Ghi Tullio, Dall'Asta Andrea, Saccone Gabriele, Bellussi Federica, Frusca Tiziana, Martinelli Pasquale, Pilu Gianluigi, Rizzo Nicola
Obstetrics and Gynecology Unit, University of Parma, Parma, Italy.
Obstetrics and Gynecology Unit, University of Parma, Parma, Italy.
Eur J Obstet Gynecol Reprod Biol. 2017 Sep;216:74-78. doi: 10.1016/j.ejogrb.2017.07.010. Epub 2017 Jul 10.
To assess the association between fetal size and the incidence of reduced short-term variability (STV) following bethametasone administration for fetal lung maturity.
This was a retrospective, multicenter, cohort study conducted in two Tertiary University Units. Only uncomplicated singleton pregnancies admitted for threatened preterm labor between 26 and 34 weeks and submitted to betamethasone for fetal lung maturity were included. Delivery occurring within 72h from betamethasone administration represented criteria for exclusion. Computerized cardiotocography was carried out on a daily basis. Cases were identified by persistently reduced STV, defined as <5th percentile for gestational age and lasting for at least 72h after the first dose of betamethasone. The primary outcome was estimated fetal weight (EFW) at ultrasound in fetuses with normal and in those with persistently reduced STV. Pregnancy outcomes were also evaluated.
Persistently reduced STV occurred in 33/405 of the included patients (8.1%). Compared to women with normal STV, those with persistently reduced STV had significantly lower EFW (1472±435 vs 1812±532g, p 0.04), lower birthweight (2353±635 vs 2857±796g, p<0.01) and earlier gestational age at delivery (35.1±4.2 vs 37.3±2.4weeks, p<0.01), whereas all the other variables including gestational age on admission were comparable.
Reduced STV following maternal betamethasone administration among appropriately grown fetuses seems to correlate with lower fetal size. Furthermore, fetuses with such abnormal response to steroids seem to carry a higher risk of perinatal complications, including lower birthweight and earlier gestational age at delivery.
评估倍他米松用于促进胎儿肺成熟后，胎儿大小与短期变异（STV）降低发生率之间的关联。
这是一项在两家三级大学附属医院开展的回顾性、多中心队列研究。纳入的仅为孕26至34周因先兆早产入院且接受倍他米松促进胎儿肺成熟的单胎妊娠，且无并发症。排除在倍他米松给药后72小时内分娩的病例。每天进行电脑化胎心监护。通过持续降低的STV来确定病例，持续降低的STV定义为低于胎龄的第5百分位数且在首剂倍他米松后持续至少72小时。主要结局是超声测量的STV正常和持续降低的胎儿的估计胎儿体重（EFW）。还评估了妊娠结局。
纳入的405例患者中有33例（8.1%）出现持续降低的STV。与STV正常的女性相比，STV持续降低的女性EFW显著更低（1472±435 vs 1812±532g，p = 0.04），出生体重更低（2353±635 vs 2857±796g，p<0.01），分娩时的胎龄更早（35.1±4.2 vs 37.3±2.4周，p<0.01），而包括入院时胎龄在内的所有其他变量具有可比性。
在发育正常的胎儿中，母亲使用倍他米松后STV降低似乎与胎儿较小有关。此外，对类固醇有这种异常反应的胎儿似乎有更高的围产期并发症风险，包括出生体重较低和分娩时胎龄较早。
