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Old 01-23-2007, 10:35 AM - Thread Starter
 
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So, it looks like this baby may well end up being early as my BP has started to trend up (I had severe pre-e in my last pregnancy and delivered at 35 weeks).

So far, everything is ok bloodwork wise, but the OB consult yesterday suggested that we do it (I'll be 32 weeks on Thursday) just in case things go south in a hurry and we need to deliver.

I decided to wait until Thursday to see because I don't really understand the risks (he said there were none, so right there I knew I had to do more research), but also I understand that the effects take 24-48 hours to kick in and only last about 7 days, so I'm thinking we'd want to have a better idea of things going downhill before "locking in" so to speak.

Any thoughts or suggestions?

Michelle, mama to Isabelle (03/04) and Tom (02/07)
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Old 01-23-2007, 11:29 AM
 
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well... i had a round of steroid shots with my twins and they were born at 30 weeks. their lungs werent perfect but i feel positive the shots helped. they did both need surfectant and cannulas for 7 and 9 days, but otherwise did VERY VERY well!

the only side effect i had was it increased my blood sugar. im a diabetic but maintain normal blood sugar without medication by restricting my diet. but i had to have insulin for about a week because of the shots. i was in the hospital so they monitored it very closely.
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Old 01-23-2007, 12:50 PM
 
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They do take 24-48 hours to kick in, because you need to get two shots, which is why they want you to get the shots ASAP. I've never heard of the effects only lasting 7 days. The way betamethazone (and other steroid shots) work is that they speed the maturation of the infant's lungs.

Side effects - I've never heard of any to the mother. Maybe the normal steroidal reactions? With the baby, I do know that since it is a steroid, there can be a few complications such as hypoglycemia, but as far as I know, none that are worse than a baby who isn't breathing well and has to be vented. I think betametazone also can protect against hemorrhage in preterm infants but I may be completely wrong on that. Your OB actually isn't that far off - in his mind, there probably aren't any side effects - most OBs very much believe that the benefits of these shots far outweigh the risks.

Personally, as someone who has had pre-eclampsia and had to deliver very early and very quickly, I would go for the shots as soon as possible. We didn't have time to get both in for me and I really regret that. I think they would have helped.

And FWIW it's not a very painful shot, at least.

-sarah-
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Old 01-23-2007, 01:57 PM
 
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Originally Posted by miche28 View Post
I decided to wait until Thursday to see because I don't really understand the risks (he said there were none, so right there I knew I had to do more research)....Any thoughts or suggestions?
Here's some citations and quotes. I know it's long, but I hope it helps. I had PIH and then developed pre-eclampsia and had to delivery early, so I understand what a confusing and scary time this can be:

From National Guideline Clearinghouse
Effectiveness of Antenatal Corticosteroid Therapy

[Definitions:Grading of Recommendations:

Grade A - Requires at least one randomised controlled trial as part of a body of literature of overall good quality and consistency addressing the specific recommendation (evidence levels Ia, Ib)]

A - Clinicians should offer antenatal corticosteroid treatment to women at risk of preterm delivery because antenatal corticosteroids are associated with a significant reduction in rates of respiratory distress syndrome (RDS), neonatal death, and intraventricular haemorrhage.

Safety
A - Women may be advised that the use of a single course of antenatal corticosteroids does not appear to be associated with any significant maternal or fetal adverse effects.

Indications for Antenatal Corticosteroid Therapy
A - Every effort should be made to initiate antenatal corticosteroid therapy in women between 24 and 34 weeks of gestation with any of the following:

* Threatened preterm labour
* Antepartum haemorrhage
* Preterm rupture of membranes
* Any condition requiring elective preterm delivery

Between 35 to 36 weeks obstetricians might want to consider antenatal steroid use in any of the above conditions although the numbers needed to treat will increase significantly. [Evidence level Ia]

Antenatal education programmes or patient information leaflets should be considered to encourage early recognition of these conditions, in an effort to ensure early presentation and commencement of treatment. Maternity services should consider multidisciplinary staff training in providing information, including risk ratios, to women.

...

