some gynecologist advise the pregnant with twin to take dexamethasone 12 mg injection several time ( 2 or 4 times) in the third trimester of pregnancy, what are the expected benefits and what are the risks for the pregnant and fetus.
Decease the risk of respiratory distress in preterm baby if the baby born before 36 weeks
Gentlemen, I don't know your specialities, but in Obstetrics in Europe and Northern America antenatal corticosteroids are only administered once - the data relating to singleton pregnancies cannot be extrapolated to twins and there are concerns with multiple doses regarding head size (see the MACS studies), cerebral palsy and maternal addisonian like symptoms
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What exactly do you mean 2 to 4 times (actual cycles or injections?) because the first might be associated with microcephaly, whereas the first entirely depends on the regimen as previously described.
I do not have a source right now, but our OB routinely give dexamethasone twice with 12 or 24 h interval. Check ACOG site for the exact justification. The second round is given if there were more than 1 month since the last dexa course. The second round is a controvertial one, there are reports that it does not seem adding any benefit.
And need to correct other people a bit: it GREATLY reduce the incidence and severety of respiratory distress syndrome in premature newborns by increasing fetal surfactant production.
While not specific to twin pregnancy, it is worth noting that the administration of antenatal corticosteroids can impact lactation - a potential negative to put in the mix.
See: Effect of Preterm Birth and Antenatal Corticosteroid Treatment on Lactogenesis II in Women
http://pediatrics.aappublications.org/content/121/1/e92.full.html
betamethasone is usually preferred over dexamethasone, if it is available in your country. Benefits are reported when used in accordance with guidelines in case of preterm deliveries. They should not be administered to twins prophylactically with the fear of preterm delivery. Use should be reasonable and with clear indications. Apparently solid data supports the use of betamethasone earlier than 32 weeks of gestation. Initial concern should be the survival of the preterm fetus with as little complications as possible, everything else comes second. Still, this should be well documented and written consents should be received from the parents with good counseling if it seems that antenatal corticosteroids could be detrimental to the health of the mother.
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