30 weeks, 1 cm. dilated, betamethasone?

fergus51 · Jun 2, 2005

I would actually not expect a dr to order steroids if that's all that was happening (she isn't actually in labor or anything). Steroids given at 30 weeks are gonna be useless if she holds on for 3 more weeks. ACOG only recommends steroids be given if the woman is likely to deliver within ONE week. Too early and they're useless and it is not recommended that women receive more than one round of steroids so we don't use it unless it really looks like mom will be delivering soon.

http://www.babycenter.com/expert/pregnancy/childbirth/5437.html

Since the benefits of the steroids are greatest during the first seven days after treatment, it used to be common practice to repeat steroid treatment weekly for those women who continued to be at high risk for preterm delivery but remained pregnant after the first treatment. But experts now think the risks of repeated treatments probably outweigh the benefits. They've been associated in some studies with decreased fetal growth, suppressed adrenal gland function, and adverse effects on long-term lung development. Some studies have also found that multiple courses of corticosteroids affected childhood behavior and may have caused delayed development, but other studies have not. As a result, both the NIH and ACOG currently recommend that unless you're enrolled in a clinical trial, you should not have repeat courses of corticosteroids in preterm labor until there's more evidence of the relative risks and benefits.

wannabeL&D73 · Jun 2, 2005

Thank you Fergus. I know those are the current recommendations...I guess I just disagree with them, and was hoping some NICU nurses did too, LOL! I had steroids every week for 4 weeks prior to my daughter's birth, and she is now a very healthy and smart 4 yr. old with no behaviour or learning problems (so far at least!). With my son I had one round at 26 weeks, and he was born at 33 with no respiratory problems. I guess there is no way to know if it was due to the steroids--I know it is possible for 33 weekers to breathe on their own. But of course my personal experience doesn't make for solid evidence. I just hate to think of someone delivering early without time for steroids, and then the baby having problems because of it. I already had a "discussion" with the MFM about this if we do another pg., and I don't think he will be swayed to my point of view either. I appreciate the input!

Shannon

fergus51 · Jun 3, 2005

I haven't had any kids of my own, so I obviously don't have any personal anectotes on the matter but I would refuse steroids if I was at 30 weeks, 1cm and inactive. I'm a NICU nurse and former L&D nurse I agree with the current recommendations. Every week for four weeks like with your daughter could cause problems in lung development (among other things) and one dose weeks before birth like you had with your son is probably useless and potentially harmful (if the mom gets steroids early, then holds on for 2 weeks, we can't give it again and its effects have worn off so baby is in a worse place than he would have been if we'd just waited to give it). I firmly believe in evidence based practise.

I sometimes wonder if the fact that I started in L&D is what makes me feel this way. I've noticed most NICU nurses think that any cervical changes or activity limitations should trigger medical interventions because they think that indicated imminent delivery. That isn't the case though, and that's what I've seen in my work, so I agree with waiting until there are some real indications that the baby will be coming.

wannabeL&D73 · Jun 3, 2005

OK, Fergus, you make a pretty good argument--for some reason it carries more weight for me coming from a nurse than my dr., go figure! I too agree with evidence based practice--most of the time. I guess this one is just hard for me because I *did* have the steroids, I didn't have complications (that I am aware of) and my kids didn't have any respiratory issues. I better accept the current practice before we TTC again though or I will drive myself crazy worrying about it. Now to go tell my friend I was wrong...

Thanks again for sharing your opinion and experience.

Shannon

fergus51 · Jun 3, 2005

:) No problem. I can certainly empathize with you. NRP is changing next year and it's gonna be really hard for me, but I have to accept the evidence and try to change accordingly. One of my mom's favorite sentences is "when you know better, you do better".... and we are always learning new things....

LilPeanut, MSN, RN, NP · Jun 3, 2005

I'm going to totally agree with fergus. Especially only being 1cm dilated in a multigravida, that would not even meet my peri's standards for labor. When you have had children before, often the cervix either doesn't completely close, or it tends to open just a little bit, unassociated with labor. Plus, steroids can have the side effect of throwing you into labor, so if it's not absolutely needed, it's not a good idea.

With my son, at 24 weeks I was fetal fibronectin positive, 3cm, 90% and actively contracting. (I was admitted obviously :lol:) I got steroids then, and they repeated them in a week, but then I went back to being fFN negative (after 3 pos. go figure) and held out until 34 weeks for delivery. They found via amnio his lungs weren't ready and gave me another shot of steroids in desperation (If I hadn't been on mag, I likely would have refused that. But you know how mag goes) But this was all before they knew that multiple rounds of steroids didn't give more benefits.

With my daughter, I only received 1 round at 28 weeks. Again, I was fFN positive, 3-4cm, 90+% and actively contracting. We managed to get it under control again and I held out with her until 35 weeks, no lung issues.