From the National Institutes of Health, Consensus Development Conference Statement (February 28-March 2, 1994): The Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes

The consensus panel concluded that antenatal corticosteroid therapy for fetal maturation reduces mortality, respiratory distress syndrome, and intraventricular hemorrhage in preterm infants. These benefits extend to a broad range of gestational ages (24 to 34 weeks) and are not limited by gender or race. Although the beneficial effects of corticosteroids are greatest more than 24 hours after beginning treatment, treatment less than 24 hours in duration may also improve outcomes. The benefits of antenatal corticosteroids are additive to those derived from surfactant therapy.

What Are the Short-Term and Long-Term Adverse Effects for the Infant and Mother?

Short-Term Adverse Effects for the Infant: Short-term adverse effects of antenatal corticosteroid administration of greatest concern in the neonate include infection and adrenal suppression. The evidence presented to date shows no increase in infection in treated infants, no clinically important adrenal suppression, and rapid return of adrenal function when antenatal corticosteroids are discontinued.

Some animal studies have suggested that antenatal corticosteroid treatment might promote maladaptive responses to hypoxia. Other animal studies have shown that corticosteroids in doses similar to those used in humans antenatally provide protection against hypoxic-ischemic brain injury. More data are needed from human studies in this area of research.

Long-Term Adverse Effects for the Infant: Studies initiated in the 1970's, which followed the development of children treated antenatally with corticosteroids up to the age of 12 years, showed no adverse outcomes in the areas of motor skills, language, cognition, memory, concentration or scholastic achievement. The possibility of adverse, long-term neurodevelopmental outcomes has been suggested by studies of corticosteroid administration in animals. These studies were conducted using doses approximately 10 times the doses used in human clinical trials. There does not seem to be an increased risk in children of long-term neurodevelopmental impairment as reflected in any greater prevalence of learning, behavioral, motor, or sensory disturbances. Long-term effects of antenatal corticosteroids on growth and the onset of puberty are not fully known.

Short- and Long-Term Adverse Maternal Effects: Maternal pulmonary edema can occur when antenatal corticosteroids are used in combination with tocolytic agents. This complication is more commonly associated with maternal infection, fluid overload, and multiple gestation. Pulmonary edema has not been reported when antenatal corticosteroids are used alone.

The risk of maternal infection may be increased when corticosteroids are used in preterm premature rupture of membranes (PPROM), however, the degree of this effect, if any, is unclear. Furthermore, there is no evidence that antenatal corticosteroid treatment interferes with the ability to diagnose maternal infection. When corticosteroids are administered to pregnant diabetic women, diabetic control may become more difficult and insulin may have to be adjusted accordingly. Screening for gestational diabetes may similarly be affected. In serious maternal medical conditions that necessitate premature delivery, the delay necessary to demonstrate maximal corticosteroid effects for the fetus may worsen the maternal medical status. A subgroup analysis in the first randomized trial suggested that antenatal corticosteroid administration might predispose to fetal death in hypertensive women. Subsequent trials failed to demonstrate this effect. No long-term maternal adverse effects have been reported.

...

From The American Academy of Family Physicians: PreTerm Labor

Dexamethasone and betamethasone are the preferred corticosteroids for antenatal therapy (Table 4). Corticosteroid therapy for fetal maturation reduces mortality, respiratory distress syndrome and intraventricular hemorrhage in infants between 24 and 34 weeks of gestation. Strong evidence shows that neonatal benefits start at 24 hours and last up to seven days after treatment. There is not enough data to establish that clinical benefit lasts beyond seven days after treatment. The potential benefits or risks of repeated administration of corticosteroids after seven days are unknown.

No long-term maternal or neonatal adverse effects have been reported in association with the use of corticosteroid therapy.35 Maternal pulmonary edema can occur when antenatal corticosteroids are used in combination with tocolytic agents. This complication is more commonly associated with maternal infection, fluid overload and multiple gestation. Pulmonary edema has not been reported when corticosteroids are used alone.

