Highlights in Obstetrics From the 50th Annual Meeting of The American College of Obstetricians and Gynecologists

David Cole, MD

Disclosures

June 11, 2002

In This Article

Corticosteroids

The use of corticosteroids to increase fetal lung maturity has been one of the great successes of modern obstetrics, although the obstetric community was slow to embrace the use of corticosteroids. In 1994, the National Institutes of Health (NIH) recommended that corticosteroids be considered for all fetuses between 24 and 34 weeks at risk of preterm labor.[16] Either dexamethasone or betamethasone is appropriate.

If 1 course of steroids is good, then would not 2 courses be better for the fetus? Although 1 course of steroids has proven beneficial, there are data from both animal and human studies that show that repeated courses of steroids can have detrimental effects on the central nervous system. This led to a second NIH conference in 2000 that recommended that repeat doses of steroids be given only as part of a clinical trial.[17] Several randomized studies on the use of multiple courses of steroids are being conducted worldwide. The Multiple Antenatal Corticosteroid Study (MACS) is under way in the United States and Canada. Because only 1 course of steroids is recommended, the timing of the course of steroids is crucial, as the greatest benefit of the steroids is within 1 week of its administration.

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