mele L, Wapner RJ, Spong CY, Peaceman A, Sorokin Y, et al. The effect of plurality and obesity on betamethasone concentrations in women at risk for preterm delivery. Am J Obstet Gynecol 2010;203(3):219.e1–5.
  • 5. Blickstein I, Shinwell ES, Lusky A, Reichman B, in collaboration with the Israel Neonatal Network. Plurality-dependent risk of respiratory distress syndrome among very-low-birth-weight infants and antepartum corticosteroid treatment. Am J Obstet Gynecol 2005;192(2):360–4.
  • 6. Booker WA, Gyamfi-Bannerman C. Antenatal Corticosteroids: Who Should We Be Treating? Clin Perinatol. 2018;45(2):181-198. doi: 10.1016/j.clp.2018.01.002.
  • 7. Riskin-Mashiah S, Reichman B, Bader D, Kugelman A, Boyko V, Lerner-Geva L, Riskin A. Population-based study on antenatal corticosteroid treatment in preterm small for gestational age and non-small for gestational age twin infants. J Matern Fetal Neonatal Med. 2018;31(5):553-559. doi: 10.1080/14767058.2017.1292242
  • 8. Melamed N, Shah J, Yoon EW, Pelausa E, Lee SK, Shah PS, Murphy KE; Canadian Neonatal Network Investigators. The role of antenatal corticosteroids in twin pregnancies complicated by preterm birth. Am J Obstet Gynecol. 2016;215(4):482.e1-9.
  • 9. Vaz A, Malheiro MF, Severo M, Rodrigues T, Guimarães H, Montenegro N. Effect of antenatal corticosteroids on morbidity and mortality of preterm singletons and twins. J Matern Fetal Neonatal Med. 2018; 31(6):754-760. doi: 10.1080/14767058.2017.1297408.
  • 10. Fillion A, Boutin A, Gareau-Léonard A, Labine L, Gasse C, Gaudreau C, Demers S, Bujold E. Use of Antenatal Corticosteroid Therapy: A Descriptive Study of Clinical Practice Trends. J Obstet Gynaecol Can. 2018 23. pii: S1701-2163(18)30523-1.
  • 11. Gyamfi-Bannerman C, Son M. Preterm Premature Rupture of Membranes and the Rate of Neonatal Sepsis After Two Courses of Antenatal Corticosteroids. Obstet Gynecol. 2014;124(5):999-1003.
  • 12. Haviv HR, Said J, Mol BW. The place of antenatal corticosteroids in late preterm and early term births Semin Fetal Neonatal Med. 2018 4. pii: S1744-165X(18)30112-4.
  • 13. Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis JP, McGoldrick E. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database Syst Rev. 2018 Aug 3;8:CD006614.
  • 14. Salem SY, Kibel M, Asztalos E, Zaltz A, Barrett J, Melamed N. Neonatal Outcomes of Low-Risk, Late-Preterm Twins Compared With Late-Preterm Singletons. Obstet Gynecol. 2017;130(3):582-590. doi: 10.1097/AOG.0000000000002187.

Preterm doğum riski olan çoğul gebelerde akciğer maturasyonu için kortikosteroid kullanımı; Perinatal sonuçlar

Yıl 2019, , 1206 - 1213, 15.04.2019
https://doi.org/10.30569/adiyamansaglik.490432

Öz

Amaç: Erken doğmuş bebeklerde respiratuvar distres sendromunun (RDS) önlenmesinde antenatal kortikosteroid
(AKS) tedavisi yaygın bir şekilde kullanılmasına rağmen, bu tedavinin çoğul
gebeliklerdeki sonuçları halen tartışmalıdır. Bu çalışmanın amacı, erken doğum
riski taşıyan çoğul gebeliklerde AKS’in etkisini araştırmaktır.

Yöntem: İki yıllık bir dönemde bir
Üniversite Hastanesinde çoğul gebelik ve erken doğumu riski ile hospitalize
edilerek doğum yapan 68 kadının tıbbi kayıtları incelendi. Çalışmaya alınan
kadınların 67’si ikiz gebelik, bir tanesi ise üçüz gebelikti. Demografik
özellikler, obstetrik öykü, gebelik yaşı, maternal komorbidite varlığı, doğum
şekli, maternal ve fetal sonuçlar kaydedilerek incelendi.

Bulgular: Olguların yaş ortalaması
31,9±5,7 yıldı. Hastaneye yatırıldıklarında ortalama gebelik haftası 33.1±2.5
haftaydı. Hastaların %48,5'i spontan, %26,5'i kontrollü ovaryan stimülasyon ve
intrauterin inseminasyon ve %25'i in vitro fertilizasyon ve embriyo transferi
yöntemiyle gebe kalmıştı. Altmış sekiz hastanın 45’inde (%66,2) tek doz,
23'ünde (% 33.8) multidoz kortikosteroid uygulandı. Kortikosteroid ile doğum
arasındaki ortalama süre 81±276 saat idi. 
Postpartum dönemde bir hastada fasiyal paralizi ve bir hastada da
cerrahi alan enfeksiyonu gelişti. Doğan 137 bebeğin %51,1’inde yoğun bakım
gereksinimi olmaz iken, %48.9’u yenidoğanın geçici takipnesi, RDS, sarılık
nedeni ile yenidoğan yoğun bakım (YDYB) ünitesine alındı. Üç yenidoğan
postpartum dönemde kaybedildi (650, 750 ve 875 gr).







