|
|
|
|
Research Article
|
|
Efficacy of Betamethasone on the Fetal Motion and Biophysical Profile and Amniotic Fluid Index in Preterm Fetuses |
|
Shamsi Abbasalizadeh,
Zahra Neghadan Pharabar,
Fatmeh Abbasalizadeh,
Morteza Ghojazadeh
and
Mohamad Goldust
|
|
|
ABSTRACT
|
The term of preterm birth is used to define the premature
neonates considering pregnancy age. In less than 34 week pregnancies, corticosteroids
are prescribed to promote embryos
lung maturity. The presents study aimed at evaluating effects of betamethasone
injection on feeling embryo motion by mother and index and biophysical profile
in preterm pregnancies. In a descriptive-analytical study, 40 pregnant women
with the pregnancy age of 30-34 weeks were evaluated. Embryo motion and index
and biophysical profile of the amniotic fluid were checked before prescription
of double dosage of muscular betamethasone (12 mg) at a 24 h time interval.
The injection was repeated for 24 and 48 h after the first injection. The resulted
outcomes were compared with those results related to before betamethasone injection.
In this study, there was statistically meaningful relationship between embryo
motions before injection of betamethasone and 12 h after its injection (p =
0.03). Also, there was a significant relationship between embryo motions 24
and 48 h after injection of betamethasone (p = 0.001). In other words, the embryo
motions decreased 12 h after injection of betamethasone. They were improved
48 h after betamethasone injection. But, index and biophysical profile results
of amniotic fluid were left unchanged. Application of betamethasone leads to
evident but transient decrease in embryo motions. Although motion element of
index and biophysical profile of amniotic fluid which is one of the tests used
in evaluating the embryo health is fixed and normal, it can be concluded that
injection of betamethasone may not affect embryo health.
|
|
|
|
|
Received: January 14, 2013;
Accepted: March 07, 2013;
Published: May 08, 2013
|
|
INTRODUCTION
The term of preterm birth is used to describe the premature neonates considering
pregnancy age. Preterm birth is defined as birth taking place before completing
of 37 weeks of pregnancy (Autret-Leca et al., 2009;
Golfurushan et al., 2011; Haas
et al., 2012; Milan et al., 2011).
In this condition, 85% of neonate mortality results from prematurity. Some before
37 weeks of pregnancy increase in comparison with term birth neonates. It is
associated with mortality increase of these neonates (Goldust
et al., 2011; Khandelwal et al., 2012;
Newnham and Jobe, 2009; Sadeghpour
et al., 2011). Some medicines and interventions including hydration,
mitigating beta-adrenergic receptors agonists, magnesium sulphate, prostaglandin
controller and blockers calcium have been used to control preterm labor (Caldas
et al., 2012; Goldust et al., 2012;
Sadighi et al., 2011). Corticosteroids are prescribed
to promote embryo lungs mature in less than 34 week pregnancies (Bensley
et al., 2012; Goldust et al., 2013a;
Vafaee et al., 2012). Betamethasone is a glucocorticoid
used to induce pulmonary maturation in preterm babies and reduce the incidence
of respiratory distress (Hjalmarson and Sandberg, 2011).
The mechanism for this action is still unclear. Additionally, betamethasone
increases the size of the air sacs in the lungs (alveoli) and improves oxygen
exchange (Anonymous, 2010). Despite the positive effects
of this drug, there are several side effects with its use (Goldust
et al., 2013b, c; Jarreau
et al., 2010) When preterm is created with a long distance from term,
complications and mother and neonatal mortality rate increase significantly.
Therefore, intensive medical care's are of high importance in women with preterm
labor (Goldust et al., 2013d; Mohebbipour
et al., 2012; Schwab et al., 2012).
Biophysical profile is a non-invasive method to study embryo health before birth.
