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Lung development begins at approx 4 weeks gestation and continues throughout pregnancy

Testing for

Fetal Lung Maturity

Respiratory Distress

Syndrome

  • Lamellar body count
  • Lecithin/sphingomyelin (L/S) ratio
  • Phosphatidylglycerol (PG)
  • Most common cause of respiratory distress in preterm infant (most common in <38 weeks)

  • Less surfactant produced by immature Type 2 pneumocytes leads to atelectasis and ischemia

Test for lung maturity 32-39 weeks gestation

Not necessary after 39 weeks (maturity likely) or before 32 weeks (immaturity likely)

Fetal Lung Maturity and Antenatal Steroids

Use of Antenatal Steroids

Accelerate development of Type 1 and Type 2 pneumocytes

Increased production of surfactant

by Type 2 pneumocytes

Improvement of lung mechanics and gas exchange!

Tiffany Chritz, OMS-IV

Recommended Treatment

Betamethasone (2 doses of 12 mg IM q24 hours) or

Dexamethasone (4 doses of 6 mg IM q12 hours)

When do you give steroids?

At 24-34 weeks gestation if increased risk of preterm delivery within the next 7 days

Should be considered routine for all preterm deliveries

References

  • American College of Obstetrics and Gynecologists (ACOG) - ACOG Practice Advisory on Use of Antenatal Corticosteroids (2014), and Practice Bulletin Management of Preterm Labor (2012).
  • Up To Date - Antenatal corticosteroid therapy for reduction of neonatal morbidity and mortality from preterm delivery (2015).

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