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id="_NBK576742_"><span itemprop="name">Evidence review for long-term systemic steroids</span></h1><div class="subtitle">Intrapartum care for women with existing medical conditions or obstetric complications and their babies</div><p><b>Evidence review E</b></p><p><i>NICE Guideline, No. 121</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Alliance (UK)</span>.</p><div class="half_rhythm">London: <a href="http://www.nap.edu/" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2019 Mar</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3296-2</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div></div><div class="bkr_clear"></div></div><div id="ch5.s1"><h2 id="_ch5_s1_">Intrapartum care for women on long-term systemic steroid medication</h2><div id="ch5.s1.1"><h3>Review question</h3><p>What steroid replacement regimen should be used during the peripartum period for women on long-term systemic steroid medication?</p><div id="ch5.s1.1.1"><h4>Introduction</h4><p>The aim of this review is to determine what kind, if any, of steroid replacement regimen should be used during labour and birth for women who are on long-term steroid medication. This is important because although women with an underlying condition requiring long-term systemic steroid therapy can usually continue using oral corticosteroid medication (such as prednisone) during pregnancy (because prednisone does not cross the placenta), during the highly stressful events of labour and birth, a temporary increase in steroid therapy (that is, a stress dose of steroids) might be needed.</p></div><div id="ch5.s1.1.2"><h4>Summary of the protocol</h4><p>See <a class="figpopup" href="/books/NBK576742/table/ch5.tab1/?report=objectonly" target="object" rid-figpopup="figch5tab1" rid-ob="figobch5tab1">Table 1</a> for a summary of the population, intervention, comparison and outcomes (PICO) characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch5tab1"><a href="/books/NBK576742/table/ch5.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figch5tab1" rid-ob="figobch5tab1"><img class="small-thumb" src="/books/NBK576742/table/ch5.tab1/?report=thumb" src-large="/books/NBK576742/table/ch5.tab1/?report=previmg" alt="Table 1. Summary of the protocol (PICO) table." /></a><div class="icnblk_cntnt"><h4 id="ch5.tab1"><a href="/books/NBK576742/table/ch5.tab1/?report=objectonly" target="object" rid-ob="figobch5tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (PICO) table. </p></div></div><p>For further details see the full review protocol in <a href="#ch5.appa">Appendix A</a>. The search strategies are presented in <a href="#ch5.appb">Appendix B</a>.</p></div><div id="ch5.s1.1.3"><h4>Clinical evidence</h4><div id="ch5.s1.1.3.1"><h5>Included studies</h5><p>One retrospective cohort study was included in this review (see ‘<a href="#ch5.s1.1.4">Summary of clinical studies included in the evidence review</a>’).</p><p>This study compared additional high dose hydrocortisone (100 mg) and low dose hydrocortisone (50 mg) in labour (<a class="bibr" href="#ch5.ref2" rid="ch5.ref2">Owa 2017</a>).</p><p>Evidence from the studies included in the review is summarised below (see ‘<a href="#ch5.s1.1.5">Quality assessment of clinical studies included in the evidence review</a>’).</p><p>Data was reported on the critical outcome, acute adrenal insufficiency for the woman, long-term neurodevelopmental outcomes for the baby, and the important outcome, adverse effects for the woman. There was no evidence identified for the following outcomes for the woman, mortality (critical outcome) and women’s satisfaction with labour and birth (important outcome). There was no evidence identified for the following outcomes for the baby, mortality (critical outcome), acute adrenal insufficiency (critical outcome) and admission to a neonatal unit (of limited importance).</p><p>There was no evidence available for other interventions, continuation of antenatal steroid medication, or variation of or addition to antenatal steroid therapy regimen, including variation in dose, mode of administration, timing and interval of administration or type of corticosteroid.</p><p>There was no evidence available for other comparisons, no steroid medication, different modes of administration, different timings and intervals of administration or different corticosteroids.</p><p>See also the study selection flow chart in <a href="#ch5.appc">Appendix C</a>.</p></div><div id="ch5.s1.1.3.2"><h5>Excluded studies</h5><p>Studies not included in this review with reasons for their exclusions are provided in <a href="#ch5.appd">Appendix D</a>.</p></div></div><div id="ch5.s1.1.4"><h4>Summary of clinical studies included in the evidence review</h4><p><a class="figpopup" href="/books/NBK576742/table/ch5.tab2/?report=objectonly" target="object" rid-figpopup="figch5tab2" rid-ob="figobch5tab2">Table 2</a> provides a brief summary of included studies.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch5tab2"><a href="/books/NBK576742/table/ch5.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figch5tab2" rid-ob="figobch5tab2"><img class="small-thumb" src="/books/NBK576742/table/ch5.tab2/?report=thumb" src-large="/books/NBK576742/table/ch5.tab2/?report=previmg" alt="Table 2. Summary of included studies." /></a><div class="icnblk_cntnt"><h4 id="ch5.tab2"><a href="/books/NBK576742/table/ch5.tab2/?report=objectonly" target="object" rid-ob="figobch5tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of included studies. </p></div></div><p>See also the study evidence tables in <a href="#ch5.appe">Appendix E</a>. No meta-analysis was undertaken for this review (and so there are no forest plots in <a href="#ch5.appf">Appendix F</a>).</p></div><div id="ch5.s1.1.5"><h4>Quality assessment of clinical studies included in the evidence review</h4><p>The clinical evidence profiles for this review question are presented in <a href="#ch5.appg">Appendix G</a>.</p></div><div id="ch5.s1.1.6"><h4>Economic evidence</h4><div id="ch5.s1.1.6.1"><h5>Included studies</h5><p>No economic evidence was identified for this review.</p><p>See the study selection flow chart in <a href="/books/NBK576742/bin/bm2.pdf">Supplement 2 (Health economics)</a>.</p></div><div id="ch5.s1.1.6.2"><h5>Excluded studies</h5><p>No full-text copies of articles were requested for this review and so there is no excluded studies list (see <a href="/books/NBK576742/bin/bm2.pdf">Supplement 2 (Health economics)</a>).</p></div></div><div id="ch5.s1.1.7"><h4>Summary of studies included in the economic evidence review</h4><p>No economic evidence was identified for this review (and so there are no economic evidence tables in <a href="/books/NBK576742/bin/bm2.pdf">Supplement 2 (Health economics)</a>).</p></div><div id="ch5.s1.1.8"><h4>Economic model</h4><p>No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation (see <a href="/books/NBK576742/bin/bm2.pdf">Supplement 2 (Health economics)</a>).</p></div><div id="ch5.s1.1.9"><h4>Evidence statements</h4><div id="ch5.s1.1.9.1"><h5>Comparison: High dose hydrocortisone versus low dose hydrocortisone</h5><div id="ch5.s1.1.9.1.1"><h5>Outcomes for the woman</h5><div id="ch5.s1.1.9.1.1.1"><h5>Acute adrenal insufficiency: adrenal insufficiency</h5><p>Very low quality evidence from one retrospective cohort study (N=102) reported that there was no case of adrenal insufficiency in either the group of women who received high dose hydrocortisone or those who had low dose hydrocortisone.</p></div><div id="ch5.s1.1.9.1.1.2"><h5>Adverse effects: endometriosis or hyperglycaemia or wound infection</h5><p>Very low quality evidence from one retrospective cohort study (N=102) reported that there was no clinically important difference in the risk of adverse effects (endometriosis or hyperglycaemia or wound infection) between the group of women who received high dose and those who received low dose hydrocortisone.</p></div></div><div id="ch5.s1.1.9.1.2"><h5>Outcomes for the baby</h5><div id="ch5.s1.1.9.1.2.1"><h5>Long-term neurodevelopmental outcomes: oesophageal atresia or cleft lip or congenital cystic adenomatoid malformations</h5><p>Very low quality evidence from one retrospective cohort study (N=102) reported that there was no clinically important difference in the risk of long-term neurodevelopmental outcomes of babies (oesophageal atresia or cleft lip or congenital cystic adenomatoid malformations) between the group of women who received high dose hydrocortisone and those who received low dose hydrocortisone.</p></div></div></div></div><div id="ch5.s1.1.10"><h4>The committee’s discussion of the evidence</h4><div id="ch5.s1.1.10.1"><h5>Interpreting the evidence</h5><div id="ch5.s1.1.10.1.1"><h5>The outcomes that matter most</h5><p>Maternal and neonatal outcomes were prioritised for review, as the committee considered these important and believed that steroids could influence them.</p><p>Mortality and acute adrenal insufficiency (hypotension, cardiovascular collapse, hypoglycaemia, disorientation, weakness and hyponatremia) were considered as critically important outcomes for women and babies because these are disastrous and fatal consequences for both the woman and the baby if there is failure to give adequate steroids to women who require them. Long-term neurodevelopmental outcomes such as cerebral palsy and developmental delay were regarded as being of critical importance to the baby because these are serious and lifelong complications.</p><p>Women’s satisfaction with labour and birth (including psychological wellbeing) and incidence of adverse effects were considered to be important outcomes for women because these would act as proxy measures for successful control of adrenaline levels during labour.</p></div><div id="ch5.s1.1.10.1.2"><h5>The quality of the evidence</h5><p>The quality of the evidence was very low and it came from a single retrospective cohort study. The study considered only women who took steroid therapy orally during pregnancy. There was an increased proportion of women with idiopathic thrombocytopenic purpura (ITP) in the high dose (HD) hydrocortisone group compared to the low dose (LD) hydrocortisone group and the study authors did not perform any adjustment in their analysis. The study periods for the HD and LD groups were also different and thus, there is a possibility that pregnancy and labour care other than hydrocortisone treatment could have differed between the groups. There was no clinically important difference in the reported outcomes, with the confidence intervals being very wide. Thus, it was considered that no definite conclusion could be drawn from this very low quality evidence, and so the committee based their recommendations on their knowledge and experience.</p></div><div id="ch5.s1.1.10.1.3"><h5>Benefits and harms</h5><p>The committee discussed that taking a smaller dose of prednisolone for a defined period of time would not suppress adrenal function and thus, supplementary steroids during labour would not be recommended in these circumstances. They explained that recommendations would be beneficial for women taking 5 mg or more of daily oral prednisolone for more than 3 weeks or the equivalent amount of other form of steroids. Thus, the committee made their recommendations based on preventing adrenal crisis (which could be fatal) while attempting to limit the woman’s dose of steroids as far as possible. As the committee believed that the physiological stress of labour was lower than for caesarean section, they made separate recommendations for the 2 situations.