In this method, possibility of asphyxia and risk of embryo mortality are evaluated
(Bontis et al., 2011). The results may lead to
some interventions for immediate terminating of preterm pregnancy considering
increase of preterm labor rate within the recent decades, the complications
created in neonates associated with more labor load on society, family and health
system, importance of effects of prescription of betamethasone to evaluate embryo
lung in preterm neonates, referring of some references to effects of corticosteroid
on tests used to evaluated embryo health considering effects of corticosteroid
therapy on decreasing index and biophysical profile score of amniotic fluid
in preterm embryo (Crowther et al., 2011; Goldust
and Rezaee, 2013; Lotti et al., 2013). Therefore,
it was decided to study effects of betamethasone on tests used to evaluated
embryo health (index and biophysical profile of amniotic fluid and embryo motions).
MATERIALS AND METHODS In this descriptive-analytical study, forty 18-35 years old women hospitalized with preterm pregnancy of 30-34 weeks as well as need to corticosteroid injection were evaluated for two years (Mar. 2010 to Mar. 2012) in Tabriz, Alzahra hospital. Written consent was obtained from all the patients. This study was approved by ethic committee of Tabriz University of medical sciences. The inclusion criteria included preterm labor without receiving sulphate, placenta previa, preterm associated with vaginal hemorrhage, history of preterm labor, uterus abnormalities and interest in attending the study. The exclusion criteria were preterm labor receiving tocolytic medicines, suffering from uterus infection, receiving benzodiazepines and narcotic analgesic, growth inter-uterus disorder with distorted color Doppler, embryo heart arrhythmia, congenital anomalies of embryo, history of receiving steroid and heart diseases of embryo. The subjects were tested before injection, 24 and 48 h after injection considering index and biophysical profile. The results of before betamethasone injection (12 mg IM at a 24 h time interval and two times per day) were compared with those outcomes obtained after injection of betamethasone. Feeling of embryo motion by the mother was evaluated and compared before injection of betamethasone and 12, 24 and 48 h after its prescription. This study evaluated parameters such as chronological age of the patients, pregnancy age, gravidity, parity, history of diseases including eclampsia, pregnancy diabetes, hypertension, reasons of patients' referring to the center such as delivery pain, history of preterm labor, vaginal hemorrhage, uterus disorders, number of embryo motions, index of amniotic fluid, total score of Biophysical Profile (BPP) and Non-stress Test (NST) result. Statistical analysis: The obtained data were analyzed using descriptive statistical methods (Mean±Standard deviation, frequency and percentage) and quantitative variables were compared using mean difference test for dependent groups. Also, Chi square test and Mc Nemmar test was applied to compare qualitative variables. To statistically analyze the data, SPSS.15 software was used. In this study, p = 0.05 was regarded as significant. RESULTS
Mean age of the understudy subjects was 29.12±5.27 years and the youngest
and oldest patients were 18 and 35 years old, respectively. Mean pregnancy age
of the understudy subjects was 31.55±1.23 weeks such that the minimum
and maximum pregnancy age was respectively 30 and 34 weeks. In this study, there
were two cases of abortion history with three abortions in one case and 4 abortions
in another subject. The understudy subjects gave birth to 15 alive neonates
with one alive birth in 11 cases (73%) and three alive births in two cases (13%).
Additionally, two neonates (13.3%) died after birth. Out of 15 subjects, 4 (26.7%)
and 11 (73.3%) cases suffered from parity 2 and 1, respectively. Considering
40 subjects, gravid 3, 2 and 1 was observed in 3 (7.5%), 11 (27.5%) and 26 (65%)
cases, respectively. Out of 40 patients, 2 cases (5%) suffered from pregnancy
diabetes and one case (2.5%) experienced hypertension during pregnancy. Also,
out of 40 cases, 25 patients (62.5%) suffered from premature delivery pain,
15 subjects (37.5%) experienced no premature delivery pain, vaginal hemorrhage
was seen in 13 cases (32.5%) and 27 patients (67.5%) did not experienced vaginal
hemorrhage. None of the 40 understudy patients experienced history of preterm
birth. In this study, 12 patients (30%) were cared without any especial action,
28 cases (70%) was treated using serum therapy. Before prescription of betamethasone,
appropriate and inappropriate embryo motions were identified in 34 (85%) and
6 (15%) cases, respectively. Number of embryo motions was appropriate in 26
cases (65%) 12 h after prescription of betamethasone. It was inappropriate in
14 cases (35%). Number of embryo motions was appropriate in 27 cases (67.5%)
and inappropriate in 13 cases (32.5%) after 24 h of betamethasone prescription.
