TY - JOUR
T1 - Fetal heart rate variation after corticosteroids for fetal maturation
AU - Knaven, Olga
AU - Ganzevoort, Wessel
AU - de Boer, Marjon
AU - Wolf, Hans
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Introduction Several studies report a decrease of fetal heart rate (FHR) short-term variation (STV) after corticosteroids for improvement of fetal maturity and advice not to deliver a fetus for low STV within 2–3 days after corticosteroids. However, literature is not unanimous in this respect. This study intends to asses STV longitudinally after corticosteroid administration. Material and methods A retrospective cohort study in a tertiary perinatal centre from 2009 to 2015 included all women who had been treated with corticosteroids at gestational age of 26–34 weeks, had a computerized cardiotocography (cCTG) before and after medication and did not deliver within 48 h. FHR and STV were stratified over 12-h periods and compared before and after corticosteroids. Women with imminent preterm labour (including PPROM) and women with placental problems (fetal growth restriction (FGR) or preeclampsia) (PE) were analysed separately. The effect of co-medication and gestational age was assessed. Results The study included 406 women, 211 with imminent preterm labour, 195 with FGR-PE. After corticosteroids STV increased 1–2 ms (median 1.4; IQR 0.1–3.1) during the first 36 h after start of corticosteroids. Thereafter a small decrease of less than 1 ms (median −0,6; IQR −1.6 to 0.3) compared to before CC was seen. Conclusions The most conspicuous effect of corticosteroids is a short term increase of STV and decrease of FHR. A slight decrease after 48–71 h is possible, but abnormally low values should be considered as a sign of fetal distress. The clinical guidance, given by some, not to intervene because of a low STV after corticosteroids appears invalid.
AB - Introduction Several studies report a decrease of fetal heart rate (FHR) short-term variation (STV) after corticosteroids for improvement of fetal maturity and advice not to deliver a fetus for low STV within 2–3 days after corticosteroids. However, literature is not unanimous in this respect. This study intends to asses STV longitudinally after corticosteroid administration. Material and methods A retrospective cohort study in a tertiary perinatal centre from 2009 to 2015 included all women who had been treated with corticosteroids at gestational age of 26–34 weeks, had a computerized cardiotocography (cCTG) before and after medication and did not deliver within 48 h. FHR and STV were stratified over 12-h periods and compared before and after corticosteroids. Women with imminent preterm labour (including PPROM) and women with placental problems (fetal growth restriction (FGR) or preeclampsia) (PE) were analysed separately. The effect of co-medication and gestational age was assessed. Results The study included 406 women, 211 with imminent preterm labour, 195 with FGR-PE. After corticosteroids STV increased 1–2 ms (median 1.4; IQR 0.1–3.1) during the first 36 h after start of corticosteroids. Thereafter a small decrease of less than 1 ms (median −0,6; IQR −1.6 to 0.3) compared to before CC was seen. Conclusions The most conspicuous effect of corticosteroids is a short term increase of STV and decrease of FHR. A slight decrease after 48–71 h is possible, but abnormally low values should be considered as a sign of fetal distress. The clinical guidance, given by some, not to intervene because of a low STV after corticosteroids appears invalid.
KW - Corticosteroids
KW - Fetal growth restriction
KW - Fetal heart rate
KW - Preeclampsia
KW - Preterm labour
KW - Short term variation
UR - http://www.scopus.com/inward/record.url?scp=85023594491&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejogrb.2017.06.042
DO - https://doi.org/10.1016/j.ejogrb.2017.06.042
M3 - Article
C2 - 28715659
SN - 0301-2115
VL - 216
SP - 38
EP - 45
JO - European Journal of Obstetrics Gynecology and Reproductive Biology
JF - European Journal of Obstetrics Gynecology and Reproductive Biology
ER -