</p><p>In the case of women with adrenal insufficiency, or taking 5 mg or more of daily oral prednisolone for more than 3 weeks or the equivalent amount of other forms of steroids, and planning a vaginal birth, regular oral steroids should be continued. The committee explained that the risk in discontinuing the steroids to more accurately gauge dose of supplementary steroids was that this might cause problems for the woman in restarting steroids after the birth, and that continuing oral medication would not make a significant difference to outcomes for the woman or the baby (since oral medication is not well absorbed during labour). In addition, 6-hourly intravenous or intramuscular hydrocortisone of 50 mg or more should be added in the established first stage of labour and this dosage should be continued until 6 hours after the baby is born.</p><p>The committee recommended that supplementary steroids be given by the intravenous or intramuscular route, since oral medication is not well absorbed during labour (blood is required by the uterus and so the bowel receives less supply) and vomiting is not uncommon. This means the intravenous or intramuscular route is likely to be a more reliable method of medication delivery. The committee recommended hydrocortisone, because a smaller amount of hydrocortisone crosses the placenta than beta- or dexa-methasone and this minimises the risk of fetal toxicity. The committee recommended that a minimum of 50 mg of hydrocortisone should be given per dose if the woman is in established labour. This was based on clinical consensus. The committee explained that existing guidelines (such as the <a href="https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2016/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Intercollegiate Guidelines Network (SIGN) guideline on the management of asthma</a>, <a href="https://www.addisons.org.uk/files/file/4-adshg-surgical-guidelines/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Addison’s disease self-help group (ADSHG) surgical guidelines</a>, <a class="bibr" href="#ch5.ref1" rid="ch5.ref1">Bancos 2015</a>) recommended doses of between 50 mg and 100 mg with the dosage interval of 6–8 hourly. Thus, these were important cut-off points for use in clinical practice. The committee noted that there was no evidence for either threshold, and also that an extended duration of increased steroid dose carried potential risks, but the committee was unable to recommend how to respond in this situation as it would depend on many factors specific to the individual woman. However, they explained that using the lower 50 mg dose would minimise the side effects of acute administration of high-dose steroids.</p><p>In the case of women giving birth through caesarean section and who have adrenal insufficiency or who have been taking long-term oral steroids, the committee recommended continuing with regular oral steroids and adding hydrocortisone, but they added that the dose would depend on whether the woman had already been in labour. The committee intended for the total dose for a woman having a caesarean section to be 100 mg (the upper end of clinical consensus), with a supplementary 50 mg 6 hours after the baby is born. In order to reach this dose, either 100 mg should be given outright if the woman has not already had any hydrocortisone for labour (as above) and 50 mg if she has already had a 50 mg dose in labour. The committee discussed how this could mean the woman might have as little as 75 mg overall (if the last 50 mg dose she received in labour was around 6 hours prior to the 50 mg caesarean section dose) but they concluded that there was insufficient evidence that the added benefit of the remaining 25 mg hydrocortisone justified more invasive blood monitoring, which could make the woman anxious. The risks associated with this higher dose were greatly reduced by the fact that caesarean section could be completed much faster than labour and so the total dose (that is, the number of doses times the amount per dose) was relatively small. The committee recommended giving the dose every 6 hours since they knew this to be the half-life of steroids in the body (and this would therefore give better control over the dose). They recommended giving a final dose 6 hours after the baby was born in order to prevent adrenal collapse in the immediate postpartum period.</p><p>The committee discussed how most women taking inhaled or topical steroids do not require supplemental hydrocortisone in the intrapartum period, because the bioavailability of steroids in this form is known to be poor and so these women would be unlikely to be receiving a high dose of steroids from an inhaled or topical dose alone. This would prevent such women from being exposed to the harmful side-effects of steroids, without increasing their risk of adrenal crisis. However the committee explained that this was not always the case, and a specialist may be required to determine whether the dose was high enough to be treated as being 5 mg or more prednisolone daily for more than 3 weeks or an equivalent amount of another steroid.</p><p>The committee explained that antenatal steroids given for fetal lung maturation should be treated as for any other steroid for the purpose of determining intrapartum dosing; although they agreed that stopping the dose during the intrapartum period did not carry the same risk as stopping the dose for a condition that would persist after the birth (since the dose would be stopping anyway). The committee considered that the high levels of steroids used for fetal lung maturation might mean that suddenly stopping them could have a negative effect on the woman’s health, for example provoking an adrenal crisis. For the sake of continuing the dose for a few extra hours the committee believed the risk was balanced by the likely benefits.</p></div></div><div id="ch5.s1.1.10.2"><h5>Cost effectiveness and resource use</h5><p>No evidence was found for this review and the committee made a qualitative assessment of cost effectiveness.</p><p>The committee noted that steroids are relatively inexpensive and so they reasoned that recommendations that minimised the risk of an adrenal crisis, which can be fatal, were likely to be cost effective. The committee believed that recommending a higher dose of additional steroids for women having a caesarean section would be cost effective as this procedure is more stressful physiologically than labour.</p><p>The committee believed that there is variation in practice and that steroids are likely to be overprescribed for women in labour. Therefore the recommendations might reduce the amount of steroids given, particularly for women using inhaled or topical steroids. However, because steroids are inexpensive, this is unlikely to have a significant impact on resource use within the NHS in England.</p></div><div id="ch5.s1.1.10.3"><h5>Other factors the committee took into account</h5><p>As only very low quality evidence from one study was identified, the committee made a research recommendation on whether supplemental steroids are required in the intrapartum period for women taking regular antenatal steroids. See <a href="#ch5.appl">Appendix L</a> for further details.</p></div></div></div></div><div id="ch5.rl.r1"><h2 id="_ch5_rl_r1_">References</h2><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="ch5.ref1"><p id="p-87">
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<strong>Bancos 2015</strong>
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</p>Bancos, Irina, Hahner, Stefanie, Tomlinson, Jeremy, Arlt, Wiebke, Diagnosis and management of adrenal insufficiency, The Lancet Diabetes & Endocrinology, 3, 216–226, 2015 [<a href="https://pubmed.ncbi.nlm.nih.gov/25098712" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25098712</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="ch5.ref2"><p id="p-88">
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<strong>Owa 2017</strong>
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</p>Owa, Takao, Mimura, Kazuya, Kakigano, Aiko, Matsuzaki, Shinya, Kumasawa, Keiichi, Endo, Masayuki, Tomimatsu, Takuji, Kimura, Tadashi, Pregnancy outcomes in women with different doses of corticosteroid supplementation during labor and delivery, The journal of obstetrics and gynaecology research, 43, 1132–1138, 2017 [<a href="https://pubmed.ncbi.nlm.nih.gov/28422424" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28422424</span></a>]</div></p></li></ul></div><div id="appendixes.appgroup5"><h2 id="_appendixes_appgroup5_">Appendices</h2><div id="ch5.appa"><h3>Appendix A. Review protocol</h3><div id="ch5.appa.s1"><h4>Intrapartum care for women on long-term systemic steroid medication</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch5appatab1"><a href="/books/NBK576742/table/ch5.appa.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figch5appatab1" rid-ob="figobch5appatab1"><img class="small-thumb" src="/books/NBK576742/table/ch5.appa.tab1/?report=thumb" src-large="/books/NBK576742/table/ch5.appa.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="ch5.appa.tab1"><a href="/books/NBK576742/table/ch5.appa.tab1/?report=objectonly" target="object" rid-ob="figobch5appatab1">Table</a></h4><p class="float-caption no_bottom_margin">Women in spontaneous or induced labour (or who have a caesarean section) who are or have been on long-term systemic steroid therapy for at least 2 weeks. Long-term systemic steroid therapy includes the following oral tablet medications:
