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Fibroblast-Pneumonocyte Factor
Published in Jason Kelley, Cytokines of the Lung, 2022
Significant quantities of surfactant are not synthesized until close to term. The fine regulation of this quantitative progression in expression of phenotype (e.g., when the fetus is threatened with premature birth) is under multihormonal control (Smith, 1979a, 1984), yet local cell and tissue interactions continue to modulate the endocrine signals. A central role is played by endogenous fetal glucocorticoids. This physiological function has been reviewed (Smith, 1984), and evidence for it has been strengthened by observations that the antiglucocorticoid RU486 delays fetal lung maturation when administered to the dam (Guettari et al., 1989) and by observations that lung maturation is delayed in mice with H-2 (HLA) phenotypes associated with low expression of glucocorticoid receptors (Honig et al., 1984). The use of synthetic steroids antenatally in the prevention of respiratory distress syndrome (Collaborative Group on Antenatal Steroid Therapy, 1981; Liggins and Howie, 1972; Taeusch et al., 1979) represents a pharmacologic attempt to trigger the physiological responses precociously.
Placental Disorders
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Daniele Di Mascio, Francesco D’Antonio
In case of antenatal bleeding, a course of corticosteroids should be administered to women who are eligible and are managed expectantly if delivery is likely within 7 days, the GA is between 340/7 and 366/7 weeks of gestation, and antenatal steroids have not previously been administered [32].
Neonatal Care
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Sylvia Garry, Andrew Chapman, Elizabeth Ledger
The management of early onset labour is covered in Chapter 14.4. Several interventions will improve the health outcomes for the LBW or premature infant:Infection in the antenatal period should be treated, including asymptomatic bacteriuria and sexually transmitted infections (STIs).Antenatal steroids can be given to reduce respiratory distress.6The newborn should be closely monitored in utero and timely delivery is required if there is neonatal distress.Skilled birth attendant presence and delivery at a healthcare facility.
Incidence, Risk Factors and Screening Evaluation of Retinopathy of Prematurity in High Birthweight Infants: A Large Cohort Study in Turkey
Published in Ophthalmic Epidemiology, 2022
Volkan Dericioğlu, Sedat Butur, Hande Celiker, Özlem Şahin
This study revealed a highly significant protective effect of antenatal steroid therapy in ROP development (p < .001). Although there are different results about the protective effect of antenatal steroid administration, a meta-analysis that included 28 studies in 2018 has shown that antenatal steroid administration is associated with reduced risk of ROP development and progression to severe ROP.23 Furthermore, a Cochrane review revealed that in addition to the mortality rate, the risk of severe complications and the need for respiratory support is also reduced by antenatal steroid administration.24 However, the positive effects of antenatal steroid could not be demonstrated in infants with a GA below 28 weeks.25 The authors speculated that “the effect of corticosteroids on the maturation of the alveoli might differ depending on the GA at exposure, considering that the alveoli develop from 28 to 35 weeks’ gestation”.25 As a result, a highly significant protective effect revealed in our study could be explained by a more mature population of this study. In future prospective studies, the impact of antenatal steroid administration on ROP development in more mature infants can be investigated.
Abnormal Umblical Artery Doppler is Utilized for Fetuses with Intrauterine Growth Restriction Birth at 280/7–336/7 Gestational Weeks
Published in Fetal and Pediatric Pathology, 2020
Emre Baser, Istemi Han Celik, Melek Bilge, Taner Kasapoglu, Dilek Ulubas Isik, Ethem Serdar Yalvac, Omer Lutfi Tapisiz, Safak Ozdemirci
The total rate of respiratory disorders in the AREDF group was higher than that of the NEDF group, though definitive diagnosis of respiratory morbidities, such as RDS, pneumothorax, mechanical intubation, pulmonary hypertension and surfactant use, was similar between the two groups, despite the lower GA and BW in the AREDF group. This finding may be explained by the small size of our study. This may be associated with higher antenatal steroid use in the AREDF group. It is well known that antenatal steroid use at 24–34 gestational weeks promotes fetal lung maturation and reduces respiratory and neurologic morbidities, as well as mortality [11]. BPD was found to be increased in patients with AREDF [12]. However, better antenatal care, antenatal steroids and noninvasive NICU protocols may lead to the decreased negative effects of AREDF on BPD in our study group. Another finding of our study was that the feeding intolerance in AREDF group was significantly higher than that in the NEDF group. Similar to the results obtained in our research, studies have reported that feeding intolerance and NEC were more common in newborns with absent or reversal of end‐diastolic flow [13, 14]. These may be associated with in-utero-decreased intestinal perfusion due to shunting of blood in response to hypoxia to vital organs, including heart, brain and adrenals, focal ischemia, and hypoperistalsis [15]. A higher antenatal magnesium application rate in this group may also have played a role in feeding intolerance due to the effect of decreasing intestinal transit time [16–18].
Preeclampsia: state of art and future perspectives. A special focus on possible preventions
Published in Journal of Obstetrics and Gynaecology, 2022
Özge Kahramanoglu, Antonio Schiattarella, Oya Demirci, Giovanni Sisti, Franco Pietro Ammaturo, Carlo Trotta, Federico Ferrari, Agnese Maria Chiara Rapisarda
Careful follow-up is crucial in pregnant women candidates to expectant management. Outpatient follow-up can be performed after informing the patients who do not have severe symptoms. Whether outpatient or inpatient, every patient should have a laboratory assessment at least twice a week and blood pressure measurement should be performed. Likewise, foetal evaluation should be done twice a week. Antenatal steroids should be given if the gestational week is below 34, but delivery should not be postponed for the second dose if severe signs develop. During this period, preterm delivery should be performed if an abnormality in the antepartum assessments is found, in case of preterm prelabour rupture of membranes, vaginal bleeding and severe features.