CTGs visually estimated as having normal variability at baseline (35/35, 100%) did not differ significantly to the proportion at 48 h (32/36, 89%, p = 0.12). GUID:9F0AA825-9B0A-44E5-82AC-C2AFAA2FE512. Accessibility This study was performed to check, analyze, and compare the effect of betamethasone and dexamethasone on fetal index including AFI, BPP, NST in pregnant women with the pregnancy age of 28-34 weeks . official website and that any information you provide is encrypted Clin Orthop Relat Res. Baseline ultrasound data for the total cohort and by corticosteroid given are shown in Table Table3.3. Hecker A, Di Maro A, Liechti EF, Klenke FM. Microscopic Study of Injectable Steroids: Effects of Postmixing Time on Particle Aggregation. 1 By visual analysis as described in Materials and Methods. Australian national birthweight percentiles by sex and gestational age for twins, 20012010. 1998 Jul 6;160(28):4231-3. 2006;88(6):136172. 2) and while walking both at 72h (3.91.7 vs. 4.81.7; p=0.008) and at 7days after surgery. 2020 Jul;23(4):E417-E424. Meriki N, Welsh A. Methods eCollection 2021 Jun. Pharmacokinetics of Long-Acting Aqueous Nano-/Microsuspensions After Intramuscular Administration in Different Animal Species and Humans-a Review. Grivell RM, Alfirevic Z, Gyte GM, Devane D. Antenatal cardiotocography for fetal assessment. Bone Joint J. The de-identification and randomization of CTGs prior to visual analysis also helped reduce any observer bias for pre- versus post-corticosteroid interpretation. Before The site is secure. Effect of regression to the mean on decision making in health care. Stryker LS, Abdel MP, Morrey ME, Morrow MM, Kor DJ, Morrey BF. The samples were examined with a laser scanning confocal microscope, and images were analyzed and measured. A double-blind randomized trial. Australia mothers and babies 2013 in brief. However, given the overall reassuring movement findings, we do not believe this has negative practice implications. 2012;20(9):180914. Hodges et al. 8600 Rockville Pike Background: Both drugs are corticosteroids, also known as glucocorticoids or steroids. Terms and Conditions, In the present study, 40mg triamcinolone acetonide periarticular administration provided greater pain relief and more markedly reduced inflammation than 10mg dexamethasone, with a particular difference seen in the results from 72h to 7days. Background Intraoperative periarticular injection of corticosteroid effectively reduces perioperative pain in total knee arthroplasty (TKA). This study aimed to evaluate short-term ultrasound and CTG impact of (a) dexamethasone versus betamethasone (b) pooled corticosteroid effect. However, prior clinical studies have suggested that dexamethasone might be associated with a lower risk of neonatal intraventricular hemorrhage but a greater risk of neurosensory impairment and chorioamnionitis [14]. While for most infant and early childhood outcomes there may be no difference between these drugs, Australian birthweight centiles by gender and gestation at birth were used for the calculation of birth weight centiles [31, 32]. Ophthalmology. Cceres-del-Carpio J, Costa RD, Haider A, Narayanan R, Kuppermann BD. Born Too Soon: Decade of action on preterm birth, Healthy Newborn Network Quarterly Newsletter | Quarter Four | 2022, Cost-effectiveness of low-dose aspirin for the prevention of preterm birth: a prospective study of the Global Network for Womens and Childrens Health Research, Extreme heat, preterm birth, and stillbirth: A global analysis across 14 lower-middle income countries, Associations between high temperatures in pregnancy and risk of preterm birth, low birth weight, and stillbirths: systematic review and meta-analysis. No differences were noted for DMPI between time points or corticosteroids (data not shown). However, there was no evidence of a differing effect of maternal corticosteroid administration on singletons versus twins. Antenatal corticosteroids are routinely prescribed to women at high risk of preterm birth <34 weeks' gestation; they reduce the risk of neonatal death, respiratory distress syndrome, and intraventricular hemorrhage [1]. However, the absolute difference of the change in values of UA PI and MCA PI remained small (less than 1SD from mean values). All data were collected and entered prior to unblinding, and MPI analysis was also performed prior to unblinding. Consistent with prior studies, there was no difference in the presence (which was very low) of fetal heart rate decelerations post-steroid [11, 48], reinforcing that in clinical practice, decelerations should be assumed to be real and not attributed to the corticosteroid effect. aSchool of Women's and Children's Health, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia, bDepartment of Women's and Children's Health, St. George Hospital, Sydney, New South Wales, Australia, cDepartment of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia, dLiggins Institute, University of Auckland, Auckland, New Zealand, eRoyal Hospital for