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prednisone prednisolone <a href="/books/NBK576742/table/ch5.appa.tab1/?report=objectonly" target="object" rid-ob="figobch5appatab1">(more...)</a></p></div></div></div></div><div id="ch5.appb"><h3>Appendix B. Literature search strategies</h3><div id="ch5.appb.s1"><h4>Intrapartum care for women on long-term systemic steroid medication</h4><p id="ch5.appb.tab1"><a href="/books/NBK576742/table/ch5.appb.tab1/?report=objectonly" target="object" rid-ob="figobch5appbtab1" class="figpopup">Database: Medline; Medline EPub Ahead of Print; and Medline In-Process & Other Non-Indexed Citations</a></p><p id="ch5.appb.tab2"><a href="/books/NBK576742/table/ch5.appb.tab2/?report=objectonly" target="object" rid-ob="figobch5appbtab2" class="figpopup">Database: Cochrane Central Register of Controlled Trials</a></p><p id="ch5.appb.tab3"><a href="/books/NBK576742/table/ch5.appb.tab3/?report=objectonly" target="object" rid-ob="figobch5appbtab3" class="figpopup">Database: Cochrane Database of Systematic Reviews</a></p><p id="ch5.appb.tab4"><a href="/books/NBK576742/table/ch5.appb.tab4/?report=objectonly" target="object" rid-ob="figobch5appbtab4" class="figpopup">Database: Database of Abstracts of Reviews of Effects</a></p><p id="ch5.appb.tab5"><a href="/books/NBK576742/table/ch5.appb.tab5/?report=objectonly" target="object" rid-ob="figobch5appbtab5" class="figpopup">Database: Health Technology Assessment</a></p><p id="ch5.appb.tab6"><a href="/books/NBK576742/table/ch5.appb.tab6/?report=objectonly" target="object" rid-ob="figobch5appbtab6" class="figpopup">Database: Embase</a></p></div></div><div id="ch5.appc"><h3>Appendix C. Clinical evidence study selection</h3><div id="ch5.appc.s1"><h4>Intrapartum care for women on long-term steroid medication</h4><p id="ch5.appc.fig1"><a href="/books/NBK576742/figure/ch5.appc.fig1/?report=objectonly" target="object" rid-ob="figobch5appcfig1" class="figpopup">Figure 1. Flow diagram of clinical article selection for intrapartum care for women on long-term systemic steroid medication</a></p></div></div><div id="ch5.appd"><h3>Appendix D. Excluded studies</h3><div id="ch5.appd.s1"><h4>Intrapartum care for women on long-term systemic steroid medication</h4><div id="ch5.appd.s1.1"><h5>Clinical studies</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch5appdtab1"><a href="/books/NBK576742/table/ch5.appd.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figch5appdtab1" rid-ob="figobch5appdtab1"><img class="small-thumb" src="/books/NBK576742/table/ch5.appd.tab1/?report=thumb" src-large="/books/NBK576742/table/ch5.appd.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="ch5.appd.tab1"><a href="/books/NBK576742/table/ch5.appd.tab1/?report=objectonly" target="object" rid-ob="figobch5appdtab1">Table</a></h4><p class="float-caption no_bottom_margin">IBD: inflammatory bowel disease </p></div></div></div><div id="ch5.appd.s1.2"><h5>Economic studies</h5><p>See <a href="/books/NBK576742/bin/bm2.pdf">Supplement 2 (Health economics)</a> for details of economic evidence reviews and health economic modelling.</p></div></div></div><div id="ch5.appe"><h3>Appendix E. Clinical evidence tables</h3><p id="ch5.appe.et1"><a href="/books/NBK576742/bin/ch5-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Intrapartum care for women on long-term systemic steroid medication</a><span class="small"> (PDF, 168K)</span></p></div><div id="ch5.appf"><h3>Appendix F. Forest plots</h3><div id="ch5.appf.s1"><h4>Intrapartum care for women on long-term systemic steroid medication</h4><p>No meta-analysis was undertaken for this review and so there are no forest plots</p></div></div><div id="ch5.appg"><h3>Appendix G. GRADE tables</h3><div id="ch5.appg.s1"><h4>Intrapartum care for women on long-term systemic steroid medication</h4><p id="ch5.appg.tab1"><a href="/books/NBK576742/table/ch5.appg.tab1/?report=objectonly" target="object" rid-ob="figobch5appgtab1" class="figpopup">Table 3. Clinical evidence profile for high dose versus low dose of top-up hydrocortisone therapy during labour, outcomes for the women</a></p><p id="ch5.appg.tab2"><a href="/books/NBK576742/table/ch5.appg.tab2/?report=objectonly" target="object" rid-ob="figobch5appgtab2" class="figpopup">Table 4. Clinical evidence profile for high dose versus low dose of top-up hydrocortisone therapy during labour, outcomes for the baby</a></p></div></div><div id="ch5.apph"><h3>Appendix H. Economic evidence study selection</h3><div id="ch5.apph.s1"><h4>Intrapartum care for women on long-term systemic steroid medication</h4><p>See <a href="/books/NBK576742/bin/bm2.pdf">Supplement 2 (Health economics)</a> for details of economic evidence reviews and health economic modelling.</p></div></div><div id="ch5.appi"><h3>Appendix I. Economic evidence tables</h3><div id="ch5.appi.s1"><h4>Intrapartum care for women on long-term systemic steroid medication</h4><p>See <a href="/books/NBK576742/bin/bm2.pdf">Supplement 2 (Health economics)</a> for details of economic evidence reviews and health economic modelling.</p></div></div><div id="ch5.appj"><h3>Appendix J. Health economic evidence profiles</h3><div id="ch5.appj.s1"><h4>Intrapartum care for women on long-term systemic steroid medication</h4><p>See <a href="/books/NBK576742/bin/bm2.pdf">Supplement 2 (Health economics)</a> for details of economic evidence reviews and health economic modelling.</p></div></div><div id="ch5.appk"><h3>Appendix K. Health economic analysis</h3><div id="ch5.appk.s1"><h4>Intrapartum care for women on long-term systemic steroid medication</h4><p>See <a href="/books/NBK576742/bin/bm2.pdf">Supplement 2 (Health economics)</a> for details of economic evidence reviews and health economic modelling.</p></div></div><div id="ch5.appl"><h3>Appendix L. Research recommendations</h3><div id="ch5.appl.s1"><h4>Intrapartum care for women on long-term systemic steroid medication</h4><p>Are supplemental steroids required in the intrapartum period for women taking regular antenatal steroids?</p><div id="ch5.appl.s1.1"><h5>Why this is important</h5><p>Pregnant women who require long-term anti-inflammatory steroids are expected to have suppressed production of endogenous steroids from their adrenal glands. This would make them less able to mount a natural steroid response to stress, such as that experienced at the time of child birth.</p><p>Based on the committee’s experience and expertise, this guideline has recommended that pregnant women receiving long-term oral steroids (equivalent to a low anti-inflammatory dose of 5mg or more prednisolone daily, for more than 3 weeks) should receive a minimum of 50mg of hydrocortisone every 6 hours from the onset of established labour until 6 hours postpartum.</p><p>There has been no clinical study to determine at what regular dose of prednisolone or any other steroid formulation, is a pregnant woman unable to mount an adrenal steroid response to stress. Furthermore, it is unknown what dose of intrapartum hydrocortisone supplementation is required to protect the woman with chronically suppressed adrenal glands from adrenal crisis. It is unknown what effects antenatal hydrocortisone have on peripartum outcome for woman and neonate.</p><p>This research question aims to evaluate the effectiveness and safety of current NICE recommendation of steroid supplementation during childbirth.</p></div><div id="ch5.appl.s1.2"><h5>Research recommendation rationale</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch5appltab1"><a href="/books/NBK576742/table/ch5.appl.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figch5appltab1" rid-ob="figobch5appltab1"><img class="small-thumb" src="/books/NBK576742/table/ch5.appl.tab1/?report=thumb" src-large="/books/NBK576742/table/ch5.appl.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="ch5.appl.tab1"><a href="/books/NBK576742/table/ch5.appl.tab1/?report=objectonly" target="object" rid-ob="figobch5appltab1">Table</a></h4><p class="float-caption no_bottom_margin">N/A: not applicable; NICE: National Institute for Health and Care Excellence </p></div></div></div><div id="ch5.appl.s1.3"><h5>Research recommendation PICO</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch5appltab2"><a href="/books/NBK576742/table/ch5.appl.tab2/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figch5appltab2" rid-ob="figobch5appltab2"><img class="small-thumb" src="/books/NBK576742/table/ch5.appl.tab2/?report=thumb" src-large="/books/NBK576742/table/ch5.appl.tab2/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="ch5.appl.tab2"><a href="/books/NBK576742/table/ch5.appl.tab2/?report=objectonly" target="object" rid-ob="figobch5appltab2">Table</a></h4><p class="float-caption no_bottom_margin">Number of women in each group receiving intrapartum hydrocortisone supplementation Acceptability of both regimes to women</p></div></div></div></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence reviews for women at high risk of adverse outcomes for themselves and/or their baby because of existing maternal medical conditions</p><p>Developed by the National Guideline Alliance hosted by the Royal College of Obstetricians and Gynaecologists</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div><div class="small"><span class="label">Bookshelf ID: NBK576742</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/35073021" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">35073021</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobch5tab1"><div id="ch5.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICO) table</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576742/table/ch5.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch5.tab1_lrgtbl__"><table class="no_bottom_margin"><tbody><tr><th id="hd_b_ch5.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_ch5.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Women in spontaneous or induced labour (or who have a caesarean section) who are or have been on long-term systemic steroid therapy for at least 2 weeks</td></tr><tr><th id="hd_b_ch5.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_ch5.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><u>Intervention 1:</u>
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<ul id="ch5.l1"><li id="ch5.lt1" class="half_rhythm"><div>Continuation of antenatal steroid medication</div></li></ul>
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<u>Intervention 2:</u>
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<ul id="ch5.l2"><li id="ch5.lt2" class="half_rhythm"><div>Variation of or addition to antenatal steroid therapy regimen, including the following elements:
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<ul id="ch5.l3" class="circle"><li id="ch5.lt3" class="half_rhythm"><div>dose (mg)</div></li><li id="ch5.lt4" class="half_rhythm"><div>mode of administration (intramuscular [IM], intravenous [IV] bolus, IV infusion)</div></li><li id="ch5.lt5" class="half_rhythm"><div>timing and interval of administration (when and how often)</div></li><li id="ch5.lt6" class="half_rhythm"><div>type of corticosteroid</div></li></ul></div></li></ul></td></tr><tr><th id="hd_b_ch5.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_ch5.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><u>Comparison 1:</u>
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<ul id="ch5.l4"><li id="ch5.lt7" class="half_rhythm"><div>No steroid medication</div></li></ul>
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<u>Comparison 2:</u>
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<ul id="ch5.l5"><li id="ch5.lt8" class="half_rhythm"><div>Different dosages</div></li></ul>
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<u>Comparison 3:</u>
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<ul id="ch5.l6"><li id="ch5.lt9" class="half_rhythm"><div>Different modes of administration
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<ul id="ch5.l7" class="circle"><li id="ch5.lt10" class="half_rhythm"><div>IM versus IV bolus</div></li><li id="ch5.lt11" class="half_rhythm"><div>IM versus IV infusion</div></li><li id="ch5.lt12" class="half_rhythm"><div>IV bolus versus IV infusion</div></li></ul></div></li></ul>
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<u>Comparison 4:</u>
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<ul id="ch5.l8"><li id="ch5.lt13" class="half_rhythm"><div>Different timings and intervals of administration</div></li></ul>
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<u>Comparison 5:</u>
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<ul id="ch5.l9"><li id="ch5.lt14" class="half_rhythm"><div>Different corticosteroids (for example, hydrocortisone versus prednisolone versus dexamethasone)</div></li></ul></td></tr><tr><th id="hd_b_ch5.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_ch5.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For the woman:
