Prevention respiratory distress syndrome

Description:

According to recommendations of the American authors, all pregnant women between the 24th and 34th weeks of a gestation in the presence of the menacing and beginning premature births have to be considered in time as patients to whom antenatal prevention respiratory a fruit distress syndrome by glucocorticoids, promoting maturing of surfactant of lungs of a fruit is shown.

In our country prevention the distress syndrome of a fruit is carried out to gestational terms of 28-34 weeks.

The effect of antenatal prevention a distress syndrome of a fruit is proved, its advantage for the newborn surpasses potential risk and is expressed in decrease in perinatal incidence and mortality; frequencies of development respiratory distress syndrome; frequencies of intraventricular and periventrikulyarny (okolozheludochkovy) hemorrhages; frequencies of a necrotic coloenteritis.

At duration of gestation more than 34 weeks prevention respiratory a distress syndrome is not shown.

At premature of an izlitiya of amniotic waters in terms up to 32 weeks glucocorticoids are used in the absence of signs of a horioam-nionit.

Signs of a horioamnionit is the combination of body temperature of Mother of 37,8 °C and above and from 2 and more following symptoms:
tachycardia of mother (more than 100 beats per minute);
fruit tachycardia (more than 160 beats per minute);
morbidity of a uterus at a palpation;
amniotic waters with an unpleasant (putrefactive) smell;
leukocytosis (more than 15000000000/l) with a deviation to the left.

In addition to a horioamnionit, contraindications to glucocorticoid therapy are the peptic ulcer of a stomach and duodenum, severe forms of diabetes, a nephropathy, an active form of tuberculosis, an endocarditis, nephrite, osteoporosis, a circulatory unefficiency of the III stage.

Schemes of reception: 2 doses on 12 mg of betamethasone in oil in 24 h; 4 doses on 6 mg of dexamethasone in oil in 12 h; as option 3 in oil of administration of dexamethasone in days on 4 mg within 2 days.

The optimum duration of prevention is 48 h. Preventive action of glucocorticoids is noted in 24 h after the beginning of therapy and 7 days proceed.

The advantage of a repeated course of prevention is not proved.

Introduction of glucocorticoids at duration of gestation is admissible single repeated (in 7 days) less than 34 weeks and lack of signs of a maturity of lungs of a fruit.

In our country also peroral purpose of glucocorticoids - dexamethasone on 2 mg (4 tablets) 4 times a day within 2 days is used.