Intervention Review

Transplacental versus direct fetal corticosteroid treatment for accelerating fetal lung maturation where there is a risk of preterm birth

  1. Debby P Utama*,
  2. Caroline A Crowther

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 7 SEP 2011

Assessed as up-to-date: 28 JUL 2011

DOI: 10.1002/14651858.CD008981.pub2


How to Cite

Utama DP, Crowther CA. Transplacental versus direct fetal corticosteroid treatment for accelerating fetal lung maturation where there is a risk of preterm birth. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD008981. DOI: 10.1002/14651858.CD008981.pub2.

Author Information

  1. The University of Adelaide, ARCH: Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia

*Debby P Utama, ARCH: Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, 72 King William Road, Adelaide, South Australia, 5006, Australia. debbypu@gmail.com. debby.utama@health.sa.gov.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 7 SEP 2011

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト

Background

Despite major advances in medical technology, the incidence of preterm birth remains high. The use of antenatal corticosteroid administered transplacentally, by intramuscular injection to women at risk of preterm birth, has reduced the incidence of respiratory distress syndrome and increased the survival rates of preterm infants. However, this intervention also comes with its own risks and side effects. Animal studies and early studies in pregnant women at risk of preterm birth have reported the use of an alternative route of administration, by direct intramuscular injection of corticosteroid into the fetus under ultrasound guidance, in an attempt to minimise the side effects profile. Direct fetal corticosteroid administration may have benefits over maternal administration in terms of safety and efficacy.

Objectives

To assess if different routes of corticosteroid administration (maternal versus direct fetal) have effects on maternal health, and the risk of stillbirth, neonatal, perinatal, infant and child mortality and morbidity.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (16 June 2011) and the WHO International Clinical Trials Registry Platform (ICTRP) (16 June 2011).

Selection criteria

Randomised controlled trials comparing maternal with direct fetal routes of antenatal corticosteroid administration in women at risk of preterm birth.

Data collection and analysis

We did not perform any data collection or analyses.

Main results

We did not identify any eligible randomised controlled trials to include in this review.

Authors' conclusions

The available clinical studies carried out so far on animals and human have shown that direct intramuscular injection of corticosteroid into the fetus under ultrasound guidance is feasible, but data on health outcomes are lacking. Therefore, uncertainty persists as to which method could provide better efficacy and safety profile. Randomised controlled trials are required focusing on the benefits and harms of transplacental versus direct fetal corticosteroid treatment. Until the uncertainties have been answered, it is advisable to stay with the current standard of antenatal transplacental maternally administered corticosteroid treatment.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト

Transplacental versus direct fetal corticosteroid treatment for accelerating fetal lung maturation where there is a risk of preterm birth

Babies born early, before 37 weeks, are at risk of dying, having bleeding into their brain and problems with their breathing because their lungs are not fully developed. Corticosteroid treatment given to the mother before early birth has been shown to be effective to prevent these problems and has become the standard care in many countries. The common method of giving corticosteroid is by injecting into the mother's muscles. This treatment has its own risks such as reducing fetal growth and brain development as well as increasing the baby's risks of diseases such as diabetes and high blood pressure. Injecting corticosteroid directly to the fetus is feasible with ultrasound guidance. This would prevent the risk of increased blood pressure, increased blood glucose levels, susceptibility to sepsis in the mother and reduce the amount of corticosteroid needed. However, it carries a risk of intrauterine infection, fetal injury and precipitation of preterm labour. We found that there have been no randomised controlled trials assessing the benefits and harms of direct injection into the fetus compared with injection into the mother. To establish if one method is better than the other, good quality randomised trials are needed.

 

アブストラクト

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト

早産リスクがある場合の胎児肺成熟を促進するための経胎盤副腎皮質ステロイド(薬)(以下、ステロイド)投与と胎児直接投与との比較

背景

医療技術の進歩にもかかわらず、早産の罹患率は依然として高い。早産リスクのある女性に対する、筋肉内注射による経胎盤投与での出産前ステロイド(薬)使用で、呼吸窮迫症候群の罹患率が低下し早産児の生存率が上昇した。しかし、本介入には固有のリスクと副作用が伴う。動物による研究および早期産リスクのある妊婦での初期の研究は、副作用プロファイルを最小限にする目的で、超音波ガイド下で胎児にステロイド薬を直接筋肉内投与するという代替投与経路の使用を報告している。胎児へのステロイド薬直接投与は、安全性および有効性の点で母体投与よりも利益がある可能性がある。

目的

ステロイド薬の異なる投与経路(母体投与対胎児直接投与)が、母体の健康、死産リスク、また新生児、周産期、乳児および小児の死亡率と罹病率に影響するか評価すること。

検索戦略

Cochrane Pregnancy and Childbirth Group's Trials Register(2011年6月16日)およびWHO International Clinical Trials Registry Platform(ICTRP)(2011年6月16日)を検索した。

選択基準

早期産リスクのある女性を対象に、出産前ステロイド薬の母体投与と胎児直接投与を比較しているランダム化比較試験(RCT)

データ収集と分析

データ収集および解析を実施しなかった。

主な結果

本レビューに選択する適格なランダム化比較試験(RCT)は同定されなかった。

著者の結論

これまでに実施された、動物およびヒトに関する入手可能な臨床研究では、胎児への超音波ガイド下ステロイド薬直接筋注は可能であるが、健康アウトカムに関するデータは欠如している。したがって、どちらの方法が良好な有効性かつ安全性プロファイルを示すかに関しては依然不明である。ステロイド薬経胎盤投与を胎児直接投与と比較し、その利益と有害性について焦点を当てたランダム化比較試験(RCT)が必要である。不明点が明らかになるまで、現在の標準的な、母体投与による出産前経胎盤ステロイド薬投与を維持することが勧められる。

訳注

監  訳: 江藤 宏美,2011.12.15

実施組織: 厚生労働省委託事業によりMindsが実施した。

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