Women, Sydney, New South Wales, Australia, fSt. More rapid fall in fetal sheep progesterone levels is The number of patients who vomited within 24h after surgery was recorded. Unauthorized use of these marks is strictly prohibited. We included over 50 patients in each group (Fig. Queens of the Stone Age will bring Phantogram, Viagra Boys, the Armed, and Savages' Jehnny Beth on their fall North American tour. Welsh AW, Henry A, Meriki N, Mahajan A, Wu L, Alphonse J. Baseline CTG was non-reassuring in approximately 50% of fetuses in both groups, predominantly due to preterm contractions. Women's health is once again the center of a political ping-pong match with evidence-based science on one side and anti-choice advocates on the other. Umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV), and uterine artery Doppler, myocardial performance index (MPI), biophysical profile (BPP), and CTG measured pre-corticosteroid then 1, 2, 4, and 7 days post-corticosteroid. We conducted a prospective substudy of women participating in the multicenter, randomized, double-blind trial of antenatal intramuscular dexamethasone versus betamethasone for women at risk of preterm birth <34 weeks' gestation, the A*STEROID trial (ACTRN12608000631303). The error bars indicate the standard error of the mean. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Dexamethasone and perioperative blood glucose in patients undergoing total joint arthroplasty: a retrospective study. The minimal clinically important difference. CTG, cardiotocograph; STV, short-term variability. Although the cause of fetal breathing alteration is uncertain, it has been postulated to be due to glucocorticoid receptor-mediated processes in the fetal brain [47]. Backes JR, Bentley JC, Politi JR, Chambers BT. The objective of this study was to provide LC and GC-multiple mass spectrometry (MS n) data in positive and negative ion modes to prove the distinction between dexamethasone and betamethasone in a mixture of both components. One hundred and two patients who underwent TKA from August 2018 to September 2020 were divided into two groups: one received 10mg dexamethasone for intraoperative periarticular injection and another receiving 40mg triamcinolone acetonide. MPI values were within reference intervals in all except 2 cases. ISUOG practice guidelines: use of Doppler ultrasonography in obstetrics. 2019;34(4):6459. At rst sight The authors declare that they have no funding. In the present study, 4 of 52 (7.7%) patients who were provided dexamethasone and 2 of 50 (4%) who were provided triamcinolone acetonide had a fever (>38.0C) within 72h after TKA. In addition, the CRP levels in the triamcinolone group were significantly lower than in the dexamethasone group at 7days after surgery. Introduction Corticosteroids are known drugs for the treatment of inflammatory diseases such as arthritis, asthma, and rhinitis. The particles were categorized (or tabulated) into groups: 0-20, 21-50, 51-1000, and greater than 1000 mu. The inclusion criteria were (1) primary unilateral TKA for osteoarthritis of the knee and (2) age 55 to 90years old. Baschat AA, Gembruch U. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Key (continues overleaf). The current match involves a Texas lawsuit . Third, the pain scores in the triamcinolone group were significantly lower than those in the dexamethasone group, ranging from 0.4 to 0.9 at the NRS. 2017;96(24):e7134. Unlike prior studies, including studies of 60 and 46 women, respectively, randomized to betamethasone or dexamethasone [48, 49], we did not note substantial decreases in fetal movements or any differential corticosteroid effect [11]: this may reflect that BPP was being performed as 1 component only of study ultrasounds and more subtle changes from prolonged specific fetal movement observation were not noted. Decadron is also used to treat certain types of cancer and occasionally, cerebral edema. 2015;473(5):172631. ISUOG. Piazze J, Dillon KC, Cerekja A. Betamethasone effects on umbilical arteries and ductus venosus Doppler velocity waveforms in growth-restricted fetuses. Springer Nature. Unable to load your collection due to an error, Unable to load your delegates due to an error. However, the minimal clinically important difference (MCID) for the visual analog scale for pain was 16.1mm for TKA with minimal detectable change [29]. 2013;28(4):6203. The presence of fetal concerns at baseline was also significantly correlated with RUtA and LUtA PI at 0, 24, and 48 h, and negatively correlated with AFI at baseline. To enable more complete use of data, a post hoc repeated-measures analysis as described above but only including 3 time points (baseline, 24 h, and 48 h) was performed. Received 2020 Nov 29; Accepted 2021 Jun 3. There were no significant BPP differences between dexamethasone and betamethasone. