The combined effect of betamethasone and ritodrine on the middle cerebral artery in low risk third trimester pregnancies
-
Juan Piazze
Abstract
Aims: To evaluate the effect of antenatal betamethasone and ritodrine in third trimester low risk singleton pregnancies by Doppler technology.
Subjects and methods: Eighty-four third trimester pregnant women who received a full course of betamethasone and delivering uneventfully were recruited. The Doppler examination included the assessment of the pulsatility index (PI) of the umbilical artery (UA PI) and the middle cerebral artery (MCA PI) prior to treatment (baseline), and 48, 72 and 96 h after the second dose of betamethasone.
Results: No significant difference was found in UA PI and UA/MCA values following betamethasone therapy. In contrast, MCA PI decreased significantly 48 h from the last injection of betamethasone in the whole study group (P<0.001), and returned to basal values at 96 h. We also found that MCA PI was reduced significantly at 48 h in the subgroup under tocolysis (n=41) and in the subgroup not receiving tocolysis (n=43). We compared MCA PI values for both subgroups in the four timings, and found a non-significant difference comparing baseline and 96 h values. However, when comparing MCA PI values after 48 and 72 h, significantly lower differences in PI values in both subgroups were found.
Conclusion: In low risk pregnancies, betamethasone therapy in the third trimester is related to a significant but transient reduction of MCA PI, which is more pronounced during tocolytic therapy. Although the physiological basis of this effect is currently unclear, it could be related to the local regulation of intracerebral blood flow.
References
1 Brashear WT, BR Kuhnert, R Wei: Maternal and neonatal urinary excretion of sulfate and glucuronide ritodrine conjugates. Clin Pharmacol Ther43 (1988) 634Suche in Google Scholar
2 Canterino JC, U Verma, PF Visintainer, A Elimian, SA Klein, N Tejani: Antenatal steroids and neonatal periventricular leukomalacia. Obstet Gynaecol97 (2001) 135Suche in Google Scholar
3 Challis JRG, SG Matthews, C Van Meir, MM Ramirez: Current topic: the placental corticotrophin-releasing hormone adrenocorticotrophin axis. Placenta16 (1995) 481Suche in Google Scholar
4 Chitrit Y, P Caubel, R Herrero, AL Schwinte, D Guillaumin, MC Boulanger: Effects of maternal dexamethasone administration on fetal Doppler flow velocity waveforms. Br J Obstet Gynecol107 (2000) 501Suche in Google Scholar
5 Clerici G, R Luzietti, A Cutuli, GC Di Renzo: Cerebral hemodynamics and fetal behavioral states. Ultrasound Obstet Gynaecol19 (2002) 340Suche in Google Scholar
6 Clifton VL, MA Read, IM Leitch, WB Giles, AL Boura, PJ Robinson, et al.: Corticotrophin-releasing hormone induced vasodilatation in the human fetal-placental circulation: involvement of the nitric oxide-cyclic guanosine 3′5′ monophosphate-mediated pathway. J Clin Endocrinol Metab80 (1995) 2888Suche in Google Scholar
7 Cohen BJ, RH Stigter, JB Derks, EJ Mulder, GHA Visser: Absence of significant hemodynamic changes in the fetus following maternal betamethasone administration. Ultrasound Obstet Gynecol8 (1996) 252Suche in Google Scholar
8 Collaborative Group of Antenatal Steroid Therapy: Effects of antenatal dexamethasone administration on the prevention of respiratory distress syndrome. Am J Obstet Gynecol 141 (1981) 276Suche in Google Scholar
9 Cosmi EV, R Caldeyro-Barcia: Fetal homeostasis. In: Cosmi EV (ed): Obstetric Anesthesia and Perinatology. Appleton Century Crofts, New York 1981Suche in Google Scholar
10 Crowley P: Prophylactic corticosteroids for preterm birth. Cochrane Database Syst Rev3 (2002) CD000065Suche in Google Scholar
11 De Kloet ER, JMHM Reul, W Sutanto: Corticosteroids and the brain. J Steroid Biochem Mol Biol37 (1990) 387Suche in Google Scholar
12 Dörr HG, HT Versmold, WG Sippell, F Bidlingmaier, D Knorr: Antenatal betamethasone therapy. Effects on maternal, fetal, and neonatal mineralocorticosteroids, glucocorticosteroids and progestins. J Pediat108 (1986) 990Suche in Google Scholar
13 Edwards A, LS Baker, EM Wallace: Changes in fetoplacental vessel flow velocity waveforms following maternal administration of betamethasone. Ultrasound Obstet Gynecol20 (2002) 240Suche in Google Scholar
