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Role of steroid injections in prematurity

Any woman who has had an episode of threatened or real premature labor will probably know that steroid injections are offered "help mature the baby's lungs".

The problem that we try to correct using steroids is not the same as the one created by lack or deficiency of water.

Lack of water impairs structural development of the lungs and therefore there is insufficient lung tissue development in such a situation. Steroids are meant to stimulate lung tissue to produce a chemical (surfactant) which facilitates normal lung function.

What all this means is that, for the steroids to be useful, there has to be a sufficient amount of lung tissue there in the first place. Steroids facilitate lung function and not lung development.

PPROM: What the mother should expect

The primary goal of the doctors is to evaluate the situation and the chances of a favorable outcome. They will then give thorough and on-going counseling to the prospective parents. It is very important to be honest. In cases where preterm rupture of membranes occurs before 26 weeks of gestation, the chances of the baby surviving intact are probably less than 40%.

Even for those who survive, well over half will have some degree of handicap. Prematurity is the main problem. For gestation of over 27 weeks, the outlook is more favorable, but prematurity and its complications can still cause considerable havoc.

After 31 weeks of gestation, the outlook is good and nine out of ten babies survive without problems.

Individualized care with preterm rupture of membranes

Each case of preterm membrane rupture (PPROM) must be evaluated and managed individually. All women will be given antibiotics, usually Erythromycin. However, if there is already an infection involving the membranes, delivery will be made promptly, regardless of the gestation.

The method of delivery will also depend on the circumstances, even though the chances of having a caesarean section are increased considerably because of such potential problems as cord compression or fetal distress. Rupture of membranes in itself is not an indication for caesarean section.

Late and pre-labor membrane rupture

If membranes rupture between 34 and 37 weeks of gestation, worry about the baby's well-being has receded and many obstetricians will just wait for things to happen. This is on the proviso that both the mother and the baby are well.

This policy is adopted mostly because the alternative is to induce labor. This may not be easy, increasing the chance of an otherwise unnecessary caesarean section. In many cases labor will start anyway within 24 to 48 hours.

If delivery was going to be by caesarean section anyway, for other reasons, and preterm rupture of membranes occurs, then delivery will be brought forward, because there is no conceivable benefit in waiting at this gestation.

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