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<ul id="ch5.l10"><li id="ch5.lt15" class="half_rhythm"><div>mortality</div></li><li id="ch5.lt16" class="half_rhythm"><div>acute adrenal insufficiency (hypotension, cardiovascular collapse, hypoglycaemia, disorientation, weakness, or hyponatremia)</div></li><li id="ch5.lt17" class="half_rhythm"><div>women’s satisfaction with labour and birth (including psychological wellbeing)</div></li><li id="ch5.lt18" class="half_rhythm"><div>adverse effects</div></li></ul>
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For the baby:
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<ul id="ch5.l11"><li id="ch5.lt19" class="half_rhythm"><div>mortality</div></li><li id="ch5.lt20" class="half_rhythm"><div>acute adrenal insufficiency (hypotension, cardiovascular collapse, hypoglycaemia, disorientation, weakness, or hyponatremia)</div></li><li id="ch5.lt21" class="half_rhythm"><div>long-term neurodevelopmental outcomes (for example, cerebral palsy, or developmental delay)</div></li><li id="ch5.lt22" class="half_rhythm"><div>admission to a neonatal unit</div></li></ul></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">IM: intramuscular; IV: intravenous</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch5tab2"><div id="ch5.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of included studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576742/table/ch5.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch5.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch5.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_ch5.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_ch5.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Intervention/Comparison</th><th id="hd_h_ch5.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch5.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_ch5.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#ch5.ref2" rid="ch5.ref2">Owa 2017</a>
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</p>
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<p>Retrospective cohort study</p>
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<p>Japan</p>
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</td><td headers="hd_h_ch5.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=102 women taking oral corticosteroid therapy during their pregnancy</p>
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<p>ART: 54.5%</p>
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<p>Average oral prednisolone: 9.3 mg/day</p>
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<p>Oral steroid therapy for ≥1year: 90%</p>
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<p>Underlying medical conditions: SLE 29.3%, ITP 12.5%, renal transplant 11.5%, RA 11.5%, MCTD 6.9%, Aortitis syndrome 5.6%, others 23.5%</p>
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</td><td headers="hd_h_ch5.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch5.l12"><li id="ch5.lt23" class="half_rhythm"><div>High dose (HD): 100 mg hydrocortisone at onset of labour and then 8 hourly until birth. After birth, some received 50 mg hydrocortisone 8 hourly for 1 day. (n=47)</div></li><li id="ch5.lt24" class="half_rhythm"><div>Low dose (LD): 50 mg hydrocortisone at onset of labour and then 8 hourly until birth. After birth, all received 25 mg hydrocortisone 8 hourly for 1 day. (n=55)</div></li></ul>
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Note – All women continued their regular oral corticosteroids throughout labour, birth and after birth in both groups.</td><td headers="hd_h_ch5.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For the woman:
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<ul id="ch5.l13"><li id="ch5.lt25" class="half_rhythm"><div>Adrenal insufficiency<sup>*</sup></div></li><li id="ch5.lt26" class="half_rhythm"><div>Major side-effects</div></li></ul>
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For the baby:
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<ul id="ch5.l14"><li id="ch5.lt27" class="half_rhythm"><div>Congenital anomalies</div></li></ul></td><td headers="hd_h_ch5.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch5.l15"><li id="ch5.lt28" class="half_rhythm"><div>There were more women with ITP in HD than in LD group.</div></li><li id="ch5.lt29" class="half_rhythm"><div>HD and LD were those having babies during 2008–2012 and 2012–2016, respectively.</div></li></ul></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">ART: Assisted reproductive technology; HD: High dose; ITP: Idiopathic thrombocytopenia; LD: Low dose; MCTD: Mixed connective tissue disease; RA: Rheumatoid arthritis; SLE: Systemic lupus erythematosus</p></div></dd></dl><dl class="bkr_refwrap"><dt>*</dt><dd><div id="ch5.tab2_1"><p class="no_margin">hypotension, cardiovascular collapse, hypoglycaemia, disorientation, weakness, hyponatremia</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch5appatab1"><div id="ch5.appa.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576742/table/ch5.appa.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch5.appa.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Item</th><th id="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Details</th><th id="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Working notes</th></tr></thead><tbody><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Area in the scope</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Women at high risk of adverse outcomes for themselves and/or their baby because of existing maternal medical conditions – intrapartum care for women on long-term systemic steroid medication - steroid replacement regimens</td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review question in the scope</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">What steroid replacement regimen should be used during birth and the peripartum period for women on long-term systemic steroid medication?</td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review question for the guideline</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">What steroid replacement regimen should be used during the peripartum period for women on long-term systemic steroid medication?</td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Objective</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The aim of this review is to determine what kind, if any, of steroid replacement regimen should be used during labour and birth for women who are on long-term steroid medication. This is important because although women with an underlying condition requiring long-term systemic steroid therapy can usually continue using oral corticosteroid medication (such as prednisone) during pregnancy (because prednisone does not cross the placenta), during the highly stressful events of labour and birth, a temporary increase in steroid therapy (that is, a stress dose of steroids) might be needed</td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population and directness</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Women in spontaneous or induced labour (or who have a caesarean section) who are or have been on long-term systemic steroid therapy for at least 2 weeks.</p><p>Long-term systemic steroid therapy includes the following oral tablet medications:
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<ul id="ch5.l16"><li id="ch5.lt30" class="half_rhythm"><div>prednisone</div></li><li id="ch5.lt31" class="half_rhythm"><div>prednisolone</div></li><li id="ch5.lt32" class="half_rhythm"><div>hydrocortisone</div></li><li id="ch5.lt33" class="half_rhythm"><div>dexamethasone.</div></li></ul></p>
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<p>Conditions that might require long-term steroid therapy include (but are not limited to):
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<ul id="ch5.l17"><li id="ch5.lt34" class="half_rhythm"><div>asthma</div></li><li id="ch5.lt35" class="half_rhythm"><div>systemic lupus erythematosus (SLE)</div></li><li id="ch5.lt36" class="half_rhythm"><div>Addison’s disease (primary adrenal insufficiency, primary adrenocortical insufficiency, chronic adrenal insufficiency, hypocortisolism, hypoadrenalism)</div></li><li id="ch5.lt37" class="half_rhythm"><div>chronic obstructive pulmonary disease (COPD)</div></li><li id="ch5.lt38" class="half_rhythm"><div>inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis</div></li><li id="ch5.lt39" class="half_rhythm"><div>polymyalgia rheumatica</div></li><li id="ch5.lt40" class="half_rhythm"><div>autoimmune thrombocytopenia, including idiopathic thrombocytopenic purpura (ITP)</div></li><li id="ch5.lt41" class="half_rhythm"><div>arthritis, including rheumatic arthritis/rheumatoid arthritis</div></li><li id="ch5.lt42" class="half_rhythm"><div>atopic eczema</div></li><li id="ch5.lt43" class="half_rhythm"><div>multiple sclerosis (MS)</div></li><li id="ch5.lt44" class="half_rhythm"><div>polymorphic eruption of pregnancy (PEP)</div></li></ul></p>
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<p>Women who have had an organ transplant may also be on long-term systematic steroid therapy</p></td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Continuation of antenatal steroid medication</p>
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<p>Variation of or addition to antenatal steroid therapy regimen, including the following potential elements:
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<ul id="ch5.l18"><li id="ch5.lt45" class="half_rhythm"><div>dose (mg)</div></li><li id="ch5.lt46" class="half_rhythm"><div>mode of administration (intramuscular [IM], intravenous [IV] bolus, IV infusion)</div></li><li id="ch5.lt47" class="half_rhythm"><div>timing and interval of administration (when and how often)</div></li><li id="ch5.lt48" class="half_rhythm"><div>type of corticosteroid (this could be any steroid, but is expected to be prednisone, fluprednisolone, methylprednisolone, prednimustine, hydrocortisone, fludrocortisone or dexamethasone)</div></li></ul></p>
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</td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>No steroid medication (stopping steroids during the intrapartum period)</p><p>Different dosages</p><p>Different modes of administration
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<ul id="ch5.l19" class="circle"><li id="ch5.lt49" class="half_rhythm"><div>IM versus IV bolus</div></li><li id="ch5.lt50" class="half_rhythm"><div>IM versus IV infusion</div></li><li id="ch5.lt51" class="half_rhythm"><div>IV bolus versus IV infusion</div></li></ul></p>
|
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<p>Different timings and intervals of administration</p>
|
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<p>Different corticosteroids (for example, hydrocortisone versus prednisolone versus dexamethasone)</p></td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Critical outcomes:
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<ul id="ch5.l20"><li id="ch5.lt52" class="half_rhythm"><div>for the woman:
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<ul id="ch5.l21" class="circle"><li id="ch5.lt53" class="half_rhythm"><div>mortality</div></li><li id="ch5.lt54" class="half_rhythm"><div>acute adrenal insufficiency (hypotension, cardiovascular collapse, hypoglycaemia, disorientation, weakness, or hyponatremia)</div></li></ul></div></li><li id="ch5.lt55" class="half_rhythm"><div>for the baby:
