October 28, 2010

Role of corticosteroid In PPROM


Question: in case of PPROM, should we give dexamethazone to prepare 4 pre-mature labour? [deeba]


salam deeba.. i'm going to aborigine villages and could not comment on ur answer yet.. but your question in cbox is very good and I will give some highlight on this...


ok! remember that PPROM (differ from PROM) means that the fetus is not achieve term yet, but basically more than period of viability. Ie 22 week above. Some may take 20 week as cut off poitnt.


Regarding the dexamethasone, ideally it is given between 24-34 weeks. It is given Intramuscularly 12 mg B.D, 12 hourly apart. The main role is to prevent ARDS. Beyond 34W, it has no role except reducing the risk of intraventricular hemorrhage and necrotizing enterocolitis. However the practice in KKM is still to give it even up to term. Therefore, it is depend on the policy of the center where you work or attached to. If you give, it is not harmful to the mother or fetus.


Some patient with PPROM may present before the week suitable for dexamethasone. Since the risk of chorioamnionitis is high in any case of PPROM. therefore, you should close monitor the patient and give dexamehtasone later. However if patient develop chorioamnionitis, therefore delivery is the option


Let say patient already in the period whereby dexamethasone is justifiable but there is presence of establish uterine contraction. Here, the role of tocolytics drug is significant. Bear in mind that the tocolytic is only to give time for the dexamethasone to work and not to prolong the pregnancy.


Hope that will answer your question. Thank you

5 comments:

  1. Thanks for making my question into a post. =////=

    Aborigine village? For how long? What program are u joining? Make sure you tell the whole story in your blog.. ="p

    Back to question, what is confusing if PPROM before 24 weeks and develop chorioamnionitis?

    of coz we manage by giving antibiotic for expectant management.

    In that stage, giving corticosteroid will not do any benefit is it?

    We just have to deliver the baby?

    Sorry this issue is quite controversial, so I just want to hear your answer.

    jazakallah

    ReplyDelete
  2. dear white raven.....

    before the chorioamnionitis develop, we give the prophylactic antibiotic. but of course, whenever chorioamnionitis develop, therefore the baby should be delivered. in this situation, the life of the mother is more important in justifying the decision. besides, the survival rate for baby born before 23W is almost zero (of course miracle can happen)..

    ReplyDelete
  3. and one more thing... if you check the RCOG guidelines on PPROM, the antibiotic co-amoxiclav is no more rcommended. the recommended prophylactic antibiotic is tab. erythromycin 250 mg q.i.d

    ReplyDelete
  4. thank you so much for the brief and specific mx for PPROM.
    I have one issue that I hope you could discuss on..
    When patient presented with PPROM and chorioamnionitis sets in, immediate delivery is indicated and in conjunction, IM dexa is to be given as well despite not giving it in complete dose. I hope you could discuss on the significants or benefit of the efficacy of dexa in a short course.

    ReplyDelete

Ya Allah! Permudahkanlah aku untuk menuntut ilmuMu, memahaminya, mengingati dan menyebarkannya. Berkatilah ilmu itu dan tambahkanlah ia. Amin.