Betamethasone

• Threatened preterm birth 24–34⁺⁶ weeks
• Planned preterm CS up to 38⁺⁶ weeks (consider)

Crosses placenta → glucocorticoid receptor → ↑ surfactant production, alveolar maturation, ↓ IVH, NEC.

• 12 mg IM × 2 doses 24 h apart
• Maximal effect 24 h–7 days after first dose
• Single rescue if <34 wks & >7 days since first course

Course

12 mg IM, 2 doses 24 h apart

• AbsoluteActive systemic infection (e.g. TB, chorioamnionitis — relative)
• CautionMaternal diabetes — expect 24–72 h hyperglycaemia

• Maternal hyperglycaemia
• Transient ↓ fetal movements & HRV
• Maternal pulmonary oedema (with tocolytics)

• • Reduces neonatal mortality by ~30%.
• • Repeat courses not routinely recommended — single rescue only.

• Insulin

  Caution

  Hyperglycaemia — increase insulin 24–72 h

• Tocolytics + fluids

  Avoid

  Pulmonary oedema risk

• 💡 Counsel about ↓ fetal movements for 48 h.
• 💡 Do not delay delivery solely to complete course in severe pre-eclampsia.