FETUS, PLACENTA, AND NEWBORN

A comparison of two glucocorticoid regimens for acceleration of fetal lung maturation in premature labor GERALD JOHN ALLEN

G. E.

WHITT,

M.D.

BUSTER, P.

WILLIAM

M.D.,

KILLAM, H.

F.A.C.O.G.

M.D.,

SCRAGG,

F.A.C.O.G. M.D.,

F.A.C.0.G

El Paso, Texas

This study compares fetal corticoid response from conventional dose (12.0 mg.) intramuscular betamethasone to large dose (1,000 mg.) intravenous cortisol administered to women in premature labor for acceleration of fetal lung maturity. To compare these two regimens, 14 women selected at random were treated in groups of seven with either cortisol or betamethasone. Peripheral levels of unconjugated estriol were measured by spect$ic radioimmunoassay prior to the corticoid dose and at 1, 4, 8, and 12 hours following the dose. The rate of corticoid delivery to the fetal hypothalamic-adrenal axis was estimated by the per cent suppression of unconjugated estriol at each post-treatment interval. Least-squares regression lines fitted (P < 0.01) for each regimen were compared for time saved (At) when co&sol was used. Mean At (1, 4, 8, and 12 hours) was 9.0 k 0.2 S.E.M. hours. It is concluded that: (1) Intravenous cortisol delivers a fetal corticoid effect that is significantly more rapid in onset and more profound in magnitude than does intramuscular betamethasone and that (2) the cortisol regimen 2sprobably better suited to the acceleration of fetal lung maturation in premature labor when time is short and rapid action is essential.

SEVERAL

maturation tramuscular

studies of glucocorticoid effect on fetal lung have utilized varying regimens of inbetamethasone,‘, ’ a synthetic, high-po-

tency, long-acting analogue of cortisol. The efficiency and speed at which this drug crosses the placenta and exerts its pharmacologic effect at reported dose schedules has not been studied. In addition, there has as yet been no published investigation into potentially quicker acting corticosteroid regimens applicable to accelerating fetal lung maturation during premature labor when time is short and rapid action is essential. With the use of suppression of unconjugated maternal serum estriol (EJ3 levels as an indicator of fetal hypothalamic-adrenal axis response,4 the following

From the Department of Obstetrics and Gynecology, William Beaumont Army Medical Center. Received

for publication

Revised June Accepted June

March

21, 1975.

13, 1975. 18, 1975.

Reprint requests: Gerald G. Whit& M. D., Department Obstetrics and Gynecology, William Beaumont Army Medical Center, El Paso, Texas 79920.

of

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BETAMETHASONE CORTISOL (n=7)

(n=7) (~0.998

(~0.979 P=

A comparison of two glucocorticoid regimens for acceleration of fetal lung maturation in premature labor.

FETUS, PLACENTA, AND NEWBORN A comparison of two glucocorticoid regimens for acceleration of fetal lung maturation in premature labor GERALD JOHN ALL...
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