Corticosteroid therapy

A. Dexamethasone and betamethasone are the preferred corticosteroids for antenatal therapy. Corticosteroid therapy for fetal maturation reduces mortality, respiratory distress syndrome and intraventricular hemorrhage in infants between 24 and 34 weeks of gestation.

Recommended Antepartum Corticosteroid Regimens for Fetal Maturation in Preterm Infants

Medication

Dosage

Betamethasone (Celestone)

12 mg IM every 24 hours for two doses

Dexamethasone

6 mg IM every 12 hours for four doses

IX. Intrapartum antibiotic prophylaxis against group B streptococcus is recommended for the following:

A. Pregnant women with a positive screening culture unless a planned Cesarean section is performed in the absence of labor or rupture of membranes

B. Pregnant women who gave birth to a previous infant with invasive GBS disease

C. Pregnant women with documented GBS bacteriuria during the current pregnancy

D. Pregnant women whose culture status is unknown (culture not performed or result not available) and who also have delivery at <37 weeks of gestation, amniotic membrane rupture for >18 hours, or intrapartum temperature >100.4°F (>380C)

E. The recommended IAP regimen is penicillin G (5 million units IV initial dose, then 2.5 million units IV Q4h). In women with non-immediate-type penicillin-allergy, cefazolin (Ancef, 2 g initial dose, then 1 g Q8h) is recommended.

References: See page 184.

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