Additionally, number of embryo motions was appropriate in 38 cases (95%) after
48 hours of betamethasone prescription. It was inappropriate in 2 cases (5%).
There was a statistically meaningful relationship between feeling of embryo
motion before prescription of betamethasone and 12 h after its prescription
(p = 0.03). But, there was not any statistically meaningful relationship between
feeling of embryo motio before prescription of betamethasone and 12 and 24 h
after its prescription (p = 0.9).
Table 1: |
Comparison of biophysical profile before and 24 and 48 h after
injection of betamethasone |
 |
Values in brackets are percentage |
There was a statistically significant relationship between feeling of embryo
motion before prescription of betamethasone and 24 and 48 h after its prescription
(p = 0.001). Generally, results of statistical tests demonstrate that frequency
distribution between embryo motion status before injection of betamethasone
and 12 h after its injection was statistically meaningful (p = 0.03). Considering
p = 0.11, it can be stated that test results before and 24 h after injection
of betamethasone was not meaningful. Test results before and 48 h after injection
of betamethasone was not meaningful since p = 0.21. Biophysical profile before
prescription of betamethasone was 10 and 8 in 35 (87.5%) and 5(12.5%) cases,
respectively. After 24 h of betamethasone prescription, it was 10 and 8 in 35
(87.5%) and 5(12.5%) cases, respectively. Biophysical profile relationship after
48 h of betamethasone prescription was 10 and 8 in 3 (95%) and 2 (5%) cases.
There was not any statistically meaningful relationship between biophysical
profile before and 24 h after prescription of betamethasone (p = 1). Additionally,
there was not any statistically meaningful relationship between biophysical
profile 24 and 48 h after prescription of betamethasone (p = 0.37) (Table
1).
DISCUSSION
Effects of betamethasone injection on embryo motions, index and biophysical
profile of amniotic fluid in preterm 30-34 weeks pregnancies were evaluated
in this study. In this study, number of embryo motions was appropriate in 85%
of cases before injection of betamethasone. It was appropriate in 65% of subjects
after 12 h of betamethasone injection. Considering p = 0.03, there was a meaningful
relationship between feeling of embryo motions before and 12 h after injection
of betamethasone. There was a meaningful relationship between feeling of embryo
motions 24 h after injection of betamethasone in comparison with 48 h after
betamethasone injection (p = 0.01). It refers to the fact that feeling of embryo
motion improves after 48 h of betamethasone injection (Haas
et al., 2011). But, this study does not demonstrate any relationship
between index and biophysical profile of amniotic fluid before and after prescription
of betamethasone. Previous studies have pointed out that biophysical profile,
feeling of embryo motion by the mother, embryo's heart rate, motion and breathing
decrease after injection of corticosteroid but index of amniotic fluid may be
normal or decreased. (Schaffer et al., 2010).
Bastek et al. (2010) demonstrated that injection
of betamethasone in pregnant women led to transient decrease of embryo's motions,
heart rate and breathing during first 48 h. Then, they were returned to their
normal condition within 4-6 days. Also, they demonstrated that injection of
corticosteroid did not affect variability of the embryo's heart pulse. It significantly
decreased base heart rate of the embryo. In their study on pregnant women (29-34
weeks) using Doppler after corticosteroid therapy, Hashima
et al. (2010) indicated to no changes in umbilical arterial circulation
but MCA circulation was decreased within 72 h. In the study, conducted by Subtil
et al. (2003), it was made clear that embryo heart rate was decreased
within first 32 h after injection of corticosteroid. FHR variability was increased
within the first 8 h and then, it was decreased to 8 h. Body motions of the
embryo were left unchanged (Subtil et al., 2003).