Sonuç: Çoğul gebeliklerin yaklaşık
% 50'sinde görülen preterm doğum yenidoğan mortalite/morbiditesi için önemli
risk oluşturmaktadır. Çoğul gebelerde preterm doğum bağlı gelişecek RDS’nin
önlenmesi ve YDYB ihtiyacının azaltılması için AKS kullanımı önemlidir. Preterm
doğum ile komplike olan çoğul gebeliklerde RDS gelişimi sağ kalımı etkileyen en
önemli faktördür. RDS önlenmesinde AKS kullanımı önemlidir.

Kaynakça

  • 1. Kulkarni AD, Jamieson DJ, Jones Jr HW, Kissin DM, Gallo MF, Macaluso M, et al. Fertility treatments and multiple births in the United States. N Engl J Med 2013;369(23):2218–25.
  • 2. Ward RM, Beachy JC. Neonatal complications following preterm birth. BJOG 2003;110:8–16.
  • 3. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006;3, CD004454.
  • 4. Gyamfi C, Mele L, Wapner RJ, Spong CY, Peaceman A, Sorokin Y, et al. The effect of plurality and obesity on betamethasone concentrations in women at risk for preterm delivery. Am J Obstet Gynecol 2010;203(3):219.e1–5.
  • 5. Blickstein I, Shinwell ES, Lusky A, Reichman B, in collaboration with the Israel Neonatal Network. Plurality-dependent risk of respiratory distress syndrome among very-low-birth-weight infants and antepartum corticosteroid treatment. Am J Obstet Gynecol 2005;192(2):360–4.
  • 6. Booker WA, Gyamfi-Bannerman C. Antenatal Corticosteroids: Who Should We Be Treating? Clin Perinatol. 2018;45(2):181-198. doi: 10.1016/j.clp.2018.01.002.
  • 7. Riskin-Mashiah S, Reichman B, Bader D, Kugelman A, Boyko V, Lerner-Geva L, Riskin A. Population-based study on antenatal corticosteroid treatment in preterm small for gestational age and non-small for gestational age twin infants. J Matern Fetal Neonatal Med. 2018;31(5):553-559. doi: 10.1080/14767058.2017.1292242
  • 8. Melamed N, Shah J, Yoon EW, Pelausa E, Lee SK, Shah PS, Murphy KE; Canadian Neonatal Network Investigators. The role of antenatal corticosteroids in twin pregnancies complicated by preterm birth. Am J Obstet Gynecol. 2016;215(4):482.e1-9.
  • 9. Vaz A, Malheiro MF, Severo M, Rodrigues T, Guimarães H, Montenegro N. Effect of antenatal corticosteroids on morbidity and mortality of preterm singletons and twins. J Matern Fetal Neonatal Med. 2018; 31(6):754-760. doi: 10.1080/14767058.2017.1297408.
  • 10. Fillion A, Boutin A, Gareau-Léonard A, Labine L, Gasse C, Gaudreau C, Demers S, Bujold E. Use of Antenatal Corticosteroid Therapy: A Descriptive Study of Clinical Practice Trends. J Obstet Gynaecol Can. 2018 23. pii: S1701-2163(18)30523-1.
  • 11. Gyamfi-Bannerman C, Son M. Preterm Premature Rupture of Membranes and the Rate of Neonatal Sepsis After Two Courses of Antenatal Corticosteroids. Obstet Gynecol. 2014;124(5):999-1003.
  • 12. Haviv HR, Said J, Mol BW. The place of antenatal corticosteroids in late preterm and early term births Semin Fetal Neonatal Med. 2018 4. pii: S1744-165X(18)30112-4.
  • 13. Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis JP, McGoldrick E. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database Syst Rev. 2018 Aug 3;8:CD006614.
  • 14. Salem SY, Kibel M, Asztalos E, Zaltz A, Barrett J, Melamed N. Neonatal Outcomes of Low-Risk, Late-Preterm Twins Compared With Late-Preterm Singletons. Obstet Gynecol. 2017;130(3):582-590. doi: 10.1097/AOG.0000000000002187.
Toplam 14 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makalesi
Yazarlar

Mehmet Bülbül 0000-0001-5695-2586

Esra Boyar 0000-0002-5849-1602

İpek Çakılkaya Bu kişi benim 0000-0002-8360-236X

Selahaddin Akar 0000-0001-5915-8652

Berna Dilbaz Bu kişi benim 0000-0003-1137-8650

Yayımlanma Tarihi 15 Nisan 2019
Gönderilme Tarihi 30 Kasım 2018
Kabul Tarihi 28 Aralık 2018
Yayımlandığı Sayı Yıl 2019

Kaynak Göster

AMA Bülbül M, Boyar E, Çakılkaya İ, Akar S, Dilbaz B. Preterm doğum riski olan çoğul gebelerde akciğer maturasyonu için kortikosteroid kullanımı; Perinatal sonuçlar. ADYÜ Sağlık Bilimleri Derg. Nisan 2019;5(1):1206-1213. doi:10.30569/adiyamansaglik.490432