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<ul id="ch5.l22" class="circle"><li id="ch5.lt56" class="half_rhythm"><div>mortality</div></li><li id="ch5.lt57" class="half_rhythm"><div>acute adrenal insufficiency (hypotension, cardiovascular collapse, hypoglycaemia, disorientation, weakness, or hyponatremia)</div></li><li id="ch5.lt58" class="half_rhythm"><div>long-term neurodevelopmental outcomes (for example, cerebral palsy, or developmental delay)</div></li></ul></div></li></ul>
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Important outcomes:
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<ul id="ch5.l23"><li id="ch5.lt59" class="half_rhythm"><div>for the woman:
|
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<ul id="ch5.l24" class="circle"><li id="ch5.lt60" class="half_rhythm"><div>women’s satisfaction with labour and birth (including psychological wellbeing)</div></li><li id="ch5.lt61" class="half_rhythm"><div>adverse effects</div></li></ul></div></li></ul>
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Outcomes of limited importance:
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<ul id="ch5.l25"><li id="ch5.lt62" class="half_rhythm"><div>for the baby:
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<ul id="ch5.l26" class="circle"><li id="ch5.lt63" class="half_rhythm"><div>admission to a neonatal unit</div></li></ul></div></li></ul></td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Importance of outcomes</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Preliminary classification of the outcomes for decision making:
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<ul id="ch5.l27"><li id="ch5.lt64" class="half_rhythm"><div>critical (up to 3 outcomes)</div></li><li id="ch5.lt65" class="half_rhythm"><div>important but not critical (up to 3 outcomes)</div></li><li id="ch5.lt66" class="half_rhythm"><div>of limited importance (1 outcome)</div></li></ul></td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Given the small volume of evidence available for inclusion overall, the committee agreed to consider more than the nominal maximum of 7 outcomes for this question</td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Setting</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All settings</td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Stratified, subgroup and adjusted analyses</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Groups that will be reviewed and analysed separately:
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<ul id="ch5.l28"><li id="ch5.lt67" class="half_rhythm"><div>women having steroids for fetal lung maturity</div></li><li id="ch5.lt68" class="half_rhythm"><div>mode of birth</div></li></ul>
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In the presence of heterogeneity, the following subgroups will be considered for sensitivity analysis:
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<ul id="ch5.l29"><li id="ch5.lt69" class="half_rhythm"><div>women with different underlying health conditions for which they are taking systemic steroids (see Population and directness above)</div></li><li id="ch5.lt70" class="half_rhythm"><div>women on different doses and/or types of long-term steroid medication</div></li><li id="ch5.lt71" class="half_rhythm"><div>women with different durations of long-term steroid medication prior to the peripartum period</div></li></ul>
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Potential confounders:
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<ul id="ch5.l30"><li id="ch5.lt72" class="half_rhythm"><div>obesity</div></li><li id="ch5.lt73" class="half_rhythm"><div>kidney and liver disease</div></li></ul></td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Language</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">English</td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch5.l31"><li id="ch5.lt74" class="half_rhythm"><div>Published full-text papers only</div></li><li id="ch5.lt75" class="half_rhythm"><div>Systematic reviews</div></li><li id="ch5.lt76" class="half_rhythm"><div>RCTs</div></li><li id="ch5.lt77" class="half_rhythm"><div>Only if RCTs unavailable or there is limited data to inform decision making:
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<ul id="ch5.l32" class="circle"><li id="ch5.lt78" class="half_rhythm"><div>prospective or retrospective comparative cohort studies</div></li></ul></div></li><li id="ch5.lt79" class="half_rhythm"><div>Prospective study designs will be prioritised over retrospective study designs</div></li><li id="ch5.lt80" class="half_rhythm"><div>Conference abstracts will not be considered</div></li></ul></td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search strategy</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Sources to be searched: Medline, Medline In-Process, CCTR, CDSR, DARE, HTA and Embase.</p>
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<p>Limits (e.g. date, study design): All study designs. Apply standard animal/non-English language filters. No date limit.</p>
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<p>Supplementary search techniques: No supplementary search techniques were used.</p>
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<p>See <a href="#ch5.appb">appendix B</a> for full strategies</p>
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</td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review strategy</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Appraisal of methodological quality:
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<ul id="ch5.l33"><li id="ch5.lt81" class="half_rhythm"><div>the methodological quality of each study will be assessed using checklists recommended in the NICE guidelines manual 2014 (for example, AMSTAR or ROBIS for systematic reviews, and Cochrane RoB tool for RCTs) and the quality of the evidence for each outcome (that is, across studies) will be assessed using GRADE</div></li><li id="ch5.lt82" class="half_rhythm"><div>if studies report only p-values, this information will be recorded in GRADE tables without an assessment of imprecision</div></li></ul>
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Synthesis of data:
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|
<ul id="ch5.l34"><li id="ch5.lt83" class="half_rhythm"><div>meta-analysis will be conducted where appropriate</div></li><li id="ch5.lt84" class="half_rhythm"><div>default MIDs will be used; 0.8 and 1.25 for dichotomous outcomes; 0.5 times the SD of the measurement in the control arm (or median score across control arms if multiple studies are included) for continuous outcomes</div></li><li id="ch5.lt85" class="half_rhythm"><div>for continuous data, change scores will be used in preference to final scores for data from non-RCT studies; final and change scores will not be pooled; if any study reports both, the method used in the majority of studies will be adopted</div></li></ul></td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Review questions selected as high priorities for health economic analysis (and those selected as medium priorities and where health economic analysis could influence recommendations) will be subject to dual weeding and study selection; any discrepancies will be resolved through discussion between the first and second reviewers or by reference to a third person. This review question was not prioritised for health economic analysis and so no formal dual weeding, study selection (inclusion/exclusion) or data extraction into evidence tables will be undertaken.</p>
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<p>However, internal (NGA) quality assurance processes will include consideration of the outcomes of weeding, study selection and data extraction and the committee will review the results of study selection and data extraction</p>
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</td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Equalities</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Equalities considerations will be considered systematically in relation to the available evidence and draft recommendations.</p>
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<p>The guideline scope includes women with cognitive or physical disability as populations for whom there may be equalities issues.</p>
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<p>Women who have received no antenatal care will be considered as a subgroup for all systematic reviews performed within the medical conditions work stream and a specific question has been included in the obstetric complications work stream for this population</p>
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</td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Notes/additional information</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch5.l35"><li id="ch5.lt86" class="half_rhythm"><div>SIGN British guideline on the management of asthma, p120:</div><div>“Women receiving steroid tablets at a dose exceeding prednisolone 7.5 mg per day for > more than two weeks prior to delivery should receive parenteral hydrocortisone 100 mg 6–8 hourly during labour.” Reference: <a href="https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2016/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.brit-thoracic<wbr style="display:inline-block"></wbr>​.org.uk/document-library<wbr style="display:inline-block"></wbr>​/clinical-information<wbr style="display:inline-block"></wbr>​/asthma/btssign-asthma-guideline-2014/</a></div></li><li id="ch5.lt87" class="half_rhythm"><div>Nelson-Piercy C. Asthma in pregnancy. In: Respiratory diseases in pregnancy 1. Thorax 2001;56:325–328:</div><div>“Those on oral steroids (>7.5 mg prednisolone daily for more than 2 weeks) at the onset of labour or delivery should receive parenteral steroids (hydrocortisone 100 mg 6–8 hourly) during labour, and until they are able to restart their oral medication.”</div><div>Reference: <a href="http://thorax.bmj.com/content/56/4/325.full.pdf+html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://thorax<wbr style="display:inline-block"></wbr>​.bmj.com/content/56/4/325<wbr style="display:inline-block"></wbr>​.full.pdf+html</a></div></li><li id="ch5.lt88" class="half_rhythm"><div>Pandey D, Pai M, Kumar P. Systemic lupus erythematosus and pregnancy: Today’s scenario. The Internet Journal of Gynecology and Obstetrics. 2008 Volume 11 Number 2:</div><div>“…stress dose of glucocorticoids should be given during labor or cesarean, to all patients who have been treated with chronic steroids within the previous year. Hydrocortisone, in three doses of 100 mg, 8 hourly IV is an acceptable regimen.”</div><div>Reference: <a href="http://ispub.com/IJGO/11/2/7581" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://ispub<wbr style="display:inline-block"></wbr>​.com/IJGO/11/2/7581</a></div></li><li id="ch5.lt89" class="half_rhythm"><div>Surgical literature includes some studies on stress dose steroid therapy, however, evidence is somewhat limited and the common recommendations are being questioned by new evidence. In a review by Kelly and Domajnko (2013), they conclude that “Based on the existing evidence, it is recommended that patients on long-term exogenous steroids do not require the high-dose corticosteroids that were once the standard of care. Rather, patients should remain on their baseline maintenance doses, throughout the perioperative period and be treated for hypotension that is otherwise unresponsive or unexplained with a rescue dose of steroids.” (Kelly K. N., Domajnko B. Perioperative Stress-Dose Steroids. Clin Colon Rectal Surg 2013;26:163–167.)</div></li><li id="ch5.lt90" class="half_rhythm"><div>Below are two examples of guidelines for perioperative steroid therapy for patients on long-term steroid therapy from the UK. It should be noted, that surgery and labour and delivery cannot be compared as such.
