Q. 1: What is AFI & what is its
relevance? Ans:-The amniotic fluid index (AFI)
has been an integral component of fetal assessment during antepartum ultrasound
examination for >20 years. The other methods are subjective movement of Foetal movements (Daily
Foetal Movement Counts-DFMC). Decreased
amniotic fluid or oligohydramnios, is typically defined as an AFI below 5-cm, which represents the value below the first percentile. In term and
near-term gestations, this 5-cm threshold has been associated with increased
rates of complications, including small for gestational age neonate,
nonreassuring fetal heart rate (FHR), stillbirth, and neonatal death. The
amniotic fluid volume is most abundant in the early third trimester,
subsequently decreasing until term.
Q.2: What is
preterm births? Ans;- The term of preterm birth is used to define the premature neonates
considering pregnancies age of less than 34 weeks and corticosteroids are
commonly prescribed to promote embryos lung maturity.
How
best to define decreased AFI?? Ans:-Decreased
amniotic fluid or oligohydramnios, is typically defined as an AFI below 5-cm, which represents the value below the first percentile.
Q.3:
When to administer ACS ( ante natal
corticosteroids)? Ans:- The
preferred gestational age for administration of dexamethasone and betamethasone
is usually 28-34 weeks.
Q.4.Why we are worried
if AFI is < 5 Cm ? Why
this threshold or cutoff points? Ans:-In term and near-term
gestations, this 5-cm threshold has been associated with increased rates of
complications, including small for gestational age neonate, nonreassuring fetal
heart rate (FHR), stillbirth, and neonatal death. The amniotic fluid volume is
most abundant in the early third trimester, subsequently decreasing until term.
Before 34 weeks, the value of 8-cm is
below the fifth percentile for gestational age.
Q.5. What is the normal AFI range?? Ans .normal range of AFI in fetus is 8-23 cm and its average is
12.8-cm in Jackson study. Jackson et al measured the effect of corticosteroids
on AFI in cases where in the study population about 72% of cases the AFI was
decreased. Before 34 weeks, the value of
8-cm is below the fifth percentile for gestational age. AFI values between 5- and 8-cm have been termed “borderline.”
.
Q.6: What are the potential threats to foetus associated with
borderline amniotic fluid in the preterm period ? Ans: Well, the
potential risks associated with borderline amniotic fluid in the preterm period
are not fully understood. AFI has no significant change before and after
corticosteroids administration.
Q.7: What is the dose of antenatal
corticosteroids( A N C) ?? The usual dose of betamethasone is 0.17 mg/kg
daily for 2 doses.
Q.8:
What arte the observed advantages of ante natal corticosteroids i.e. N C?? Ans:-Dexamethasone and betamethasone cause to produce surfactant in
fetus lung and thereby it reduces the resistant between layers of airways and
sacs to simply slide on each other and eventually easily breathing of neonate
after birth preventing respiratory distress syndrome in neonate. Moreover ,ANC reduces
the risk of 1) intraventricular
hemorrhage, 2) chronic lung diseases, 3) necrotizing enterocolitis, and 4)retinopathy
of prematurity, 5) sepsis, and 6) admission in Neonatal Intensive Care Unit.
Q.9: Which steroid is preferred??
Ans:-Imagine if both drugs are freely
available in the area where U practice then one has to select the most optimum agent,
most beneficial for foetus . Ans:-The
question that we the obstetrician have to address in such a situation are what changes may follow in foetus after
the injection of either betamethasone or dexamethasone? The clinicians, therefore
should be familiar with changes that may ensue after the doses of steroids be
it Dexa or betamethasone. We the practitioner
must be fully aware of the usual effects
of betamethasone versus dexamethasone on
the AFI in the women when administered
to at risk of preterm labor thereby the best decision may be made for each
patient.
.
Ill effects , which may occasionally be demonstrable as a
minor transient side effects on foetus induced by steroid injection: Ans;-Few
studies have been done to evaluate the side effects of dexamethasone and
betamethasone. The indices were Corticosteroid
administration to mother & effect on BPP_-1) BPP:-Biophysical
profile parameters (BPP) consists of five parameters including:
1.
Fetal tone,
2.
Fetal gross movement,
3.
Fetal breathe,
4.
AFI,
5.
Nonstress test (NST) changes, each
of these parameters is assigned number 0-2.
The
normal score of BPP is 8-10 and 6-8 is unclear and below 6 considers as
abnormal. BPP for the most of the fetus (95.95%) is normal. In the Jackson study
that measured BPP after administration of corticosteroids, fetal gross movement
and AFI score were decreased in 44% and 87% of cases, respectively..
Corticosteroid administration to
mother & effect on NST:_-To
evaluate the effect of corticosteroids on NST, the parameters that change in
NST are a short and long beat to beat which are decreased generally, and it can
be neglect the corticosteroids effect on acceleration.
What are the changes that may follow
after ACS, dexamethasone in particular ?? Ans:-The difference between dexamethasone and betamethasone on 1) NST,
2) AFI, 3) and BPP, WE should keep in
mind that there are some changes, albeit rare after administration of this
about dexamethasone injection . Prior
information about such minor transient changes changes
prevents rash decision for patients. In a study made by Comparison of the effect of betamethasone versus
dexamethasone on the amniotic fluid index in the women at risk of preterm labor
Conclusion 1:-What about foetal activity(DFMC) & AFI changes that may follow after
Dexamethasone ?? Ans;-dexamethasone has no clear effect on NST, AFI, and BPP
Conclusion 2 -What about foetal
activity(DFMC) & AFI changes that
may follow after Betamethasone?? What about Betamethasone?? Ans;- Betamethasone usually 1) decreases AFI in 63% of
cases, 2) short beat to beat in NST in all cases and 3) fetal movement in 80%
cases but other parameters have no changes.
Studies
have been made to check, analyze, and compare the effect of betamethasone and
dexamethasone on fetal index including AFI, BPP, NST in pregnant women with the
pregnancy age of 28-34 weeks experiencing prematurity Thus because of the
importance of NST, AFI, and BPP on decision for the fetus, the changes after administration of dexamethasone and
betamethasone on BPP, NST, and AFI and differences between their effects on the
BPP, AFI, NST are important for us.
No comments:
Post a Comment