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Antepartum eclampsia <34 weeks case series: advisable to postpone delivery to administer corticosteroids for fetal pulmonary benefit?
MedLine Citation:
PMID:  21072041     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Objective:To determine if postponement of delivery to administer fetal lung maturation corticosteroids (PDACs) in mothers with antepartum eclampsia <34 weeks gestation benefits the fetus without compromising the mother.Study Design:A case series of 37 maternal-perinatal pairs over a 9-year period with antepartum eclampsia between 24 and 34 weeks gestation from a single tertiary center were reviewed retrospectively. Duration of PDAC, clinical course and maternal-fetal outcomes, including impact of duration of PDAC on neonatal pulmonary function, were recorded for each case. Group assignment was based on length of corticosteroid treatment course before delivery: Group A, 0 to 24 h, n=28; B, 24 to <48 h, n=5; C, 48 h, n=4. Data were collected and analyzed by one-way analysis of variance (ANOVA), ANOVA on ranks, χ(2)-test and Fisher's exact tests where appropriate; statistical significance was determined by a P-value <0.05.Result:Overall, 37 of 68 eclampsia patients in 1999 to 2007 met inclusion criteria. No adverse maternal or fetal event occurred while delivery was postponed. Immediate neonatal intubation or continuous positive airway pressure was required for 23/28 in A, 4/5 in B and 2/4 in C; room air was sufficient at birth for 5/28 in A, 1/5 in B and 2/4 in C. No newborn >33 weeks gestation required INI. Prolonged (that is, >1 day) mechanical ventilation was not required for any infant with a gestational age 32 weeks or PDAC 48 h. Two of three neonatal deaths in group A were attributed to pulmonary insufficiency.Conclusion:PDAC for antepartum preterm eclampsia, especially 32 weeks gestation, appears to offer notable fetal pulmonary benefit without significantly increasing maternal or fetal risk.
Authors:
K B Tam Tam; S D Keiser; S Sims; J Brewer; M Y Owens; J N Martin
Publication Detail:
Type:  Journal Article     Date:  2010-11-11
Journal Detail:
Title:  Journal of perinatology : official journal of the California Perinatal Association     Volume:  31     ISSN:  1476-5543     ISO Abbreviation:  J Perinatol     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8501884     Medline TA:  J Perinatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  161-5     Citation Subset:  IM    
Affiliation:
Department of Obstetrics and Gynecology, Winfred L Wiser Hospital for Women and Infants, University of Mississippi Medical Center, Jackson, MS, USA.
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