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<ul id="ch5.l36" class="circle"><li id="ch5.lt91" class="half_rhythm"><div class="half_rhythm">Guidelines for perioperative steroids By Dr N Loh, Senior House Officer, and Dr M Atherton, Consultant, Department of Anaesthesia, Arrowe Park Hospital, Wirral CH49 5PE:</div><div class="half_rhythm">“Suggested steroid treatment regimen for patients who have received a regular daily dose of more than 10mg prednisolone or equivalent in the last three months:</div><div class="half_rhythm">Minor Surgery: 25mg Hydrocortisone at induction (hernias, hands)</div><div class="half_rhythm">Moderate Surgery: Usual pre-op steroids (hysterectomy) + 25mg Hydrocortisone at induction +100mg hydrocortisone/day</div><div class="half_rhythm">Major Surgery: Usual pre-op steroids + 25mg Hydrocortisone at induction +100mg hydrocortisone/day for 2–3 days.</div><div class="half_rhythm">Resume normal oral therapy when gastrointestinal function has returned.”</div><div class="half_rhythm">Reference: <a href="http://www.e-safe-anaesthesia.org/sessions/02_02/pdf/Perioperative-Steroids.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.e-safe-anaesthesia<wbr style="display:inline-block"></wbr>​.org/sessions<wbr style="display:inline-block"></wbr>​/02_02/pdf/Perioperative-Steroids.pdf</a></div></li><li id="ch5.lt92" class="half_rhythm"><div class="half_rhythm">Clinical Guideline for the Perioperative Steroid Replacement Royal Cornwall Hospital (NHS Trust):</div><div class="half_rhythm">“Patients currently taking steroids:</div><div class="half_rhythm"><10 mg day-1</div><div class="half_rhythm">Additional steroid cover not required.</div><div class="half_rhythm">>10 mg day-1
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<dl id="ch5.l37" class="temp-labeled-list"><dl class="bkr_refwrap"><dt>-</dt><dd id="ch5.lt93"><p class="no_top_margin">Minor surgery</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd id="ch5.lt94"><p class="no_top_margin">25 mg hydrocortisone at induction</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd id="ch5.lt95"><p class="no_top_margin">Moderate surgery</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd id="ch5.lt96"><p class="no_top_margin">Usual pre-operative steroids + 25 mg hydrocortisone at induction + 100 mg day-1 for 24 h.</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd id="ch5.lt97"><p class="no_top_margin">Major surgery</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd id="ch5.lt98"><p class="no_top_margin">Usual pre-operative steroids + 25 mg hydrocortisone at induction + 100 mg day-1 for 48–72 h.</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd id="ch5.lt99"><p class="no_top_margin">Patients stopped taking steroids</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd id="ch5.lt100"><p class="no_top_margin"><3 months</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd id="ch5.lt101"><p class="no_top_margin">Treat if on steroids</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd id="ch5.lt102"><p class="no_top_margin">>3 months</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd id="ch5.lt103"><p class="no_top_margin">No peri-operative steroids necessary”</p></dd></dl></dl></div><div class="half_rhythm">Reference: <a href="http://www.rcht.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Clinical/Anaesthetics/PeriOperativeSteroidReplacement.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.rcht.nhs.uk<wbr style="display:inline-block"></wbr>​/DocumentsLibrary/RoyalCornwallHospitalsTrust<wbr style="display:inline-block"></wbr>​/Clinical/Anaesthetics<wbr style="display:inline-block"></wbr>​/PeriOperativeSteroidReplacement.pdf</a></div></li></ul></div></li></ul></td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch5.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Key papers</td><td headers="hd_h_ch5.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Lebbe M, Arlt W. What is the best diagnostic and therapeutic management strategy for an Addison patient during pregnancy? Clin Endocrinol (Oxf). 2013 Apr;78(4):497–502. doi: 10.1111/cen.12097.</p>
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<p>Adonakis G, Georgopoulos NA, Michail G, Spinos N, Papadopoulos V, Kourounis GS, Kyriazopoulou V. Successful pregnancy outcome in a patient with primary Addison’s disease. Gynecol Endocrinol. 2005 Aug;21(2):90–2.</p>
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<p>Kristin N. Kelly and Bastian Domajnko. Perioperative Stress-Dose Steroids. Clin Colon Rectal Surg. 2013 Sep; 26(3): 163–167. doi: 10.1055/s-0033-1351132</p>
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</td><td headers="hd_h_ch5.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">AMSTAR: Assessing the Methodological Quality of Systematic Reviews; CCTR: Cochrane Central Register of Controlled Trials; CDSR: Cochrane Database of Systematic Reviews; COPD: chronic obstructive pulmonary disease; DARE: Database of Abstracts of Reviews of Effects; GRADE: Grading of Recommendations Assessment, Development and Evaluation; HTA: Health Technology Assessment; IBD: inflammatory bowel disease; IM: intramuscular; ITP: idiopathic thrombocytopenic purpura; IV: intravenous; MID: minimally important difference; MS: multiple sclerosis; NGA: National Guideline Alliance; NICE: National Institute for Health and Care Excellence; PEP: polymorphic eruption of pregnancy; RCT: randomised controlled trial; RoB: risk of bias; ROBIS: Risk of Bias in Systematic Reviews; SD: standard deviation; SLE: systemic lupus erythematosus</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch5appbtab1"><div id="ch5.appb.tab1" class="table"><h3><span class="title">Database: Medline; Medline EPub Ahead of Print; and Medline In-Process & Other Non-Indexed Citations</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576742/table/ch5.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch5.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">#</th><th id="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Searches</th></tr></thead><tbody><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PERIPARTUM PERIOD/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PARTURITION/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp LABOR, OBSTETRIC/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp DELIVERY, OBSTETRIC/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">OBSTETRIC LABOR, PREMATURE/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(labo?r or childbirth or partu$ or intra?part$ or peri?part$).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((during or giving or give) adj3 birth?).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(c?esar#an$ or c section$ or csection$ or (deliver$ adj3 abdom$) or ((vagina$ or cephalic$ or forcep? or induc$ or extract$ or ventouse? or spontaneous$) adj3 (birth$ or born or deliver$))).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1–8</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp STEROIDS/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp ADRENAL CORTEX HORMONES/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PREDNISONE/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp PREDNISOLONE/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp HYDROCORTISONE/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp DEXAMETHASONE/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">steroid$.mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">corticosteroid?.mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">prednisone.mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(prednisolone or fluprednisolone or methylprednisolone or prednimustine).mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(hydrocortisone or fludrocortisone).mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">dexamethasone.mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10–21</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((stress or rescue or maintenance or increment$ or boost$ or supplement$ or additional$ or added$ or increas$) adj3 (dose? or dosag$)).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((Temporar$ or short term or physiological$) adj3 increase$).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/23–24</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (stress or rescue or maintenance or increment$ or boost$ or supplement$ or additional$ or added$ or increas$)).mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (high$ adj2 (dose? or level?))).mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 replace$).mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (regimen$ or long term)).mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 22 and 25</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 26</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 27</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 28</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 29</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/30–34</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 35 to english language</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LETTER/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">EDITORIAL/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NEWS/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp HISTORICAL ARTICLE/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ANECDOTES AS TOPIC/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">COMMENT/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CASE REPORT/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/37–44</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RANDOMIZED CONTROLLED TRIAL/ or random*.ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45 not 46</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ANIMALS/ not HUMANS/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp ANIMALS, LABORATORY/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp ANIMAL EXPERIMENTATION/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp MODELS, ANIMAL/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp RODENTIA/</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/47–53</td></tr><tr><td headers="hd_h_ch5.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55</td><td headers="hd_h_ch5.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36 not 54</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch5appbtab2"><div id="ch5.appb.tab2" class="table"><h3><span class="title">Database: Cochrane Central Register of Controlled Trials</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576742/table/ch5.