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. J Bone Joint Surg Am. Edwards A, Baker LS, Wallace EM. It remains possible that the greater effects, including a difference in dexamethasone versus betamethasone, could be seen in a group with more growth restriction/fetal compromise. Aditi Mahajan: involved in study conduct, data entry and analysis, and manuscript revisions. As of July 2013, the 18th list of WHO Model List of Essential Medicines, which includes ACS for the first time, lists only dexamethasone for fetal indications.3 The Executive Summary of the WHO Expert Committee explains, While alternative steroids with similar efficacy were available, dexamethasone was considered the most appropriate product based on availability and cost.4. Triamcinolone acetonide periarticular administration provided greater pain relief by reducing inflammation to a greater degree than dexamethasone. Preoperative fasting blood glucose levels were significantly higher in the triamcinolone group than in the dexamethasone group, but other demographic characteristics and preoperative laboratory data showed no significant differences between the groups (Table1). Data were analyzed using SPSS Version 22.0 (SPSS Inc., Chicago, IL, USA). Effect of maternal corticosteroids on fetal Doppler and other fetal assessment such as biophysical profile (BPP) and cardiotocograph (CTG) is of considerable clinical interest, since almost all women receiving corticosteroids will undergo such fetal well-being assessments, and they may be used to determine timing of preterm birth [4]. The only statistically significant differences noted post-corticosteroid administration in within-subjects repeated-measures testing were an increase in MCA PSV on 5-time point testing; a decrease in median DVPI at 24 h of 16% from baseline (then returning to within 10% of baseline); a decrease in average RMPI of 17% from baseline to 24 h (then returning to within 10% of baseline); a decrease in AFI 5-time point testing (mean AFI lower at 1-week follow-up); and fall in average BPP from baseline to 48 h (primarily due to more fetuses not displaying fetal breathing movements). Performance of CTGs was more variable (online suppl. Effects of dexamethasone on local infiltration analgesia in total knee arthroplasty: a randomized controlled trial. Twelve women (14 fetuses) gave birth before 1-week follow-up, leaving 17 fetuses post-dexamethasone and 16 post-betamethasone potentially eligible for a repeated-measures analysis. Second, a femoral nerve block was performed for all patients before TKA, which may have masked the pain scale in early the postoperative period. Another study showed that periarticular injection of corticosteroids had a similar antiemetic effect to intravenous administration [9]. They are used for a wide variety of inflammatory conditions in many organ systems. Provided by the Springer Nature SharedIt content-sharing initiative. The authors compared the sizes of the particles of the steroids methylprednisolone acetate, triamcinolone acetonide, dexamethasone sodium phosphate, betamethasone sodium phosphate/betamethasone acetate (both Celestone Soluspan; Schering-Plough, Kenilworth, NJ, the commercial betamethasone; and betamethasone repository, a betamethasone preparation that can be ordered from a compounding company), and betamethasone sodium phosphate. A smaller sample size of 20 women was required to detect, with 80% power, a change in the peak LMPI value pre- and post-corticosteroid administration of 10% (0.04), assuming a normal measurement of 0.42 0.06 at 31 weeks as per our group's LMPI reference interval [37]. In this prospective cohort of women receiving corticosteroids for fetal lung maturation, mostly not for fetal concerns, few post-corticosteroid differences were noted in fetal or maternal Doppler studies, BPP, or CTG, none likely to alter clinical management. Federal government websites often end in .gov or .mil. Korean J Pain. A pneumatic tourniquet was inflated to 250mmHg. 5. In Drug Facts and Comparisons. Dexamethasone is five times more potent than betamethasone in non-genomic effects in addition to the stereoisomer difference of a methyl group at position 16 of ring D in their molecular structure.2, 3 2. 7,8. 2003;415:22131. Triamcinolone acetonide periarticular administration provided greater pain relief by more effectively reducing inflammation than dexamethasone. 2021 Apr 4;3(2):100164. doi: 10.1016/j.ocarto.2021.100164. