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PROM and steroids - follow onFrom: Malcolm Griffiths (Malcolm@mgriff22.demon.co.uk)Sat Aug 17 11:33:52 1996
In message <01BB8BBD.F9EC18A0@dialup-70.publab.ed.ac.uk>, Dr Vivienne Souter <viv@tattoo.ed.ac.uk> writes > >2- prom at 30 weeks. Is everyone using weekly steroids or just one >course? > >The RCOG recently circulated guidelines for the use of corticosteroids >which came down against the use of repeated courses in general. They >have also recommended the use of steroids up until 36 weeks. I know >they are guidelines but I would be interested to know if they have >influenced practice in the UK (I see that Malcolm Griffiths was >advocating weekly repeats...) and what obstetricians elsewhere think >about them. > Viv, Hadn't actually got round to reading the RCOG guidelines yet. I'd actually been rather critical that the college hadn't been more aggressive in promoting steroids until now. A paper I submitted to Br.J.Obstet. Gynaecol. and a leader I wrote at a former editors request were both eventually rejected. One reason given was that I had said the college hadn't pushed the idea enough ! My reading is that there is little evidence on which to say whether repeat doses are of benefit, though some of the replies to this thread suggest that is changing - in the direction of single courses. I have a study in mind, but I'm not sure how to execute it, so anyone out there with ideas or expertise please comment. One could obviously easily demonstrate that if we give steroids to a woman about to deliver at within a few days at 30 weeks then it will clearly be massively cost effective. For some other categories of women the cost-effectiveness will be less impressive, for instance preterm- pre-labour ROM, a large proportion of which won't deliver before 34 weeks. What about giving steroids to all women with multiple pregnancy or past history of preterm delivery. How would the cost-effectiveness vary at different gestations chosen to give/start prophylaxis ? How would the cost-effectiveness look if we gave ALL pregnant women a sinlge dose at ( say ) 30 weeks ? Any ideas/comments ?
--
Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt
Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK.
Tel: 01582-497459 (office)
01525-222849 (home)
Fax: 01582-497424
email: Malcolm@mgriff22.demon.co.uk
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