In women with PPROM, antenatal corticosteroid therapy reduced the risk of respiratory distress syndrome. The magnitude of the reduction in this group is not as great as in women with intact membranes. In women with PPROM at less than 30 to 32 weeks of gestation, in the absence of clinical chorioamnionitis, antenatal corticosteroid use is recommended because of the high risk of intraventricular hemorrhage at this early gestational age.35 Although the risk of maternal and fetal infection may increase with corticosteroid use, the increased risk is small. There is no evidence that corticosteroid therapy interferes with the physician's ability to diagnose maternal infection.
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Old 01-23-2007, 02:02 PM
 
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I knew my babe would be born a bit early. we did the series of steroid shots (very painful- big needle to the hip!!). He was STILL born w/ lungs as hard as rocks at 33 weeks (above 10,000 feet altitutude)
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Old 01-23-2007, 03:03 PM
 
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I knew my babe would be born a bit early. we did the series of steroid shots (very painful- big needle to the hip!!). He was STILL born w/ lungs as hard as rocks at 33 weeks (above 10,000 feet altitutude)
that's so funny - I hate needles and yet mine didn't hurt, really...maybe I was more out of it at that point than I thought

-sarah-
mom to three, 4 and under.
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Old 01-23-2007, 03:26 PM
 
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I started on the steroid shots, but only got one because I ended up needing an emergency c-section less than twenty-four hours later. For me the shot was VERY painful, and it ended up being all for nothing.:

Never jump into a pile of leaves with a wet sucker. - Linus
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Old 01-23-2007, 04:48 PM
 
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I don't think they just work for 7 days. I did the shots twice. With my twins I did them at 28 weeks over 4 weeks before I delivered. Both of them were breathing well when they were delivered although my dd spent 2 weeks with a canula. My son was never on anything.

I remember the shots really hurting when I got them for the twins. I was at home on bedrest at the time and I went into the dr office to have them done. I don't remember them hurting much with Lydie. Of course I was in the hospital on mag sulfate at the time. I already felt miserable anyway.

mama to six ('98, '00, '04, '04, '06, '08)
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Old 01-23-2007, 05:00 PM - Thread Starter
 
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Now I remember where the 7 day thing came from - there seems to be limited evidence that they work as effectively when delivery occurs beyond 7 days (which is why they've tried the subsquenet doses and the jury seems to be out on that risk/benefit analysis).

It's a moot point most of the time since when they're needed, you take 'em because they are the best shot at a healthier baby, but in case anyone has interest, here are the links:

http://www.motherisk.org/prof/update...content_id=330

http://www.ncbi.nlm.nih.gov/books/bv....section.12790

Michelle, mama to Isabelle (03/04) and Tom (02/07)
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Old 01-23-2007, 05:55 PM
 
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i had the steroids when i was in with false labour at 28 weeks. i'm glad that i got them, because DS was born 2 weeks later and was only on CPAP for 36 hours. i'm anti-vax and like to research everything, so i was a little nervous about getting the shots without getting to research them, but really felt that i wanted to give my baby the best chance if he came early.

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Originally Posted by ksera05 View Post
that's so funny - I hate needles and yet mine didn't hurt, really...maybe I was more out of it at that point than I thought
the first one in the series hurt SO bad for me, and the second wasn't so bad!

K,
mama to 4 boys - J (2005), A (2006), N (2008), and Z (2014)
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Old 01-23-2007, 07:43 PM
 
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As I understand it, due to the location of the shot there is a tendency for it to hurt more in some women. The nerves in the hip area can be very close to the shot area, especially for those women with less...uhm...padding.

For me, while it wasn't fun, it certainly wasn't as painful as people have described. Course I'm well "padded" too

Angela - wife to my gamer hubby and SAHM to Handsome autismribbon.gif 3/6/03 (~35wks), Princess 8/9/06: (33wks) - we are HELLP survivors, Bubbalicious 9/15/09 (FULL TERM!), and pos.gif oops...here we go AGAIN! (June/July 2012?)

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Old 01-23-2007, 09:40 PM
 
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Originally Posted by ksera05 View Post

And FWIW it's not a very painful shot, at least.
Really, for me it hurt like h*ll. Seriously.. I'd rather have an IV started.

Anyways, maybe your dr. mixed up when saying they only last a week? What they do is basically increase the maturity of baby's lungs by approximately a week.