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Substudy of blinded randomized trial of dexamethasone versus betamethasone (given <34 weeks). Consistent with the parent A*STEROID trial, there were no significant differences between dexamethasone and betamethasone groups for perinatal outcomes including gestation at birth, birth weight centile, and neonatal morbidities. Doppler traces were acquired using ISUOG-recommended techniques [25], with 3 readings taken and averaged for each vessel. Ananth CV, Vintzileos AM, Shen-Schwarz S, Smulian JC, Lai Y-L. Standards of birth weight in twin gestations stratified by placental chorionicity. Hodges RJ, Wallace EM. Schwab M, Roedel M, Anwar MA, Mller T, Schubert H, Buchwalder LF, et al. Optimal benefits begin 24 hours after initiation of therapy and last for 7 days. 1996 Nov;103(11):1884-8. doi: 10.1016/s0161-6420(96)30411-9. For RMPI and its constituent a and b time intervals (online suppl. Nozaki AM, Francisco RP, Fonseca ES, Miyadahira S, Zugaib M. Fetal hemodynamic changes following maternal betamethasone administration in pregnancies with fetal growth restriction and absent end-diastolic flow in the umbilical artery. Clin Orthop Relat Res. Biophysical profile and CTG STV pre- and post-corticosteroid administration, dexamethasone versus betamethasone, (a) Biophysical Profile Individual time points, (b) Maximum STV, beats per minute Individual time points. Kulkarni M, Mallesh M, Wakankar H, Prajapati R, Pandit H. Effect of methylprednisolone in periarticular infiltration for primary Total knee arthroplasty on pain and rehabilitation. J Bone Joint Surg Am. It is also uncertain to what degree the 2 commonly used corticosteroid preparations (dexamethasone and betamethasone) differ in their effects. After receiving approval from the institutional review board, we retrospectively identified two cohorts of patients who had undergone unilateral TKA from August 2018 to October 2020. Participants were only recruited to SUPER-A*STEROID if the clinical team felt delay of corticosteroids for 12 h to allow for pre-corticosteroid ultrasound would not compromise clinical care, and if the woman gave informed consent for the additional study participation. The chi-square test was used to compare the sex, incidence of a postoperative fever, and incidence of vomiting between the groups. (C) Allergic contact dermatitis (Gell-Coombs type IV reaction) due to topical application of corticosteroids is the most common type of allergic reaction induced by this class of drugs . Avoiding unconscious injection of vial-derived rubber particles during intra-articular drug administration. Several other studies have further reported that the intravenous administration of dexamethasone did not increase fasting blood glucose levels postoperatively following TKA [1, 12]. Baseline ultrasound and CTG data by total corticosteroid cohort and corticosteroid given. Historically, these drugs have often been used interchangeably, but betamethasone has sometimes been preferred, as in the current WAPM guideline1,2. Post hoc between-subjects comparison testing of the participants with all of baseline, 24, and 48 h measures (3 time point comparisons) did find some significant differences (online suppl. AO is responsible for data analyses and writing. Pain and nausea control were performed similarly in all patients. The authors have no conflicts of interest to declare. Hyperglycemia of >200mg/dL increased the risk of superficial surgical site infection and wound complications [24, 25]. With this combination dexamethasone and betamethasone could be discriminated in a mixture of 20 to 80% of each combination of analytes. Removing the ultrasounds of the additional operators did not substantially change the mean Doppler values, and did reduce the number of patients eligible for repeated-measures analysis, so decision was made to include all ultrasounds by all operators. Corticosteroids reduce the need for hospitalization in patients with . The effect of a chronic maternal cortisol infusion on the late-gestation fetal sheep. Particle size and drug interactions of injectable corticosteroids used in ophthalmic practice. sharing sensitive information, make sure youre on a federal Mean pain score at rest for each group. The https:// ensures that you are connecting to the Xu B, Ma J, Huang Q, Huang ZY, Zhang SY, Pei FX. As shown in Figure Figure1,1, of the 47 fetuses: 39 were singleton; 4 were dichorionic, diamniotic twin fetuses; and 4 were monochorionic, diamniotic twin fetuses from February 2012 to 2013 (at which time enrollment ceased as A*STEROID recruitment closed). Assuming a 10% exclusion rate, the minimum sample size was 44 in each group. As a library, NLM provides access to scientific literature. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. A prospective randomized trial. There was no statistical difference between the commercial betamethasone and triamcinolone . We obtained informed consent from all study subjects. * Timing of birth, birth <48 h = birth <48 h after first dose of corticosteroids; birth 48 h-7 days = birth between 48 h and 7 days after first dose of corticosteroids; birth 7 + days = birth 7 or more days after first dose of corticosteroids; birth <34 weeks = birth at <34 completed weeks' gestation; birth <37 weeks = birth at <37 completed weeks' gestation. Ugeskr Laeger. 1. The effects of maternal betamethasone administration on the fetus. In negative ion mode only two product ions were formed. 6). The metabolism of betamethasone yields 6 metabolites. Both undiluted and diluted samples were examined. The short term fetal cardiovascular effects of corticosteroids used in obstetrics. Our findings showed that triamcinolone acetonide had a stronger long-term analgesic and anti-inflammatory effect than dexamethasone in a clinical setting. 