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ORIGINAL ARTICLE
Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
http://dx.doi.org/10.1016/j.mefs.2016.09.007
1110-5690 Ó 2016 Middle East Fertility Society. Production and hosting by Elsevier B.V.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article in press as: Elsnosy E et al. Effects of antenatal dexamethasone administration on fetal and uteroplacental Doppler waveforms in women at risk
for spontaneous preterm birth, Middle East Fertil Soc J (2016), http://dx.doi.org/10.1016/j.mefs.2016.09.007
2 E. Elsnosy et al.
Please cite this article in press as: Elsnosy E et al. Effects of antenatal dexamethasone administration on fetal and uteroplacental Doppler waveforms in women at risk
for spontaneous preterm birth, Middle East Fertil Soc J (2016), http://dx.doi.org/10.1016/j.mefs.2016.09.007
Antenatal dexamethasone administration on fetal and uteroplacental Doppler waveforms 3
Please cite this article in press as: Elsnosy E et al. Effects of antenatal dexamethasone administration on fetal and uteroplacental Doppler waveforms in women at risk
for spontaneous preterm birth, Middle East Fertil Soc J (2016), http://dx.doi.org/10.1016/j.mefs.2016.09.007
4 E. Elsnosy et al.
was probably not severe enough to indicate early delivery. aorta and umbilical artery 24 h after its administration. The
Moreover, Senat and Ville examined the effect of steroids on beneficial effect of its administration is consistent regardless
blood flow waveforms in IUGR fetuses and found no signifi- of the gestational age and fetal weight.
cant changes of PI, RI values in the different vessels after dex-
amethasone course. However, the MCA PI showed a trend to Conflict of interest
decrease within the course and after the treatment was
stopped. The trend might be explained by either the physiolog- The authors declare that they have no conflict of interest.
ical decrease in resistance in the fetal brain with gestation that
expected to be even more marked in IUGR fetuses, or the early
sign of redistribution of the blood flow (7). References
There was statistical significant reduction in the uterine
(1) Miracle X, Di Renzo GC, Stark A, Fanaroff A, Carbonell-
artery Doppler indices before and 24 h after dexamethasone
Estrany X, Saling E. (Coordinators of WAPM Prematurity
administration in the present study. These findings are in working group). Guideline for the use of antenatal corticosteroids
agreement with data published by Chitrit et al. who observed for fetal maturation. J Perinat Med 2008;36:191–6.
similar transient and significant decrease in uterine artery PI (2) Roberts D, Dalziel S. Antenatal corticosteroids for accelerating
and RI after maternal dexamethasone administration in fetal lung maturation for women at risk for preterm birth.
healthy fetus (13). Also, Wallace and Baker reported an asso- Cochrane Database Syst Rev 2006(3):CD004454.
ciation between betamethasone treatment and decrease in uter- (3) van Stralen G, van der Bos J, Lopriore E, et al. No short-term
ine artery flow velocity waveforms in their study (17). benefits of antenatal corticosteroid treatment in severely preterm
However, Thuring et al. reported that there was no significant growth restricted fetuses: a case-control study. Early Hum Dev
2009;85:253–7.
influence of betamethasone therapy on Doppler indices in uter-
(4) Mulder EJH, Derks JB, Zonneveld MF, Bruinse HW, Visser GH.
ine circulation in pregnancies with imminent preterm delivery
Transient reduction in fetal activity and heart rate variation after
(18). maternal betamethasone administration. Early Hum Dev
Ballard and Ballard analyzed the pharmacokinetics of dex- 1994;36:49–60.
amethasone and betamethasone and found that the two rec- (5) Derks JB, Mulder EJH, Visser GH. The effects of maternal
ommended regimens should produce only minor differences betamethasone administration on the fetus. Br J Obstet Gynaecol
in the circulating level of glucocorticoid activity in the treated 1995;102:40–6.
fetus, with lower peak levels for dexamethasone but a some- (6) Crowther CA, Harding JE. Repeat doses of prenatal corticos-
what longer time of elevated activity (19). There is no evidence teroids for women at risk of preterm birth for preventing neonatal
that these effects on blood flow are harmful to the fetus, how- respiratory disease. Cochrane Database Syst Rev 2007(3):
CD003935.
ever more concerning are data suggesting a neurotoxic effect of
(7) Senat MV, Ville Y. Effect of steroids on arterial doppler in
dexamethasone.
intrauterine growth retardation fetuses. Fetal Diagn Ther
A study on human placentas by Clifton et al. showed that 2000;15:36–40.
the mechanism behind dexamethasone-induced vasodilatation (8) Wijnberger LDE, Bilardo CM, Hecher K, Stigter RH, Visser GH.
might be an endothelium independent mechanism, as they did Effect of antenatal glucocorticoid therapy on arterial and venous
not find any involvement of endothelium-derived products blood flow velocity waveforms in severely growth-restricted
such as prostaglandin I2 and nitric oxide (20). Wijnberger fetuses. Ultrasound Obstet Gynecol 2004;23:584–9.
et al. concluded that the underlying mechanisms responsible (9) Robertson MC, Murila F, Tong S, Baker LS, Yu VY, Wallace
for the alterations in fetoplacental circulation after antenatal EM. Predicting perinatal outcome through changes in umbilical
betamethasone administration are not clear (8). artery doppler studies after antenatal corticosteroids in the
growth-restricted fetus. Obstet Gynecol 2009;113:636–40.