14 Elimian A, U Verma, J Canterin, J Shah, P Visintainer, N Tejani: Effectiveness of antenatal steroids in obstetric subgroups. Obstet Gynaecol93 (1999) 74Suche in Google Scholar
15 Gamasu HR, BM Mullinger, P Donnai, CH Dash: Antenatal administration of betamethasone to prevent respiratory distress syndrome in preterm infants: report of the UK multicentre trial. Br J Obstet Gynaecol96 (1989) 401Suche in Google Scholar
16 Gardner MO, RL Goldenberg: The clinical use of antenatal corticosteroids. Clinical Obstet Gynecol38 (1995) 4746Suche in Google Scholar
17 Gokay Z, T Ozcan, JA Copel: Changes in fetal hemodynamics with ritodrine tocolysis. Ultrasound Obstet Gynecol18 (2001) 44Suche in Google Scholar
18 Guclu S, M Gol, U Saygili, N Demir, O Sezer, AA Baschat: Nifedipine therapy for preterm labour: effects on placental, fetal cerebral and atrioventricular Doppler parameters in the first 48 h. Ultrasound Obstet Gynecol27 (2006) 403Suche in Google Scholar
19 Kahler C, E Schleussner, A Moller, HJ Seewald: Doppler measurements in fetoplacental vessels after maternal betamethasone administration. Fetal Diagn Ther19 (2004) 52Suche in Google Scholar
20 Korebrits C, DHT Yu, MM Ramirez, E Marinoni, AD Bocking, JRG Challis: Antenatal glucocorticoid administration increases corticotrophin-releasing hormone in maternal plasma. Br J Obstet Gynaecol105 (1998) 556Suche in Google Scholar
21 Liggins GC: Premature delivery of fetal lambs infused with glucococorticoids. J Endocrinol45 (1969) 51510.1677/joe.0.0450515Suche in Google Scholar PubMed
22 Liggins GC, RN Howie: A controlled trial of antepartum glucocorticoid treatment for prevention of respiratory distress syndrome in premature infants. Pediatrics50 (1972) 512Suche in Google Scholar
23 McDonald TJ, DA Myere, PW Nathanielsz: Localization of type II glucocorticoid receptor [Gr] in the fetal sheep brain at 120 days of gestation. J Physiol459 (1993) 331PSuche in Google Scholar
24 NIH Consensus development panel on the effects of corti-costeroids for fetal maturation on perinatal outcomes. Effect of corticosteroids for fetal maturation on perinatal outcomes. J Am Med Assoc 275 (1995) 41310.1001/jama.1995.03520290065031Suche in Google Scholar PubMed
25 NIH Consensus Develpoment Statement. Antenatal corticosteroids revisited: Repeat courses. Natl I Health 1 (2000) 10Suche in Google Scholar
26 NIH Consensus Develpoment Panel. Antenatal corticosteroids revisited: Repeat courses. National Institutes of Health consensus development conference statement. Obstet Gynecol 98 (2001) 14410.1097/00006250-200107000-00027Suche in Google Scholar
27 Piazze JJ, MM Anceschi, R La Torre, F Amici, L Maranghi, EV Cosmi: Effects of antenatal betamethasone therapy on maternal-fetal Doppler velocimetry. Early Human Development60 (2001) 225Suche in Google Scholar
28 Robinson BG, RL Emanuel, DM Frim, JA Majzoub: Gluco-corticosteroids stimulate expression of corticotrophin-releasing hormone gene in human placenta. Proc Natl Acad Sci USA85 (1988) 5244Suche in Google Scholar
29 Rotmensch S, M Liberati, C Celentano, Z Efrat, I Bar-Hava, M Kovo, et al.: The effect of betamethasone on fetal biophysical activities and Doppler velocimetry of umbilical and middle cerebral arteries. Acta Obstet Gynecol Scand78 (1999) 768Suche in Google Scholar
30 Senat MV, Y Ville: Effect of steroids on arterial Doppler in intrauterine growth retardation fetuses. Fetal Diagn Ther15 (2000) 36Suche in Google Scholar
31 Urban R, A Lemancewicz, J Przepiesc, J Urban, M Kretowska: Antenatal corticosteroid therapy: a comparative study of dexamethasone and betamethasone effects on fetal Doppler flow velocity waveforms. Eur J Obstet Gynecol Reprod Biol120 (2005) 170Suche in Google Scholar
32 Van Lierde M, K Thomas: Ritodrine concentrations in maternal and fetal serum and amniotic fluid. J Perinat Med10 (1982) 119Suche in Google Scholar
33 Wijnberger LD, CM Bilardo, K Hecher, RH Stigter, GH Visser: Antenatal betamethasone and fetoplacental blood flow. Lancet354 (1999) 256Suche in Google Scholar
©2007 by Walter de Gruyter Berlin New York
Artikel in diesem Heft
- To all readers, authors and subscribers
- The relationship between periodontal disease, bacterial vaginosis, and preterm birth
- Does raising the glucose challenge test threshold impact birthweight in Asian gravidas?
