Antenatal steroidA correction was published in November for this title. Click here to view the correction. This information is designed as an steroid given for preterm labor resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as legal high deaths 2015 of all proper treatments or methods of steroid given for preterm labor or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology.
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Preterm birth can result in problems of the lungs, heart, brain, and other body systems of a newborn baby. Recent advances in the study of preterm labor have identified effective drugs that may delay delivery. The longer a baby can develop in the womb, the less likely they will have problems associated with preterm birth. Symptoms of preterm labor include:. If your water has broken, you may also be given antibiotics to prevent infection and help you stay pregnant longer.
Some women go into labor very early. The injections are given two to four times over a two-day period, depending on which steroid is used.
The most common steroid, betamethasone Celestone , is given in two doses, 12 mg each, 12 or 24 hours apart. The medications are most effective from two to seven days after the first dose.
Multiple studies have shown that prenatal corticosteroids are safe for mothers and babies. Steroid treatment reduces the risk of lung problems for babies who are born early, particularly for those born between 29 and 34 weeks of pregnancy. Babies born more than 48 hours, but less than seven days , from the first dose of steroids appear to receive the greatest benefit.
All babies born at less than 28 weeks had lung problems, but the problems were milder for those who got steroids before birth. Steroids may also reduce other complications in babies. Studies have shown that some babies have fewer problems with their intestines and with bleeding in the brain when their mothers received a course of betamethasone prior to birth.
Staying pregnant for those first two days after a corticosteroid shot is the first major milestone for you and your baby or babies. Animal studies have shown that giving steroids to a pregnant female can affect the immune system, neurological development, and growth of her offspring. However, these effects have shown up only in studies where steroids were given in very high doses or early in the pregnancy.
In the treatment of preterm labor, steroids are given later in pregnancy. Human studies have not shown any significant risks associated with a single course of steroids. Older studies followed infants whose mothers were given steroids during pregnancy until the children were 12 years old. Still, more studies need to be done.
In the past, women at risk for preterm delivery received steroids once a week until they delivered. Data from infants and animal studies showed that multiple courses of steroids were linked to babies with lower birth weights and smaller heads. In , the National Institutes of Health NIH published guidelines on the administration of steroids to women with preterm labor. According to these guidelines, doctors should consider giving steroids to all women who:.
Steroids may make diabetes both long-standing and pregnancy-related more difficult to control. When given in combination with a beta-mimetic drug terbutaline , brand name Brethine , they can be even more problematic. Women with diabetes will require careful blood sugar monitoring for three to four days after receiving steroids. Some women are more likely than others to go into labor early. Women at high risk of a preterm delivery include those who:. Despite these known risks, many women who experience symptoms of preterm labor have no clear risk factors.
The most common form of progesterone hormone administered to prevent preterm birth is the OHPC shot, or alphahydroxyprogesterone caproate. The OHPC shot is a synthetic progesterone that is often administered prior to the 21st week of gestation. The hormone works by keeping the uterus from contracting. The shot is typically given into the muscles of the woman receiving treatment on a weekly basis. A prescription is required for this hormone treatment, and both the shots and the suppositories should be administered by a doctor.
A review of clinical studies of OHPC has demonstrated its ability to prolong pregnancy. Women who are at risk of delivering a baby before 37 weeks may be able to stay pregnant longer if they receive OHPC prior to the completion of 21 weeks of pregnancy. Other studies have demonstrated that if preterm birth does occur, babies who survive have fewer complications if their mothers received OHPC before the birth.
As with any shot and hormone administration, OHPC shots may cause some side effects. The most common include:. Women who receive the pessary are more likely to have unpleasant discharge or irritation in their vagina. There is no indication that OHPC shots have any negative effect on miscarriage, stillbirth, preterm birth, or birth defect risk.
Women who have a history of premature delivery should take this drug. In addition, women with allergies or serious reactions to the shot may wish to discontinue their use. As well, there are some situations in which a longer pregnancy may be harmful to the mother or the fetus.
Preeclampsia , amnionitis , and lethal fetal anomalies or imminent fetal death may make a prolonged pregnancy dangerous or fruitless. Always consult carefully with a health professional before deciding to receive OHPC shots or suppositories. Tocolytic medications are used to delay delivery. A variety of drugs have similar effects for delaying delivery 48 hours or more when a woman is experiencing preterm labor. Tocolytic drugs include the following medications:.
Tocolytics are prescription drugs that should only be administered between weeks 20 and 37 of pregnancy if symptoms of preterm labor exist.
Combining tocolytics can cause problems for both the mother and the baby. In general, tocolytic drugs only delay delivery. All tocolytics, but prostaglandin inhibitors in particular, are effective at delaying delivery between 48 hours and seven days. This allows corticosteroids time to speed fetal development. Instead, they merely give extra time for the baby to develop or for other drugs to work.
Tocolytics may also delay delivery long enough for a woman to be transported to a facility with a neonatal intensive care unit if preterm birth or complications are likely. There is some controversy over whether tocolytics themselves can cause problems at birth, such as breathing problems for the baby or infection in the mother.
In addition, each type of tocolytic drug has risks for women with certain conditions. Antibiotics are routinely given to women in preterm labor when the bag of water surrounding the fetus has broken. This is because ruptured membranes put a woman and her baby at greater risk for infection. In addition, antibiotics are frequently used to treat infections such as chorioamnionitis and group B streptococcus GBS during preterm labor.
Antibiotics require a prescription and are available in pill form or intravenous solution. Some studies have shown that antibiotics may reduce problems in the newborn. For now, using antibiotics to help treat all preterm labor remains controversial.
There is also data showing that antibiotics are helpful during preterm labor for women who carry the GBS bacteria. 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.
Most healthcare 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 begin treating a woman for GBS before confirmation of infection if a woman is in preterm labor. Most doctors think that this practice is justified because as many as one in four women test positive for GBS.
The primary risk of antibiotics during preterm labor is an allergic reaction from the mother. In addition, some babies may be born with an infection that has resistance to antibiotics, making treatment of postpartum infections in those babies more difficult. According to ACOG , only women with signs of infection or a ruptured membrane early water break should receive antibiotics during premature labor.
Women without signs of infection and with intact membranes should likely not receive antibiotics during preterm labor.
In addition, some women may have allergic reactions to particular antibiotics. At 32 weeks pregnant, you only have about eight weeks left to go. Now is a great time to start making plans for after baby arrives. To differentiate normal contractions from preterm labor, your doctor may suggest monitoring your contractions.
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