Muddler et al., conducted a study in this regard and demonstrated that
heart rate, body motions and breathing of the embryo were decreased within the
first 48 h after injection of corticosteroid. Contrary to the previous studies,
FHR variability was also decreased during the mentioned interval (Mulder
et al., 2004). In their study, Koenen et al.
(2002) demonstrated that embryo heart rate, in contrary to the previous
researches, did not change but decrease of breathing and body motions of the
embryo were observed (Koenen et al., 2002). Peltoniemi
et al. (2009) conducted a study in this regard and suggested that
breathing and body motions of embryo as well as FHR variability were decreased
during the first 72 h. But, heart rate was left unchanged (Peltoniemi
et al., 2009). In this study, only embryo motions were decreased
within the first 12 h and index and biophysical profile were not changed. According
to the results obtained from this study, although there was statistically meaningful
relationship between embryo motions before and 12 h after injection as well
as the meaningful relationship observed between embryo motions after 24 and
48 h of injection of betamethasone, decrease of embryo motions after 12 h of
betamethasone injection as well as improvement of embryo motions 48 h after
its injection and considering normalness of motion element of biophysical profile,
it can be stated that injection of Corticosteroid does not negatively affect
embryo health.
CONCLUSION
This study demonstrated that embryo motions were evident but transient after
injection of Corticosteroid. But, index of amniotic fluid and biophysical profile
did not change as a result of injection of Corticosteroid.
|
REFERENCES |
1: Anonymous, 2010. Risk of preterm delivery: A single course of antenatal corticosteroids. Prescrire Int., 19: 168-169. PubMed | Direct Link |
2: Autret-Leca, E., S. Bauer, C. Alberti, A.P. Jonville-Bera, Y. Aujard, L. Bensouda-Grimaldi and O. Baud, 2009. Glucocorticoide therapy in premature infants: French practices in 2006. Arch Pediatr., 16: 999-1004. CrossRef | PubMed |
3: Bastek, J.A., M.D. Sammel, E.C. Rebele, S.K. Srinivas and M.A. Elovitz, 2010. The effects of a preterm labor episode prior to 34 weeks are evident in late preterm outcomes, despite the administration of betamethasone. Am. J. Obstet. Gynecol., 203: 140-147. CrossRef |
4: Bensley, J.G., R. De Matteo, R. Harding and M.J. Black, 2012. Preterm birth with antenatal corticosteroid administration has injurious and persistent effects on the structure and composition of the aorta and pulmonary artery. Pediatr. Res., 71: 150-155. CrossRef | PubMed |
5: Bontis, N., D. Vavilis, D. Tsolakidis, D.G. Goulis, P. Tzevelekis, D. Kellartzis and B.C. Tarlatzis, 2011. Comparison of single versus multiple courses of antenatal betamethasone in patients with threatened preterm labor. Clin. Exp. Obstet. Gynecol., 38: 165-167. PubMed |
6: Caldas, J.P.S., M.M.S. Vilela, C.A. Braghini, T.N. Mazzola and S.T.M. Marba, 2012. Antenatal maternal corticosteroid administration and markers of oxidative stress and inflammation in umbilical cord blood from very low birth weight preterm newborn infants. J. Pediatr., 88: 61-66. CrossRef |