- Puerperal complications following elective cesarean sections for twin pregnancies
- Fortified mineral water improves folate status and decreases plasma homocysteine concentration in pregnant women
- Milk iron content in breast-feeding mothers after administration of intravenous iron sucrose complex
- Uteroplacental circulation, preeclampsia, and maternal abdominal aortic stiffness in normal and compromised pregnancies
- Induction of labor with oral misoprostol for premature rupture of membranes at term in women with unfavorable cervix: a randomized, double-blind, placebo-controlled trial
- Reference intervals for the cross sectional area of the umbilical cord during gestation
- The combined effect of betamethasone and ritodrine on the middle cerebral artery in low risk third trimester pregnancies
- Association between peak serum bilirubin and severity of respiratory distress syndrome in infants of less than 30 weeks' gestation
- Ranitidine and late-onset sepsis in the neonatal intensive care unit
- Outcome of infants born at 21–28 weeks' gestation in an inner-city hospital over an eight-year period
- Detection rate of Helicobacter pylori stool antigen in newborn infants and small children
- The potential role of high or low birthweight as risk factor for adult schizophrenia
- Multiple vascular accidents: Pentalogy of Cantrell in one twin with left sided colonic atresia in the second twin
- Solitary hepatic lymphangioma in an infant
- Spontaneous twin pregnancy in a 56-year-old primipara
- Fetal behavior analyzed by ultrasonic actocardiogram in cases with central nervous system lesions
- Congress Calendar
Artikel in diesem Heft
- To all readers, authors and subscribers
- The relationship between periodontal disease, bacterial vaginosis, and preterm birth
- Does raising the glucose challenge test threshold impact birthweight in Asian gravidas?
- Puerperal complications following elective cesarean sections for twin pregnancies
- Fortified mineral water improves folate status and decreases plasma homocysteine concentration in pregnant women
- Milk iron content in breast-feeding mothers after administration of intravenous iron sucrose complex
- Uteroplacental circulation, preeclampsia, and maternal abdominal aortic stiffness in normal and compromised pregnancies
- Induction of labor with oral misoprostol for premature rupture of membranes at term in women with unfavorable cervix: a randomized, double-blind, placebo-controlled trial
- Reference intervals for the cross sectional area of the umbilical cord during gestation
- The combined effect of betamethasone and ritodrine on the middle cerebral artery in low risk third trimester pregnancies
- Association between peak serum bilirubin and severity of respiratory distress syndrome in infants of less than 30 weeks' gestation
- Ranitidine and late-onset sepsis in the neonatal intensive care unit
- Outcome of infants born at 21–28 weeks' gestation in an inner-city hospital over an eight-year period
- Detection rate of Helicobacter pylori stool antigen in newborn infants and small children
- The potential role of high or low birthweight as risk factor for adult schizophrenia
- Multiple vascular accidents: Pentalogy of Cantrell in one twin with left sided colonic atresia in the second twin
- Solitary hepatic lymphangioma in an infant
- Spontaneous twin pregnancy in a 56-year-old primipara
- Fetal behavior analyzed by ultrasonic actocardiogram in cases with central nervous system lesions
- Congress Calendar
