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地塞米松对胎儿多普勒血流速度的影响。

Effects of dexamethasone on foetal Doppler flow velocimetry.

机构信息

Obstetrics and Gynacology Department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt.

Obstetrics and Gynacology Department, Menouf General Hospital, Shebin El-Kom, Egypt.

出版信息

J Obstet Gynaecol. 2021 Apr;41(3):390-394. doi: 10.1080/01443615.2020.1742677. Epub 2020 Jun 4.

Abstract

Corticosteroid administration before anticipated preterm birth is a well known antenatal therapy available to improve newborn outcomes. Doppler studies of maternal and foetal vessels provide a way to understand how corticosteroid affects and improves foetal respiratory outcome. This study was registered on 8th of October, 2017 by Menoufia Faculty of Medicine Board with registration number 222-2-10-2017. It included 80 pregnant women divided into two groups. Each group consisted of 40 participants. Group A: participants were between 28 weeks and 34 weeks of gestation and were at risk of preterm labour. Group B: participants were those who had undergone an elective caesarean section (CS) before completing the 39th week of gestation. Each woman had received four doses of Dexamethasone 6 mg intramuscularly, 12 h apart. Doppler studies were performed before the Dexamethasone adminstration and 24 h after the Dexamethasone course. Among both groups, only pregnant women before 34 weeks of gestation showed a significant decrease in middle cerebral artery pulsatility index. However, the other Doppler parameters showed no significant effect. In conclusion, Dexamethasone administration affected only the middle cerebral artery pulsatility index before 34 weeks of gestation.IMPACT STATEMENT Preterm births account for 75% of neonatal morbidity and pulmonary dysfunction plays an important role on such morbidities. Also, neonates born after an elective CS have significantly higher rates of respiratory morbidity and neonatal intensive care unit admission. Corticosteroids are wildly used to improve neonatal outcome in women who have expected preterm labour and before an elective CS. Dexamethasone affected blood distribution of foetal brain only before 34 weeks of gestation that had been proved by changes of foetal middle cerebral artery pulsatility index without affecting other Doppler parameters of both groups. With the improvement of foetal respiratory outcome in both groups. Maternal Dexamethasone injection is recommended for mothers at risk of preterm labour, especially if delivery is expected within six days and mothers who will undergo elective CS before completion of 39 weeks of gestation, in terms of improving neonatal respiratory functions and decreasing the possibility of admission to neonatal intensive care unit for transient tachypnoea of the newborn.

摘要

皮质类固醇在预计早产前的给药是一种众所周知的产前治疗方法,可改善新生儿结局。对母胎血管的多普勒研究提供了一种了解皮质类固醇如何影响和改善胎儿呼吸结局的方法。本研究于 2017 年 10 月 8 日由 Menoufia 医学院委员会注册,注册号为 222-2-10-2017。它纳入了 80 名孕妇,分为两组。每组 40 名参与者。A 组:参与者处于 28 至 34 周妊娠且有早产风险。B 组:参与者是那些在完成 39 周妊娠前接受选择性剖宫产(CS)的人。每位女性均接受了 4 剂地塞米松 6mg 肌内注射,间隔 12 小时。在给予地塞米松之前和地塞米松疗程后 24 小时进行了多普勒研究。在两组中,只有 34 周妊娠前的孕妇大脑中动脉搏动指数显著降低。然而,其他多普勒参数没有显示出显著影响。总之,地塞米松给药仅在 34 周妊娠前影响大脑中动脉搏动指数。

早产占新生儿发病率的 75%,肺功能障碍在这种发病率中起着重要作用。此外,选择性 CS 分娩的新生儿呼吸发病率和新生儿重症监护病房入院率显著更高。皮质类固醇广泛用于改善有预期早产和选择性 CS 前的孕妇的新生儿结局。地塞米松仅在 34 周妊娠前影响胎儿脑的血液分布,这已通过胎儿大脑中动脉搏动指数的变化得到证实,而不影响两组的其他多普勒参数。两组新生儿呼吸结局均得到改善。对于有早产风险的母亲,建议使用地塞米松进行母亲治疗,特别是如果预计在六天内分娩,并且母亲将在完成 39 周妊娠前进行选择性 CS,以改善新生儿呼吸功能,并减少因新生儿暂时性呼吸急促而入住新生儿重症监护病房的可能性。

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