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch5.appb.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">#</th><th id="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Searches</th></tr></thead><tbody><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PERIPARTUM PERIOD/</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PARTURITION/</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp LABOR, OBSTETRIC/</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp DELIVERY, OBSTETRIC/</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">OBSTETRIC LABOR, PREMATURE/</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(labo?r or childbirth or partu$ or intra?part$ or peri?part$).ti,ab,kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((during or giving or give) adj3 birth?).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(c?esar#an$ or c section$ or csection$ or (deliver$ adj3 abdom$) or ((vagina$ or cephalic$ or forcep? or induc$ or extract$ or ventouse? or spontaneous$) adj3 (birth$ or born or deliver$))).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1–8</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp STEROIDS/</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp ADRENAL CORTEX HORMONES/</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PREDNISONE/</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp PREDNISOLONE/</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp HYDROCORTISONE/</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp DEXAMETHASONE/</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">steroid$.mp,kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">corticosteroid?.mp,kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">prednisone.mp,kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(prednisolone or fluprednisolone or methylprednisolone or prednimustine).mp,kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(hydrocortisone or fludrocortisone).mp,kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">dexamethasone.mp,kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10–21</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((stress or rescue or maintenance or increment$ or boost$ or supplement$ or additional$ or added$ or increas$) adj3 (dose? or dosag$)).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((Temporar$ or short term or physiological$) adj3 increase$).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/23–24</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (stress or rescue or maintenance or increment$ or boost$ or supplement$ or additional$ or added$ or increas$)).mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (high$ adj2 (dose? or level?))).mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 replace$).mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (regimen$ or long term)).mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 22 and 25</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 26</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 27</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 28</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 29</td></tr><tr><td headers="hd_h_ch5.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35</td><td headers="hd_h_ch5.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/30–34</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch5appbtab3"><div id="ch5.appb.tab3" class="table"><h3><span class="title">Database: Cochrane Database of Systematic Reviews</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576742/table/ch5.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch5.appb.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">#</th><th id="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Searches</th></tr></thead><tbody><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PERIPARTUM PERIOD.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PARTURITION.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LABOR, OBSTETRIC.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DELIVERY, OBSTETRIC.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">OBSTETRIC LABOR, PREMATURE.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(labo?r or childbirth or partu$ or intra?part$ or peri?part$).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((during or giving or give) adj3 birth?).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(c?esar#an$ or c section$ or csection$ or (deliver$ adj3 abdom$) or ((vagina$ or cephalic$ or forcep? or induc$ or extract$ or ventouse? or spontaneous$) adj3 (birth$ or born or deliver$))).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1–8</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">STEROIDS.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ADRENAL CORTEX HORMONES.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PREDNISONE.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PREDNISOLONE.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HYDROCORTISONE.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DEXAMETHASONE.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">steroid$.ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">corticosteroid?.ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">prednisone.ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(prednisolone or fluprednisolone or methylprednisolone or prednimustine).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(hydrocortisone or fludrocortisone).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">dexamethasone.ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10–21</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((stress or rescue or maintenance or increment$ or boost$ or supplement$ or additional$ or added$ or increas$) adj3 (dose? or dosag$)).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((Temporar$ or short term or physiological$) adj3 increase$).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/23–24</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (stress or rescue or maintenance or increment$ or boost$ or supplement$ or additional$ or added$ or increas$)).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (high$ adj2 (dose? or level?))).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 replace$).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (regimen$ or long term)).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 22 and 25</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 26</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 27</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 28</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 29</td></tr><tr><td headers="hd_h_ch5.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35</td><td headers="hd_h_ch5.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/30–34</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch5appbtab4"><div id="ch5.appb.tab4" class="table"><h3><span class="title">Database: Database of Abstracts of Reviews of Effects</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576742/table/ch5.appb.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch5.appb.tab4_lrgtbl__"><table><thead><tr><th id="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">#</th><th id="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Searches</th></tr></thead><tbody><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PERIPARTUM PERIOD.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PARTURITION.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LABOR, OBSTETRIC.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DELIVERY, OBSTETRIC.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">OBSTETRIC LABOR, PREMATURE.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(labo?r or childbirth or partu$ or intra?part$ or peri?part$).tw,tx.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((during or giving or give) adj3 birth?).tw,tx.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(c?esar#an$ or c section$ or csection$ or (deliver$ adj3 abdom$) or ((vagina$ or cephalic$ or forcep? or induc$ or extract$ or ventouse? or spontaneous$) adj3 (birth$ or born or deliver$))).tw,tx.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1–8</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">STEROIDS.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ADRENAL CORTEX HORMONES.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PREDNISONE.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PREDNISOLONE.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HYDROCORTISONE.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DEXAMETHASONE.kw.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">steroid$.tw,tx.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">corticosteroid?.tw,tx.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">prednisone.tw,tx.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(prednisolone or fluprednisolone or methylprednisolone or prednimustine).tw,tx.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(hydrocortisone or fludrocortisone).tw,tx.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">dexamethasone.tw,tx.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10–21</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((stress or rescue or maintenance or increment$ or boost$ or supplement$ or additional$ or added$ or increas$) adj3 (dose? or dosag$)).tw,tx.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((Temporar$ or short term or physiological$) adj3 increase$).tw,tx.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/23–24</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (stress or rescue or maintenance or increment$ or boost$ or supplement$ or additional$ or added$ or increas$)).tw,tx.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (high$ adj2 (dose? or level?))).tw,tx.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 replace$).tw,tx.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (regimen$ or long term)).tw,tx.</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 22 and 25</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 26</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 27</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 28</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 29</td></tr><tr><td headers="hd_h_ch5.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35</td><td headers="hd_h_ch5.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/30–34</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch5appbtab5"><div id="ch5.appb.tab5" class="table"><h3><span class="title">Database: Health Technology Assessment</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576742/table/ch5.appb.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch5.appb.tab5_lrgtbl__"><table><thead><tr><th id="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">#</th><th id="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Searches</th></tr></thead><tbody><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PERIPARTUM PERIOD/</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PARTURITION/</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp LABOR, OBSTETRIC/</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp DELIVERY, OBSTETRIC/</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">OBSTETRIC LABOR, PREMATURE/</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(labo?r or childbirth or partu$ or intra?part$ or peri?part$).tw.