A 30 year old G1 with twin gestation at 28 wks is being evaluated for vaginal bleeding and uterine contractions. A bedside ultrasound examination rules out the presence of a placenta previa. Fetal heart rate tracing is reactive on both twins, and the uterine contractions are every 2 to 3 minutes and last for 60 sec. A sterile speculum examination is negative for rupture membranes. A digital examination indicates that the cervix is 2 to 3 cm dilated and 50% effaced, and the presenting part is at -3 station. Tocolysis with magnesium sulfate is initiated and intravenous antibiotics are started for group B streptococcus prophylaxis. Betamethasone, a corticosteroid is also administered. Which of the following statements regarding the use of betamethasone in the treatment of preterm labor is most accurate?
a. Betamethasone enhances the tocolytic effect of magnesium sulfate and decreases the risk of preterm delivery.
b. Betamethasone has been shown to decrease intraamniotic infections.
c. Betamethasone promotes fetal lung maturity and decreases the risk of respiratory distress syndrome.
d, The anti inflammatory effect of betamethasone decreases the risk of GBS sepsis in the newborn.
e. Betamethasone is the only corticosteroid proven to cross the placenta.
Answer and explanation
a. Betamethasone enhances the tocolytic effect of magnesium sulfate and decreases the risk of preterm delivery.
b. Betamethasone has been shown to decrease intraamniotic infections.
c. Betamethasone promotes fetal lung maturity and decreases the risk of respiratory distress syndrome.
d, The anti inflammatory effect of betamethasone decreases the risk of GBS sepsis in the newborn.
e. Betamethasone is the only corticosteroid proven to cross the placenta.
Answer and explanation
The answer is c .
The patient is in preterm labour, because she has a dilated and effaced cervix in the presence of regular uterine contractions. Therefore the treatment is aimed at delaying delivery to allow continued fetal growth and maturity. The administration of tocolytic therapy to treat the preterm contractions is indicated. In addition from 24 to 34 weeks, management also includes the administration of steroids, such as betamethasone, to promote fetal lung maturity. Respiratory distress syndrome is a sequela of preterm neonates and occurs less often in the infants given betamethasone in utero. If delivery seems likely, intravenous antibiotics are administered to prevent possible neonatal sepsis. If the patient's contractions subside and there is no evidence of infection, then the antibiotic can be discontinued.There is no need of cesarean section in this patient. Attempts are made to stop the labor first. If the patient continues to progress, then a vaginal delivery is preferred since the twins do not have a malpresentation
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