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[The induction of fetal lung maturity in pre-eclampsia]
A L Lara González1, C Espinosa Pérez, R Tenorio
1Hospital Luis Castelazo Ayala, IMSS México, D.F.
Insights
Antenatal betamethasone accelerates fetal lung maturity in severe preeclampsia, significantly reducing respiratory distress syndrome (RDS) and perinatal mortality in newborns.
Area of Science:
- Obstetrics and Gynecology
- Neonatology
- Perinatology
Background:
- Prematurity is the leading cause of perinatal morbidity and mortality.
- Respiratory Distress Syndrome (RDS) is a major complication in premature neonates.
- Severe preeclampsia necessitates early pregnancy interruption, increasing neonatal risks.
Purpose of the Study:
- To analyze the effect of antenatal steroid administration on fetal lung maturity in preeclampsia.
- To correlate fetal lung maturity indicators with the incidence of RDS in newborns of mothers with severe preeclampsia.
- To evaluate the impact of betamethasone on RDS and perinatal mortality.
Main Methods:
- A study involving 31 pregnant patients with severe preeclampsia (28-33 weeks gestation).
- Group 1 (21 patients) received antenatal betamethasone (12 mg IM daily for 2 days).
- Group 2 (10 patients) did not receive steroids; amniocentesis performed during cesarean section for both groups.
Main Results:
- The lecithin/sphingomyelin (L/E) ratio indicating lung maturity was ≥2 in 81% of Group 1 vs. 20% in Group 2.
- RDS occurred in 47% of neonates in Group 1 versus 100% in Group 2 (p=0.004).
- Perinatal mortality was 20% in Group 2 and 0% in Group 1.
Conclusions:
- Antenatal betamethasone administration accelerates fetal lung maturity in severe preeclampsia.
- Betamethasone significantly reduces the frequency and severity of RDS in affected newborns.
- Steroid treatment improves perinatal outcomes by mitigating RDS and mortality.
Abstract:
The consensus of the world literature shows that the prematurity is the first cause of perinatal morbidity and mortality. In this period several are the complications to short and long term that they can be presented, but seems be that it is the respiratory distress syndrome (RDS) the principal cause of this problems. This syndrome is frequent in the neonate of mothers with severe preeclampsia of early appearance in which exists the need of interruption the pregnancy. There are some articles, that show that preeclampsia by itself or the steroids given antenatally to the mother may accelerated the fetal lung maturity. The objective of the present study was analyze the behavior of the phospholipids responsible for the fetal lung maturity in amniotic fluid, with the administration of steroids to mothers with preeclampsia, and its correlation with the presentation of the RDS in the RDS in the newborn. 31 patients were included in the study, all of them with severe preeclampsia without complications, between 28 and 33 weeks of pregnancy. Twenty one patients received 12 mg of betametasone i.m. in 2 doses one each day (Group 1) and 10 patients who did not receive the steroid (Group 2). All the births were by cesarean section, amniocentesis was done during this procedure. The relation L/E > or = were observed in 81% of the patients of group 1. In the group 2 the relation L/E < or = 2 were observed in 80% of the cases. The RDS was present in 47% of the neonates in Group 1 and in 100% of the group that did not receive betametasone (p 0.004). The perinatal mortality (20%) was present only in the that did not receive betametasone. The findings of the present paper shows that the administration of betametasone in patients with severe preeclampsia accelerated the fetal lung maturity more the disease in consequence the frequency and severity of the RDS were less.