Bottom line is that every baby is different, and multiple courses of steroids have not shown to be helpful, only potentially harmful. Good luck on bedrest, I've spent a lot of time there.

wannabeL&D73 · Jun 3, 2005

I'm going to totally agree with fergus. Especially only being 1cm dilated in a multigravida, that would not even meet my peri's standards for labor. When you have had children before, often the cervix either doesn't completely close, or it tends to open just a little bit, unassociated with labor. Plus, steroids can have the side effect of throwing you into labor, so if it's not absolutely needed, it's not a good idea.
With my son, at 24 weeks I was fetal fibronectin positive, 3cm, 90% and actively contracting. (I was admitted obviously :lol:) I got steroids then, and they repeated them in a week, but then I went back to being fFN negative (after 3 pos. go figure) and held out until 34 weeks for delivery. They found via amnio his lungs weren't ready and gave me another shot of steroids in desperation (If I hadn't been on mag, I likely would have refused that. But you know how mag goes) But this was all before they knew that multiple rounds of steroids didn't give more benefits.
With my daughter, I only received 1 round at 28 weeks. Again, I was fFN positive, 3-4cm, 90+% and actively contracting. We managed to get it under control again and I held out with her until 35 weeks, no lung issues.
Bottom line is that every baby is different, and multiple courses of steroids have not shown to be helpful, only potentially harmful. Good luck on bedrest, I've spent a lot of time there.

Wow, what an encouraging story! That is just fantastic you were able to make it so far. Thanks for sharing your experience, you guys have me convinced.

Shannon

LilPeanut, MSN, RN, NP · Jun 3, 2005

All I can suggest is that you make bedrest your religion. That's how it was for me and I can honestly say, I never cheated on it. I was on a terb pump as well. (funny that, as it hasn't been proven to work, but my peri Jay Iams, the one who did a study that showed it shouldn't be part of general treatment said in my case it was needed and working) I never had fewer than 4 contractions an hour past 16 weeks, even on mag, terb or any other drug they gave me. The terb pump just helped keep the ctxns "disorganized" and non-productive.

dawngloves, BSN, RN · Jun 3, 2005

I agree with you Lilpeanut. With a multipara at 30 weeks and not in active labor, 1cm is nothing. At 32 weeks with my second I was 2cm and 50% effaced up until I PROMed at 36. I was on "sofa rest" :rolleyes:

I would be surprised to have seen beta given unless you were more progressed and contracting regularly. Good luck!

wannabeL&D73 · Jun 3, 2005

Wow, I do appreciate all of the replies. I guess I didn't make it clear in my first post that the patient in question is not me, but a friend. However, I am very glad to hear your opinions because we are planning on TTC in the fall and I did already have a "discussion" with my new peri (who I really love) about this in a pre-conception consult.

Lilpeanut, I also know about the research on bedrest, but I feel with every fiber of my being that in my case it is effective. With my dd I started to dilate at 24 weeks and did strict bedrest at home, was placed on hospitalized bedrest at 28 weeks and made it to 32 1/2 when my water broke.

With my 2nd, I had a cerclage at 12 weeks, was funnelling by 22, on bedrest, and by 26 completely effaced and the cerclage was the only thing holding baby in. I made it to 33--the stitch would have held longer, but I had an infection. At least this time I managed to stay out of the hospital except for 2 nights.

So, I really do believe in bedrest--I did not cheat at all, and my mom (who is also a nurse) was there to enforce it even when I was tempted. I know myself and if I had cheated, and then delivered earlier, I know that I would have felt extremely guilty. I like knowing that I did absolutely everything in my power for my babies.

Your responses mean a lot, and I am forever grateful for all of the L&D and NICU nurses who made a difference for our family!

Shannon

Jolie, BSN · Jun 3, 2005

All I can suggest is that you make bedrest your religion. That's how it was for me and I can honestly say, I never cheated on it. I was on a terb pump as well. (funny that, as it hasn't been proven to work, but my peri Jay Iams, the one who did a study that showed it shouldn't be part of general treatment said in my case it was needed and working) I never had fewer than 4 contractions an hour past 16 weeks, even on mag, terb or any other drug they gave me. The terb pump just helped keep the ctxns "disorganized" and non-productive.

You sound just like me. I went into PTL at 26 weeks with my first, and 23 weeks with my second. With both pregnancies, I was given multiple doses of steriods, as that was the practice in the 90's, along with bedrest, home monitoring, terbutaline pump, MgSO4, Indocin, and Procardia. My oldest delivered at 37 weeks, and has always been healthy as a horse. My youngest delivered at 36 weeks, and was also healthy at delivery, requiring only home phototherapy. But she has struggled a bit since then. She is now 7 years old, and still SGA. She has allergies, and probably mild asthma as well, along with some behavior issues. It is very difficult to sort out the effects of the steroids, versus the other meds, versus pre-term delivery on her health and behavior. I would love to be part of a study to determine the effects of these interventions on the long-term health and well-being of children. A motivated researcher could probably find adequate numbers of subjects among NICU and L&D nurses, as we all seem to experience these pregnancy complications!