Corticosteroid therapy

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CORTICOSTEROID THERAPY
Maternal corticosteroid treatment with betamethasone and dexamethasone has been shown in several controlled trials to decrease the incidence of respiratory distress syndrome. Antenatal corticosteroid therapy decreased the risk of respiratory distress syndrome, intraventricular hemorrhage, and mortality in infants born prematurely. Antenatal therapy with corticosteroids should be considered for all fetuses at risk for preterm delivery between 24 and 34 weeks of gestational age, regardless of race, gender, or availability of surfactant therapy. Antenatal corticosteroids should be considered in the presence of preterm PROM in pregnancies less than 30-32 weeks of gestation unless there is evidence of clinical chorioamnionitis.
There has been hesitation to use corticosteroids in some patients because of the impression that delivery will occur before a full course of therapy (ie, less than 24 hours). However, treatment with corticosteroids for less than 24 hours still appears to be associated with a significant reduction in neonatal mortality, respiratory distress syndrome, and intraventricular hemorrhage. The most commonly used regimens of antenatal corticosteroids would appear to be either two doses of 12 mg of betamethasone given intramuscularly 24 hours apart or four doses of 6 mg of dexamethasone intramuscularly 12 hours apart.
METHOD OF DELIVERY
Retrospective studies show that the singleton breech of less than 32-34 weeks of gestation or weighing less than 1,500 g has less morbidity and mortality if delivered by the cesarean method, particularly if the breech presents as a footling. There are no convincing data to indicate that cesarean delivery is indicated for cephalic presentations if labor is progressing in a normal fashion. Factors associated with intraventricular hemorrhage are the prematurity of the fetus, shock, and respiratory distress syndrome, but not the mode of delivery for cephalic presentations.