Derks et al. reported in their experimental studies that fetal
(10) Nozaki AM, Francisco RPV, Fonseca ES, Miyadahira S, Zugaib
sheep showed increased blood pressure after injection of
M. Fetal hemodynamic changes following maternal betametha-
betamethasone (21). The human fetus in a similar way possibly sone administration in pregnancies with fetal growth restriction
increases its blood pressure, and this could explain the and absent end-diastolic flow in the umbilical artery. Acta Obstet
improved fetoplacental perfusion. Also, reduced placental Gynecol Scand 2009;88:350–4.
resistance as a result of nitric oxide mediated vasodilatation (11) Cohlen BJ, Stigter RH, Derks JB, Mulder EJH, Visser GHA.
due to increased secretion of placental corticotropin releasing Absence of significant hemodynamic changes in the fetus follow-
hormone may be another explanation (22). The difference ing maternal betamethasone administration. Ultrasound Obstet
between normally grown and growth-restricted fetuses in their Gynecol 1996;8:252–5.
hemodynamic response could be explained by decreased fetal (12) Piazze JJ, Anceschi MM, La Torre R, Amici F, Maranghi L,
Cosmi EV. Effect of antenatal betamethasone therapy on
nitric oxide synthesis in IUGR (23).
maternal-fetal Doppler velocimetry. Early Hum Dev
One of the limitations of the current study that umbilical
2001;60:225–32.
artery PH was not measured after delivery for accurate assess- (13) Chitrit Y, Caubel P, Herrero R, Schwinte AL, Guillaumin D,
ment of neonatal outcome due to low facilities in our hospital, Boulanger MC. Effects of maternal dexamethasone administra-
so we depended only on Apgar score. The second limitation tion on fetal Doppler flow velocity waveforms. BJOG
that we could not match the Doppler results with the gesta- 2009;107:501–7.
tional age was due to small sample size of included study par- (14) Gudmundsson S, Marsal K. Umbilical artery and uteroplacental
ticipants. Further studies with larger sample size are needed to blood flow velocity waveforms in normal pregnancy: a cross
confirm our results. sectional study. Acta Obstet Gynecol Scand 1988;67:347–54.
In conclusion, maternal dexamethasone administration to (15) Kessler J, Rasmussen S, Hanson M, Kiserud T. Longitudinal
reference ranges for ductus venosus flow velocities and waveform
pregnant women at risk of preterm labor improves the blood
indices. Ultrasound Obstet Gynecol 2006;28:890–8.
flow of the maternal uterine artery, fetal MCA, descending
Please cite this article in press as: Elsnosy E et al. Effects of antenatal dexamethasone administration on fetal and uteroplacental Doppler waveforms in women at risk
for spontaneous preterm birth, Middle East Fertil Soc J (2016), http://dx.doi.org/10.1016/j.mefs.2016.09.007
Antenatal dexamethasone administration on fetal and uteroplacental Doppler waveforms 5
(16) Frusca T, Soregarol M, Guandalin F, Danti L. Doppler (21) Derks JB, Giussani DA, Jenkins SL, et al. A comparative study of
velocimetry of the uterine arteries in nulliparous women. Early the cardiovascular, endocrine and behavioral effects of
Hum Dev 2007;48:177–85. betamethasone and dexamethasone administration to fetal sheep.
(17) Wallace EM, Baker LS. Effect of antenatal betamethasone J Physiol 1997;1:217–26.
administration on placental vascular resistance. Lancet (22) Clifton VL, Read MA, Leitch IM, et al. Corticotropin-releasing
1999;353:1404–7. hormone-induced vasodilatation in the human fetal-placental
(18) Thuring A, Malcus P, Maršál K. Effect of maternal betametha- circulation: involvement of the nitric oxide-cyclic guanosine
sone on fetal and uteroplacental blood flow velocity waveforms. 3_,5_-monophosphatemediated pathway. J Clin Endocrinol
Ultrasound Obstet Gynecol 2011;37(6):668–72. Metab 1995;80:2888–93.
(19) Ballard PL, Ballard RA. Scientific basis and therapeutic regimens (23) Hata T, Hashimoto M, Manabe A, Aoki S, Iida K, Masumura S,
for use of antenatal glucocorticoids. Am J Obstet Gynecol Miyazaki K. Maternal and fetal nitric oxide synthesis is decreased
2005;173:254–62. in pregnancies with small for gestational age infants. Hum
(20) Clifton VL, Wallace EM, Smith R. Short-term effects of Reprod 1998;13:1070–3.
glucocorticoids in the human fetal-placental circulation in vitro.
J Clin Endocrinol Metab 2002;87:2838–42.
Please cite this article in press as: Elsnosy E et al. Effects of antenatal dexamethasone administration on fetal and uteroplacental Doppler waveforms in women at risk
for spontaneous preterm birth, Middle East Fertil Soc J (2016), http://dx.doi.org/10.1016/j.mefs.2016.09.007