Different medicaments in fetus maturation – corticosteroid usage
M. GOJNIC1, M. BRANKOVIC2, M. PERVULOV1, & S. DUGALIC3
Institute of Gynecology and Obstetrics, University of Belgrade, Belgrade, 2Medical Faculty, Hospital ‘Bezanijska Kosa’, Belgrade, and 3High medical school ‘Njegoseva’, Belgrade (Received25 March 2008; revised 10 June 2008; accepted 10 June 2008)
Abstract Objective. The object of work is pointing out the signiﬁcance of improvement highly risk pregnancies by applying artiﬁcial fetal lungs maturation in relation to expected outcomes without adequate therapy. Methods. We analyzed fetal lung maturation by using lecithin and sphingomyelin ratio in embryo ﬂuid received by foamtest. We examined successfulness of artiﬁcial fetal lungs maturation by applying corticosteroids to the embryo in a group of patients with serious form of growth retardation (group A), then to the mother (group B) and by inducing partial mild form of asphyxia with oxytocin infusion (group C). Results. The success of the method is shown by the success of ﬁnished pregnancies. We followed thedifference between expected and actual term of delivery. Conclusion. Artiﬁcial fetal lungs maturation by applying fetal corticosteroids efﬁciently increases the creation of lecithin and sphingomyelin and enables life of neonate even in period up to 30th week of gestation.
Keywords: Artiﬁcial fetal lungs maturation, corticosteroids, neonate
The evidence of fetal lung maturation is obtained byphysical or biochemical methods. Foam test and shake test (i.e. Clemet’s test according to author) are most commonly used. The Clemet’s test is very economical, efﬁcient and, if conducted by well trained person, is very precise. Of other methods, spectophotometric determination of optical density and superﬁcial voltage following with Wilhelmy scale can be mentioned . Concentration of lecithin andtotal phosphatidil glycerol can be determined by biochemical methods. These methods give more precise results but not necessary clinical practice. By following changes in L/S ratio during pregnancy, we ﬁnd that lecithin increases from 26th week of gestation up to 35th week of gestation, and then increase emerges up to 40th week of gestation. Concentration of sphingomyelin, which appears in embryoﬂuid even before lecithin, equalizes with the concentration of lecithin in the 32nd week of gestation, but stays in that level until the end of gestation. By measuring L/S ratio in the 20th week of gestation we get 0.5, in the 32nd week 1, in 36th week 1.5 and in the period up to 38th week of gestation rises up to 2 .
There are four degrees of fetal lungs maturation. (1) Not sufﬁcient for thesurvival of the embryo outside uterus, (2) L/S ratio is low, (3) there are no polygonal cells in embryo ﬂuid and (4) there are no concentrations of phosphatidyl inosotol and glycerol that can be measured. We consider the lungs to be (1) intermediary mature when L/S ratio is around 1.5/2, with lecithin over 45%, emerging of phosphatidyl inosotol and still immeasurable quantity of phosphatidylglycerol. (2) Incompletely mature when L/S ratio is above 2, with lecithin increase above 45%, but with identical values of phosphatidyl inosotol and phosphatidyl glycerol. (3) Completely mature when L/S ratio is above 2, larger percentage of lecithin with increase of phosphatidyl inosotol and emerging of phosphatidyl glycerol. Lecithin is quantitatively determined by alkaline phosphatase enzyme thatis hydrolyzed to choline and phosphate. The quantity of 5.1/100 mL of embryo ﬂuid is enough for lungs maturation. If values are between 4.7 and 5.1 mg, we consider lungs maturity on the boundary levels, and if value is under 4.7 mg we consider lungs immature.
Correspondence: M. Gojnic, MD, PhD, Institute of Gynecology and Obstetrics, 38 Milesevska Street, 11000 Belgrade, Serbia. Tel:...