Question: in case of PPROM, should we give dexamethazone to prepare 4 pre-mature labour? [deeba]
salam deeba.. i'm going to aborigine villages and could not comment on ur answer yet.. but your question in cbox is very good and I will give some highlight on this...
ok! remember that PPROM (differ from PROM) means that the fetus is not achieve term yet, but basically more than period of viability. Ie 22 week above. Some may take 20 week as cut off poitnt.
Regarding the dexamethasone, ideally it is given between 24-34 weeks. It is given Intramuscularly 12 mg B.D, 12 hourly apart. The main role is to prevent ARDS. Beyond 34W, it has no role except reducing the risk of intraventricular hemorrhage and necrotizing enterocolitis. However the practice in KKM is still to give it even up to term. Therefore, it is depend on the policy of the center where you work or attached to. If you give, it is not harmful to the mother or fetus.
Some patient with PPROM may present before the week suitable for dexamethasone. Since the risk of chorioamnionitis is high in any case of PPROM. therefore, you should close monitor the patient and give dexamehtasone later. However if patient develop chorioamnionitis, therefore delivery is the option
Let say patient already in the period whereby dexamethasone is justifiable but there is presence of establish uterine contraction. Here, the role of tocolytics drug is significant. Bear in mind that the tocolytic is only to give time for the dexamethasone to work and not to prolong the pregnancy.
Hope that will answer your question. Thank you