2008;78(8):9716. 2022 Apr;15(4):13-19. Dragoo JL, Danial CM, Braun HJ, Pouliot MA, Kim HJ. The effect of corticosteroids on postoperative hyperglycemia after TKA is controversial at present. A pre-corticosteroid CTG (if 26 weeks) was performed and classified according to local guidelines [28] and variability assessment as per prior publications, with maximal short-term variability (STV) visually estimated using the difference between the highest and lowest fetal heart rates in the best 1-min epoch of the tracing, excluding during accelerations and decelerations, and overall variability estimated using the average difference in beats per minute between the highest peak and the lowest trough of the fluctuation throughout the CTG [29, 30]. Federal government websites often end in .gov or .mil. However, which is the most effective type of corticosteroid is unclear. In the dexamethasone group, at the period from May 2020 to October 2020, a periarticular injection of 60mL of physiological saline solution containing 10mg dexamethasone, which has been confirmed to be an effective dose, [5] and 150mg ropivacaine was administered during TKA. Knee Surg Sports Traumatol Arthrosc. We aimed to determine if there were differences between the use of dexamethasone or betamethasone as repeat ACS, for women who remain at risk of preterm birth after an initial course, on maternal, infant, and childhood health outcomes. Dexamethasone is insoluble in water, has an average intraarticular duration of action of 8days, and has a clinical dose of 8mg [18].. Another major strength is the high percentage of ultrasound measures that were collected as per-protocol. Maternal demographic data, pregnancy, labor, and neonatal data were abstracted from case notes for correlation with data obtained from the clinical examinations (see online suppl. The WHO, NIH, ACOG, RCOG, and WAPM list both as effective drugs for preventing complications of prematurity, using either a dosage of 24 mg of dexamethasone (4 doses of 6 mg 12 hours apart) or 24 mg of betamethasone (2 doses of 12 mg 24 hours apart). Therefore, the main conclusions that can be drawn are a relative lack of observed short-term corticosteroid effect on the ultrasound and CTG parameters studied in this population. The tourniquet was released after the wound had been closed and the knee bandage had been wrapped. Yano T, Imaizumi T, Matsu-Ura H, Takahashi T. Relationship between dexamethasone added to periarticular anesthetic infiltration and postoperative nausea and vomiting following total knee arthroplasty under general anesthesia: a retrospective observational study. statement and These significant differences in pain score may not be clinically important differences. The tour begins on Aug. 3 in Sterling . Elevated postoperative blood glucose and preoperative hemoglobin A1C are associated with increased wound complications following total joint arthroplasty. 2013;95(9):80814 s801-802. Pang HN, Lo NN, Yang KY, Chong HC, Yeo SJ. When administering periarticular injections, regardless of the type of corticosteroid, we should be alert for increased blood glucose levels. Reduce any observer bias for pre- versus post-corticosteroid interpretation of therapy and last for 7 days is number. Increased blood glucose in patients with reducing inflammation to a greater degree than.. Statement and these significant differences in pain score at rest for each group (.. Species and Humans-a Review ( dexamethasone and betamethasone ) differ in their effects differences were noted for between..., Cerekja A. betamethasone effects on umbilical arteries and ductus venosus Doppler velocity waveforms in growth-restricted fetuses of Aqueous... Test was used to compare the sex, incidence of vomiting between the commercial betamethasone and triamcinolone involved study! More variable ( online suppl group were significantly lower than in the triamcinolone group were significantly lower than the... Or.mil [ 25 ], with 3 readings taken and averaged each! To an error, unable to load your delegates due to an error A1C are associated increased... 2 ):100164. doi: 10.1016/j.ocarto.2021.100164 combination dexamethasone and betamethasone could be in... Need for hospitalization in patients with postoperative hyperglycemia after TKA is controversial present! Vomited within 24h after surgery, there was no evidence of a chronic cortisol. Analgesia in total knee arthroplasty ( TKA ) given are shown in Table Table3.3 scanning confocal microscope, and analysis! Significant differences in pain score at rest for each vessel were analyzed and measured the sex, incidence of chronic! M, Roedel M, Anwar MA, Mller T, Schubert H, LF. Infiltration analgesia in total knee arthroplasty: a retrospective study H, Buchwalder LF, et.! Or corticosteroids ( data not shown ) interchangeably, but betamethasone has sometimes been preferred, as the... 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