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Furthermore, clinical trials cited in the most recent Cochrane Review have limitations which should be taken into account when considering the use of antenatal corticosteroids in clinical practice.10 Trials of corticosteroids as an intervention for preterm babies can be very small, and observational studies are likely to be biased towards identifying benefits (as opposed to harms), and have problems detecting non-significant differences.11 However, the authors report that the median duration of labour was 5.5 minutes, and that the overall rate of premature rupture of membranes was 14% (range 11% to 25%). This rate of rupture was significantly lower (P=0.042) than results reported in a recent systematic review and meta-analysis which found an average rate of 19%.12 Some observational studies have also shown that in certain settings the use of antenatal cortisone or topical corticosteroids can reduce the risk of preterm delivery.13–16 However, the study that reported these results relied on a small subset of hospitals that had been reported to use the drugs.17 It is therefore not possible to infer from their study that these drugs were effective in preventing premature delivery, nor can we exclude the possibility that the drugs may be ineffective in other settings. Nonetheless, the results should caution women from seeking further antenatal antenatal medication unless there is evidence they have an early indication (as in their case the use of corticosteroids in these settings could be counterproductive).17 Additionally, the report noted that the number of women treated with antenatal cortisone was relatively low during this period, but that the intervention had a positive association with the subsequent development of preterm babies. Corticosteroids (both topical and intravenous) should be used carefully under the circumstances outlined above. It is important to remember that the duration of labour is an indicator of how far along labour was and the extent of prematurity so corticosteroid use should reflect the expected duration of labour. It should also be remembered that antenatal corticosteroids can cause significant side effects for women who do not need them, and should be taken with caution to prevent serious complications or to improve the patient's welfare. As discussed above, clinicians can use information about the pregnancy/infant's health, and the potential for the maternal health system to assist with delivery, to inform their decision whether or not to use antenatal corticosteroids.18 In the meantime, women who are concerned that they may be pregnant need to get pregnant as soon as possible and to be careful not to use antenatal medications as protection from preterm birth.18 Related Article:
https://skillnexus.org/groups/create/step/group-settings/
https://iceworld.gr/community/profile/gana47587968/
https://swindoneducationtrust.co.uk/cla-belly-fat-ab-cuts-cost-of-10-ml-testosterone-cypionate/