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Author Topic: Repeat Steroid Dose?  (Read 5270 times)

sarahker

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Repeat Steroid Dose?
« on: June 04, 2011 at 10:24 AM »
Hi Ladies,
Just as a little background, I'm 28w1d with twin boys, currently on hospital bedrest for preterm labor and short cervix (2cm w/out pressure, 1.6 with).  My doctors have discussed sending me home after 29 weeks (Yay!) if things remain stable, and my cervix remains steady at more than 1cm.  One of the physicians mentioned that before they send me home, they would give me a repeat dose of corticosteroids (I had one round when I was admitted to the hospital at 24w3d).  I have been doing some research, and it seems that the ACOG and others don't recommend giving repeat rounds of steriods unless it apppears that birth will occur within the next 7 days due to risks to the baby. 

Does anyone have any experience with this, or provide some guidance?  It just seems odd to me - if they are comfortable enough to discharge me, I would assume that they are confident that I will NOT give birth that week, so not sure what the point of the repeat steroid dose is. 

Please let me know your thoughts, or if you can recommend any sites that have additional information on this topic.  I would prefer to not recieve the steroids if clinical data/medical research does not support it. 

-Sarah   

Angela

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Re: Repeat Steroid Dose?
« Reply #1 on: June 04, 2011 at 10:49 AM »
Hi, Sarah.
I agree with your opinion completely, based on the current research. There's no need to do another course unless labor is likely within 7 days. And like you said, if that was the case, they wouldn't be sending you home.

You may want to print out this page here (http://www.keepemcookin.com/prevention.aspx)  part of which says:
Timing the injections is critical. If more than seven days pass between the injections and delivery, the effectiveness is decreased. You may wonder why you can't just get another round of injections later. The National Institutes of Health does not endorse repeated cycles of cortocosteroids, and the American Journal of Obstetrics and Gynecology has reported that repeated cycles may affect the child's behavior and future health. A recent study shows that premature babies born before 34 weeks have a 31 percent reduction in serious complications when given a "rescue course" of antenatal corticosteroids, with no adverse side effects noted. Discuss your options with your doctor so that you can choose the best time to receive the injections, based on your individual circumstances.

You can simply request not to have the injections until labor again appears imminent. You're the boss of your pregnancy!

A few more links:

NIH statement: http://consensus.nih.gov/2000/2000AntenatalCorticosteroidsRevisted112html.htm

http://journals.lww.com/greenjournal/Abstract/2001/02000/Repeated_Courses_of_Antenatal_Corticosteroids.28.aspx

http://www.earlyhumandevelopment.com/article/S0378-3782(01)00248-1/abstract

Hope all that helps your decision and your discussion with your doctor.
Angela

mckoygirl

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Re: Repeat Steroid Dose?
« Reply #2 on: June 05, 2011 at 09:11 AM »
I agree Sarah. I'm a L&D nurse (RN) and we don't give repeat doses of steroids after the first round. You can refuse any treatment they want to give you, including the steroids. There was another bedrest mom who questioned this as well not too long ago and I told her the same thing, as did Angela. If ACOG & NIH don't support it, they don't have much of a leg to stand on if you bring that up as why you're refusing. Stand firm on it, be unwavering. Physicians can be very pushy sometimes.
When I was in labor with my daughter, I basically told my physician what he could & couldn't do (He wanted to break my water when I was 1+cm dilated). He was furious when I told him he couldn't do it, even slammed the labor room door when he left, saying: "Well, WE'LL be here tomorrow!".  ;) But guess what? I delivered 5 hours later and it broke on it's own.  ;D
Due date: 7/7/2011
Twins (we're not finding out the sexes!)
5th pregnancy (5yrs old-put on bedrest with her @ 35wks for PIH)
3 previous losses
Put on bedrest this pregnancy @ 17weeks for Cervical shortening & preterm labor
Thanking God for each day I'm given with my twins!

nadrobertson

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Re: Repeat Steroid Dose?
« Reply #3 on: June 05, 2011 at 05:32 PM »
My doctor also did not recommend the repeat dose. i got a round (2 shots) of the steroid at 27 weeks for short cervix AND positive fFn. when i started to dilate at 29 weeks and got admitted they still didn't do a repeat dose or anything. i'm at 35.5 weeks now and still cookin and even if the baby comes early still he won't give me any more steroids even though it's been so long since i had them. i think the one dose is supposed to be good enough.
Baby #2 EDD 7/6/11: on bedrest at 27 weeks for short cervix and +fFn
Baby #1 BD 9/1/08: natural uncomplicated term birth

sarahker

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Re: Repeat Steroid Dose?
« Reply #4 on: June 06, 2011 at 08:10 AM »
Thank you Angela, Mckoygirl and Nadrobertson for your responses - everyrthing you said supports the research I've found on the topic.  As a brief update, I spoke to one of my doctors this morning, and he said that the repeat dose of steroids was the "standard of care" and that the decision was out of my hands.  He said that because the first round of steroids was given at 24 weeks, rather than 28-34 weeks as is typical that they give repeat doses after 28 weeks.  I haven't come across anything in m research that supports this, and I'm very concerned, because I HAVE come across data suggesting that repeat steroid doses can cause developmental delays and behavioral problems.  My doctor was actually quite defensive, and got a bit nasty that I was questioning his decision.

