The short term fetal cardiovascular effects of corticosteroids used in obstetrics

Background: Corticosteroids are widely used in obstetrics due to their striking effect on perinatal morbidity and mortality of premature neonates. Despite this, relatively few studies have explored short term fetal effects of corticosteroids as measured by ultrasound. Objectives: 1) To present a literature review of short term fetal cardiovascular effects of corticosteroids 2) To describe the protocol of a current observational study (SUPER-A*STEROID) of cardiovascular effects of dexamethasone and betamethasone in the first week after their administration. This trial is nested within the A*STEROID blinded multicentre randomised controlled trial of the two steroid preparations. Findings: Existing data suggest corticosteroids have little effect on the major measured fetal blood vessels when the baseline ultrasound is normal. In the compromised fetus, where the umbilical artery end-diastolic flow is abnormal prior to maternal corticosteroids, flow is temporarily restored in approximately 50% of cases. Whether such changes are beneficial is uncertain. Very little data exist that directly compare the short-term effects of betamethasone and dexamethasone. The SUPER- A*STEROID study described will help provide this information.