I had PPROM at 32wks and got the steroid shots. I delivered 33wks and 1 day and ds spent 7hrs on a vent and then went to room air. I have no doubt in my mind that the steroids helped him, and I would do it again in a heartbeat.
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Old 01-24-2007, 01:24 AM
 
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It hurt me as well - more the first time I got them (with my 3rd guy) becuase when I got them again for #4, I had been doing the weekly progesterone shots (also in the hip/bum area) so I think I was numb to it after the weekly progesterone, LOL! Those prog shots really, really hurt. I can still vividly recall the pain and I cried often when I got them (and I have a high pain threshold)

I don't really understand the thought that they only last for 7 days. My understanding of the betamethasone is that it causes the lungs to mature to a point where they begin to produce surfactant in greater amounts. Once the lungs start producing surfactant in high quantities on their own, they won't stop - so it's not like the shots will only cause th elungs to produce the surfactant for a limited time. When we talk about immature lungs, it's really that they aren't producing surfactant (which is the substance that makes the lungs not stick to themselves) Anyway, in my case, I do think that getting the steroids earlier with #4 made a big difference in his lung maturity. I got them around 28 weeks, adn he had absolutely no breathing issues at all after birth. With #3, who I got the shots 26 hours before he was born (the second shot was 26 hours before, exactly) he needed a dose of surfactant and was on cpap for a few days.
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Old 01-24-2007, 12:16 PM
 
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I had the steroids and give them on a regular basis. The pain is due to nurse technique, needle size used, and the viscosity (thickness) of the med injected. If you have a nurse with good technique who uses a small-bore needle, it is much less painful. I used to give the shot with a large bore needle, as I was taught by other nurses to do, until I became the patient and had to get the steroids myself. The nurse who gave them to me used a very small bore needle and a different technique, and I only felt a slight burn. Since then I use her technique, and my patients all say the same thing, my steroid shots are less painful than shots they have received from other nurses using large bore needles and different technique. So tell your nurse to use a 25 gague needle that is 1.5 inches long, and to inject slowly but firmly.

As for the efficacy of steroids, if they are given the 24-48 hour period needed to work, the difference in babies who had steroids versus those who did not in the NICU is dramatic. Babies who had steroids 24-48 hours prior to birth tend to need much less respiratory support.
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Old 01-24-2007, 12:42 PM
 
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My son was born at 26 weeks, 4 days after my second steroid shot. Shots hurt horribly, but i'd rather that pain then having my baby in worse shape.

My son was vented for only 3 days, unheard of around here for a 26 weeker boy. he was on oxygen for 4 weeks, but only at about 23% for most of that.

I would get them again in a heartbeat.
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Old 01-24-2007, 01:13 PM
 
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I had the steroid shots at 27 weeks in PTL and OMG they hurt so much I yelped.

I didn't deliver for another 2 weeks, and I have often wondered how much the shots helped at that point. I know my OB did the right thing by giving them to me when he did - I was dilating and contracting and who knew what would happen? But I think they did wear off by the time my girls were born, because Kate had to be intubated for almost 2 weeks and Lilly was on a CPAP for about as long as that. Actually, sometimes I think "darn, I guess the steroids wore off" and sometimes I think "well thank goodness they got the steroids - what would've happened without them?" No way to tell

Betsy, mama to beautiful, strong MZ twins Lillian and Kate, born 11 weeks early on January 10, 2006.
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Old 01-24-2007, 01:27 PM
 
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mine did hurt, but I got them at 28 weeks. My trio came out breathing room air at 32 weeks and were not ever on canulas or any support for breathing.

I think the shots helped, but so did the stress in the womb of 3 babies and my pre-eclampsia.
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Old 01-24-2007, 04:54 PM
 
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I had it w/ Evan at 34wks and only the first one from hammer hands hurt. The student nurse was nice and did it slow and it didn't hurt. The stuff is thicker than most stuff you get through a needle so doing it fast is what makes it hurt I think.

Jennifer, LPN and nursing student, Doula, CPST, and VBAC mama x3 to
AJ (5/03), Evan (12/04), Ilana (11/06), Olivia (2/09), and Unity (8/2012)

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Old 01-26-2007, 03:29 PM
 
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Old 01-26-2007, 09:32 PM
 
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I did notice after getting them my face and cheeks were flushed and hot for like 4 days afterward. Did that happen to any of y'all?
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