7: Crowther, C.A., C.J. McKinlay, P. Middleton and J.E. Harding, 2011. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. Cochrane Database Syst. Rev. 10.1002/14651858.CD003935.pub3
8: Goldust, M., S.B. Nejad, E. Rezaee and R. Raghifar, 2013. Comparative trial of permethrin 5% vs. lindane 1% for the treatment of scabies. J. Dermatol. Treat., (In Press). 10.3109/09546634.2012.723122
9: Goldust, M., F. Golforoushan and E. Rezaee, 2011. Treatment of solar lentigines with trichloroacetic acid 40% vs. cryotherapy. Eur. J. Dermatol., 21: 426-427. CrossRef | PubMed |
10: Goldust, M., M.R. Ranjkesh, M. Amirinia, F. Golforoushan, E. Rezaee and M.A.R. Saatlou, 2013. Sertaconazole 2% cream versus hydrocortisone 1% cream in the treatment of seborrheic dermatitis. J. Dermatol. Treat., (In Press). 10.3109/09546634.2012.755251
11: Goldust, M. and E. Rezaee, 2013. The efficacy of topical ivermectin vs. malation 0.5% lotion for the treatment of scabies. J. Dermatol. Treat., (In Press). 10.3109/09546634.2013.782093
12: Goldust, M., E. Rezaee and S. Hemayat, 2012. Treatment of scabies: Comparison of permethrin 5% versus ivermectin. J. Dermatol., 39: 545-547. CrossRef |
13: Goldust, M., E. Rezaee and R. Raghifar, 2013. Comparison of oral ivermectin versus crotamiton 10% cream in the treatment of scabies. Cutaneousv Ocul. Toxicol., 10.3109/15569527.2013.768258
14: Goldust, M., M. Talebi, J. Majidi, M.A.R. Saatlou and E. Rezaee, 2013. Evaluation of antiphospholipid antibodies in youths suffering from cerebral ischemia. Int. J. Neurosci., 123: 209-212. CrossRef | Direct Link |
15: Golfurushan, F., M. Sadeghi, M. Goldust and N. Yosefi, 2011. Leprosy in Iran: An analysis of 195 cases from 1994-2009. J. Pak. Med. Assoc., 61: 558-561. PubMed | Direct Link |
16: Haas, D.M., A.S. Lehmann, T. Skaar, S. Philips and C.L. McCormick et al., 2012. The impact of drug metabolizing enzyme polymorphisms on outcomes after antenatal corticosteroid use. Am. J. Obstet. Gynecol., 206: 447.e17-447.e24. CrossRef | PubMed |
17: Haas, D.M., A.C. Sischy, W. McCullough and A.J. Simsiman, 2011. Maternal ethnicity influences on neonatal respiratory outcomes after antenatal corticosteroid use for anticipated preterm delivery. J. Matern. Fetal. Neonatal. Med., 24: 516-520. CrossRef | PubMed | Direct Link |
18: Hashima, J.N., Y. Lai, R.J. Wapner, Y. Sorokin and D.J. Dudley et al., 2010. The effect of maternal body mass index on neonatal outcome in women receiving a single course of antenatal corticosteroids. Am. J. Obstet. Gynecol., 202: 263.e1-263.e5. CrossRef |
19: Hjalmarson, O. and K.L. Sandberg, 2011. Effect of antenatal corticosteroid treatment on lung function in full-term newborn infants. Neonatology, 100: 32-36. PubMed |
20: Jarreau, P.H., M. Fayon, O. Baud , E. Autret-Leca, M. Danan, A. de Verdelhan and A. Castot, 2010. The use of postnatal corticosteroid therapy in premature infants to prevent or treat bronchopulmonary dysplasia: Current situation and recommendations. Arch Pediatr., 17: 1480-1487. CrossRef | PubMed |
21: Khandelwal, M., E. Chang, C. Hansen, K. Hunter and B. Milcarek, 2012. Betamethasone dosing interval: 12 or 24 hours apart? A randomized, noninferiority open trial. Am. J. Obstet. Gynecol., 206: 201.e1-201.e11. CrossRef | PubMed |