I have been given a tentative discharge date of June 13, but the doctor implied that if I refuse the steroids they will not let me go home so they seem to be holding that over me to bully me into going along with the plan.  I'm so depressed and feel so powerless.  I'm a healthcare attorney, so you'd think that I'd have more fight in me when it comes to this, but I just feel like I'm not getting any support or explanation from my care team --I just don't feel like I have any allies here. 

Any advice is appreciated, but I'm ready to give up.

Sarah   

Mommy_haley

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Re: Repeat Steroid Dose?
« Reply #5 on: June 06, 2011 at 03:13 PM »
As a healthcare attorney, do NOT take crap from them!  You have the right to refuse.  Stick up for yourself, girl!  I'm a former health care administrator, and I know how pushy docs can be. 

If worst comes to worst, switch docs.  You are trying to do what's best for baby, and no one should get nasty about that.
On bed rest at 23 wks (4/26) w/a BOY! Dilated to 1 cm
Mommy to a 4 yr old daughter and 3 yr old son
Previous preterm labor with DD at 31 wks

mckoygirl

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Re: Repeat Steroid Dose?
« Reply #6 on: June 06, 2011 at 06:19 PM »
Sarah- Ask him to produce the "evidenced-based" research that supports his standard of care. That is what they are teaching us in school (I am also in a nurse practitioner MSN program). Evidenced-based practice is paramount. Formulating standards of care and changing procedural processes should always be based on evidenced-based research.
I agree in that physicians can be bullies and don't like to be questioned. HOWEVER, they can't force you to do anything you don't want to. I also understand you want to go home and are tired of all of this. I'm sorry, I wish I could be more help.  :-\
Due date: 7/7/2011
Twins (we're not finding out the sexes!)
5th pregnancy (5yrs old-put on bedrest with her @ 35wks for PIH)
3 previous losses
Put on bedrest this pregnancy @ 17weeks for Cervical shortening & preterm labor
Thanking God for each day I'm given with my twins!

sarahker

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Re: Repeat Steroid Dose?
« Reply #7 on: June 06, 2011 at 06:40 PM »
Thanks so much for your support and words of encouragement!  I had a long talk with the perinatologist today about the pros and cons - he said that the second dose of steroids was essentially my "rescue" course - he said that evidence shows that the effects of steroids don't completely wear off after 7 days as some research had indicated and can protect for several weeks, but that since my initial dose was given at 24 weeks (over a month ago) the beneficial effect had worn off, and this "rescue course" given this week (I'll be 29 weeks on Friday) would cover me until 32 weeks (or close to it).  He said that after this rescue course, that's it - even if I presented to L&D in booming labor in 2 weeks, they wouldn't give me any more steriods and he believed this course of treatment was the best way to protect the babies to 32 weeks - he also said it's hospital practice to not give steroids past 32 weeks.  I'm at a large teaching hospital in NYC, so I really hope that they know what they're doing. 

I felt a lot better after talking with the perinatologist - I just don't understand why my doctor wouldn't just answer my questions and walk through the various scenarios with me?  I looked at a few recent articles that seem to support what the perinatologist said, so I think I'm going to move forward with the repeat course of steroids, but I'm so frustrated with my doctor's unwillingness to answer any of my questions or even discuss the issue with me.  He was practically gloating when the nurse told him I'd finally consented, and it made me a little sick. 

Thank you to everyone for encouraging me to be persistent in getting answers to my questions.   

flowerchica

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Re: Repeat Steroid Dose?
« Reply #8 on: June 11, 2011 at 08:14 PM »
Sarah I know this is after the fact but my peri explained to me that the 2nd steroid dose was only for emergencies - if I go into pre-term labor that they can't stop. He said he would only offer it if he felt this pregnancy couldn't continue and delivery was  imminent. I'm 35.5 weeks now and about to be released from my peri - and I won't be getting a 2nd dose
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Graduated from 104 days of bedrest. My IVF Baby girl born in July 2011 perfectly healthy @ 39w2d, 8lb9oz and 21 inches. 6 years of infertility battles have been overcome!