[Tiny1Nisolet]

Hello guys,
I have a question regarding the use of Betamethasone in a patient with preterm labor symtoms. She is a friend of mine and has denied having the shots.
She is 29 weeks, multigravida and has been having discharge and intermittant cramping since this past Friday. She is ordered to be on complete bed rest at home. She has 2 other children.

I am confused on how Beta..works. If you give the shots and do not deliver within a week, is the shot unsuccessful? Why would you want the patient to deliver within that time period? I have also read that multiple shots are debatable as far as success rate. However, most patients recieve two shots, but any more than that can be debated. Is this correct?

Also, as far as the possible side effects are these correct: for mom, possible pulmonary edema and for baby possible hypoglycemia and neonatal sepsis? Are there any others? What are the real numbers. From what I have read in my textbook, they are slim. The information on the internet has been inconsistent. I knew you guys could shed some light.

Thanks so much in advance for your assistance.

[wannabeL&D73]

Originally Posted by Tiny1Nisolet

Hello guys,
I have a question regarding the use of Betamethasone in a patient with preterm labor symtoms. She is a friend of mine and has denied having the shots.
She is 29 weeks, multigravida and has been having discharge and intermittant cramping since this past Friday. She is ordered to be on complete bed rest at home. She has 2 other children.

I am confused on how Beta..works. If you give the shots and do not deliver within a week, is the shot unsuccessful? Why would you want the patient to deliver within that time period? I have also read that multiple shots are debatable as far as success rate. However, most patients recieve two shots, but any more than that can be debated. Is this correct?

Also, as far as the possible side effects are these correct: for mom, possible pulmonary edema and for baby possible hypoglycemia and neonatal sepsis? Are there any others? What are the real numbers. From what I have read in my textbook, they are slim. The information on the internet has been inconsistent. I knew you guys could shed some light.

Thanks so much in advance for your assistance.

I am not a nurse yet, but here is my personal experience:

1st pg., received 2 shots every week starting (I think) at 26 weeks--delivered at 32 1/2 (approx. can't remember exact gestation to the day). Baby had no respiratory issues and came home in 1 week. Absolutely no complications (that we know of) related to multiple rounds of steroids. My daughter is now 5 and incredibly healthy.

2nd pg., received 1 round at 26 weeks. Delivered at 33. Baby had no respiratory issues and would also have been home quickly except for other complications unrelated to prematurity (Trisomy 21 and Hirschprungs Disease). He is now a very healthy 2 year-old.

Future potential pg.: The MFM (a different one due to a move) is adamant about only giving one round of betamethasone. This makes me nervous--I would hate to be lucky enough to get to 34 weeks but still have a baby with immature lungs. I argued with him, but he was firm about sticking to the current standards. Personally, especially since I didn't experience any complications, I would rather risk future potential but unlikely complications due to more than one round of shots than immature lungs. But my understanding is that most docs will not budge on this. Therefore, they are very careful about deciding when to give them...they don't want to do it too soon and then be out of options.

DO you mean that your friend refused the shots, or that the dr. refused to give them? Either way, I wish her good luck. I hope she has family and friends who will step up and help.

Shannon

[Tiny1Nisolet]

She refused the shots. I am trying to help inform her of the risk/benefits. Is this correct: Current practice is to give one round of shots. Multiple shots are not currently given? So, the first round covers you from the time you get it up through delivery. Is this correct?

Why aren't more people responding? Is everyone working today?

[truern]

Tiny, I found this information online:

http://health.yahoo.com/ency/healthwise/hw222067

Sorry you're not getting the responses you need

[fergus51]

We don't do multiple rounds because they don't have any benefit for the baby. One round only, and yes, it is meant for if they believe mom will deliver within one week because that's the time frame in which it's useful.

[SmilingBluEyes]

Fergus said it well.

[Tiny1Nisolet]

So if she gets it now, and does not deliver within 1 week, there is still a chance baby's lungs will not be ready?
Thanks so much. I have been searching the internet and have read in my textbook as well as a couple of research articles. I was not understanding why it is only good for one week. Also, if preterm labor is as unpredictable as they say, how do they know the week to give it in?
I am sure this seems remedial to most of you, and I appreciate you taking the time to respond. Thanks very much.

[Jolie]

Originally Posted by Tiny1Nisolet

So if she gets it now, and does not deliver within 1 week, there is still a chance baby's lungs will not be ready?
Thanks so much. I have been searching the internet and have read in my textbook as well as a couple of research articles. I was not understanding why it is only good for one week. Also, if preterm labor is as unpredictable as they say, how do they know the week to give it in?
I am sure this seems remedial to most of you, and I appreciate you taking the time to respond. Thanks very much.

This is a complex issue.

I also had 2 high risk pregnancies, with PTL beginning at 26 and 23 weeks respectively, during the time that beta-methasone was still given on a weekly basis. I had to INSIST on it with my second pregnancy, because one particular OB in my group did not believe in using it. One of my girls delivered prematurely, and was healthy, the other made it to 37 weeks. I would not have done it any other way AT THAT TIME.

However, time marches on. Research had yielded new information, and hence new protocols. There is credible evidence that repeated courses of beta-methasone can be harmful to the developing fetus, increasing the risk of (ironically) respiratory disease in the child later in life. I would love to enroll my girls in studies of such effects.

Beta-methasone affects the lungs of the developing fetus in 2 ways, structurally and biochemically. The structural changes (more rapid alveolar development) are permanent, and do not regress with time. The biochemical changes (more rapid surfactant production) are temporary, and these are the benefits that are lost over time. This was the reason for repeating the course of beta-methasone weekly in previous years. But is now believed that proper timing of a single course of steroids produces the greatest benefit to the fetus while minimizing the risk of future lung problems.

Many moms refuse steroids because of unfounded fears that they can contribute to risk of infection or gestational diabetes. Neither is the case, so if your friend is concerned about either of these issues, she can put her mind at ease.

Thanks for trying to help her understand this!

[fergus51]

Originally Posted by Tiny1Nisolet

So if she gets it now, and does not deliver within 1 week, there is still a chance baby's lungs will not be ready?

Yep, but there is always that chance, but that chance is always there even if she delivers within the time frame. The docs have no way of saying for sure a woman will deliver within a week, they have to go on her symptoms at the time. A woman having contractions and discharge at 29 weeks for days, maybe with a hx of preterm births, maybe a multip... I can't imagine a doc NOT recommending it. IMO it's better to have a 29 weeker who has the benefit of beta shots and risk having a 31 weeker who wouldn't benefit from the shots because 31 weekers lungs are so much better anyways.

[mugwump]

From what I understnad and what i tell my patients. Are that Beta is helpful it sort of artificially makes the lungs better than they were before. (will a 24 wekker come out breathing on their own and be absolulty fine, certanly not, but do they do better than 24 weekers who do not have the shot yes. Also it is not just good for a week, studies have shown extra rounds (they used to give two shots every weekd) have no added benefit. However i work with a perinatal group who is doing a research study to see if patients who get very early Beta shots (24 weeks)) can benefit from a (booster) series later in the pregnancy like 32 weeks) Keep in mind though your friend has to make the decision for her baby and live with that good or bad. It is our jobs as nurses to give her the information