22: Koenen, S.V., C.A. Mecenas, G.S. Smith, S. Jenkins and P.W. Nathanielsz, 2002. Effects of maternal betamethasone administration on fetal and maternal blood pressure and heart rate in the baboon at 0.7 of gestation. Am. J. Obstet. Gynecol., 186: 812-817. PubMed |
23: Lotti, T., M. Goldust and E. Rezaee, 2013. Treatment of seborrheic dermatitis, comparison of sertaconazole 2% cream vs. ketoconazole 2% cream. J. Dermatol. Treat., 10.3109/09546634.2013.777154
24: Milan, P.B., D.M. Nejad, A.A. Ghanbari, J.S. Rad and H.T. Nasrabadi et al., 2011. Effects of Polygonum aviculare herbal extract on sperm parameters after EMF exposure in mouse. Pak. J. Biol. Sci., 14: 720-724. CrossRef | Direct Link |
25: Mohebbipour, A., P. Saleh, M. Goldust, M. Amirnia, Y.J. Zadeh, R.M. Mohamadi and E. Rezaee, 2012. Treatment of scabies: Comparison of ivermectin vs. lindane lotion 1%. Acta Dermatovenerol. Croat, 20: 251-255. PubMed | Direct Link |
26: Mulder, E.J.H., S.V. Koenen, I. Blom and G.H.A. Visser, 2004. The effects of antenatal betamethasone administration on fetal heart rate and behaviour depend on gestational age. Early Hum. Dev., 76: 65-77. CrossRef | PubMed |
27: Newnham, J.P. and A.H. Jobe, 2009. Should we be prescribing repeated courses of antenatal corticosteroids?. Fetal Neonatal. Med., 14: 157-163. CrossRef | PubMed |
28: Peltoniemi, O.M., M.A. Kari, A. Lano, A. Yliherva and R. Puosi et al., 2009. Two-year follow-up of a randomised trial with repeated antenatal betamethasone. Arch Dis. Child Fetal Neonatal. Ed., 94: F402-F406. PubMed |
29: Sadeghpour, A., R. Mansour, H.A. Aghdam and M. Goldust, 2011. Comparison of trans patellar approach and medial parapatellar tendon approach in tibial intramedullary nailing for treatment of tibial fractures. J. Pak. Med. Assoc., 61: 530-533. PubMed | Direct Link |
30: Sadighi, A., A. Elmi, M.A. Jafari, V. Sadeghifard and M. Goldust, 2011. Comparison study of therapeutic results of closed tibial shaft fracture with intramedullary nails inserted with and without reaming. Pak. J. Biol. Sci., 14: 950-953. PubMed | Direct Link |
31: Schaffer, L., T. Burkhardt, M. Tomaske, S. Schmidt and F. Luzi et al., 2010. Effect of antenatal betamethasone administration on neonatal cardiac autonomic balance. Pediatr. Res., 68: 286-291. PubMed |
32: Schwab, M., T. Coksaygan, F. Rakers and P.W. Nathanielsz, 2012. Glucocorticoid exposure of sheep at 0.7 to 0.75 gestation augments late-gestation fetal stress responses. Am. J. Obstet. Gynecol., 206: 253.e16-253.e22. CrossRef | PubMed |
33: Subtil, D., P. Tiberghien, P. Devos, D. Therby, G. Leclerc, P. Vaast and F. Puech, 2003. Immediate and delayed effects of antenatal corticosteroids on fetal heart rate: a randomized trial that compares betamethasone acetate and phosphate, betamethasone phosphate and dexamethasone. Am. J. Obstet. Gynecol., 188: 524-531. CrossRef | PubMed |
34: Vafaee, I., M.B. Rahbani Nobar and M. Goldust, 2012. Etiology of ocular trauma: A two years cros sectional study in Tabriz, Iran. J. Coll. Phys. Surg. Pak., 22: 344-344. PubMed | Direct Link |
|
|
|
 |