</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((during or giving or give) adj3 birth?).tw.</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(c?esar#an$ or c section$ or csection$ or (deliver$ adj3 abdom$) or ((vagina$ or cephalic$ or forcep? or induc$ or extract$ or ventouse? or spontaneous$) adj3 (birth$ or born or deliver$))).tw.</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1–8</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp STEROIDS/</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp ADRENAL CORTEX HORMONES/</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PREDNISONE/</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp PREDNISOLONE/</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp HYDROCORTISONE/</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp DEXAMETHASONE/</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">steroid$.tw.</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">corticosteroid?.tw.</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">prednisone.tw.</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(prednisolone or fluprednisolone or methylprednisolone or prednimustine).tw.</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(hydrocortisone or fludrocortisone).tw.</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">dexamethasone.tw.</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10–21</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((stress or rescue or maintenance or increment$ or boost$ or supplement$ or additional$ or added$ or increas$) adj3 (dose? or dosag$)).tw.</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((Temporar$ or short term or physiological$) adj3 increase$).tw.</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/23–24</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (stress or rescue or maintenance or increment$ or boost$ or supplement$ or additional$ or added$ or increas$)).tw.</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (high$ adj2 (dose? or level?))).tw.</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 replace$).tw.</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (regimen$ or long term)).tw.</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 22 and 25</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 26</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 27</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 28</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 and 29</td></tr><tr><td headers="hd_h_ch5.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35</td><td headers="hd_h_ch5.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/30–34</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch5appbtab6"><div id="ch5.appb.tab6" class="table"><h3><span class="title">Database: Embase</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576742/table/ch5.appb.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch5.appb.tab6_lrgtbl__"><table><thead><tr><th id="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">#</th><th id="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Searches</th></tr></thead><tbody><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*PERINATAL PERIOD/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *BIRTH/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *LABOR/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *DELIVERY/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*PREMATURE LABOR/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*INTRAPARTUM CARE/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(labo?r or childbirth or partu$ or intra?part$ or peri?part$).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((during or giving or give) adj3 birth?).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(c?esar#an$ or c section$ or csection$ or (deliver$ adj3 abdom$) or ((vagina$ or cephalic$ or forcep? or induc$ or extract$ or ventouse? or spontaneous$) adj3 (birth$ or born or deliver$))).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1–9</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *STEROID/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *CORTICOSTEROID/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*PREDNISONE/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*PREDNISOLONE/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*HYDROCORTISONE/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*DEXAMETHASONE/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">steroid$.mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">corticosteroid?.mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">prednisone.mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(prednisolone or fluprednisolone or methylprednisolone or prednimustine).mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(hydrocortisone or fludrocortisone).mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">dexamethasone.mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/11–22</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((stress or rescue or maintenance or increment$ or boost$ or supplement$ or additional$ or added$ or increas$) adj3 (dose? or dosag$)).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((Temporar$ or short term or physiological$) adj3 increase$).ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/24–25</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (stress or rescue or maintenance or increment$ or boost$ or supplement$ or additional$ or added$ or increas$)).mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (high$ adj2 (dose? or level?))).mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 replace$).mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((steroid$ or corticosteroid? or prednisone or fluprednisolone or methylprednisolone or prednimustine or Hydrocortisone or fludrocortisone or Dexamethasone) adj3 (regimen$ or long term)).mp.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 and 23 and 26</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 and 27</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 and 28</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 and 29</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 and 30</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/31–35</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 36 to english language</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or LETTER/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CASE REPORT/ or CASE STUDY/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/38–42</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RANDOMIZED CONTROLLED TRIAL/ or random*.ti,ab.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43 not 44</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ANIMAL/ not HUMAN/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NONHUMAN/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp ANIMAL EXPERIMENT/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp EXPERIMENTAL ANIMAL/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ANIMAL MODEL/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp RODENT/</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/45–52</td></tr><tr><td headers="hd_h_ch5.appb.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54</td><td headers="hd_h_ch5.appb.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37 not 53</td></tr></tbody></table></div></div></article><article data-type="fig" id="figobch5appcfig1"><div id="ch5.appc.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Flow%20diagram%20of%20clinical%20article%20selection%20for%20intrapartum%20care%20for%20women%20on%20long-term%20systemic%20steroid%20medication.&p=BOOKS&id=576742_ch5appcf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK576742/bin/ch5appcf1.jpg" alt="Figure 1. Flow diagram of clinical article selection for intrapartum care for women on long-term systemic steroid medication." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Flow diagram of clinical article selection for intrapartum care for women on long-term systemic steroid medication</span></h3></div></article><article data-type="table-wrap" id="figobch5appdtab1"><div id="ch5.appd.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576742/table/ch5.appd.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch5.appd.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Study</th><th id="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reason for Exclusion</th></tr></thead><tbody><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anonymous,, Systemic lupus erythematosus in pregnancy, Annals of Internal Medicine, 94, 667–77, 1981</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design; non-comparative study</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bar, J., Fisch, B., Wittenberg, C., Gelerenter, I., Boner, G., Hod, M., Prednisone dosage and pregnancy outcome in renal allograft recipients, Nephrology Dialysis Transplantation, 12, 760–3, 1997</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design; non-comparative study</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Beck, J. C., Johnson, J. W. C., Maternal administration of glucocorticoids, Clinical Obstetrics and Gynecology, 23, 93–113, 1980</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design; non-systematic review</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Centre for, Reviews, Dissemination,, Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies (Structured abstract), Database of Abstracts of Reviews of Effects, 2015</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population outside of scope; women using hydrocortisone during pregnancy</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Daskalakis, G., Mole, I., Ntomali, A., Papantoniou, N., Antsaklis, P., Mesogitis, S., Pregnancy in a patient with eosinophilic granulomatosis with polyangiitis (churg-strauss syndrome), Journal of Maternal-Fetal and Neonatal Medicine, 27, 302–303, 2014</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference proceedings</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fawzy,M., Shokeir,T., El-Tatongy,M., Warda,O., El-Refaiey,A.A., Mosbah,A., Treatment options and pregnancy outcome in women with idiopathic recurrent miscarriage: a randomized placebo-controlled study, Archives of Gynecology and Obstetrics, 278, 33–38, 2008</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population outside of scope; women with idiopathic recurrent miscarriage</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Foocharoen, C., Nanagara, R., Salang, L., Suwannaroj, S., Mahakkanukrauh, A., Pregnancy and disease outcome in patients with systemic lupus erythematosus (SLE): a study at Srinagarind Hospital, Journal of the Medical Association of Thailand, 92, 167–74, 2009</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison outside of scope</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Goetzl,L., Zighelboim,I., Badell,M., Rivers,J., Mastrangelo,M.A., Tweardy,D., Suresh,M.S., Maternal corticosteroids to prevent intrauterine exposure to hyperthermia and inflammation: a randomized, double-blind, placebo-controlled trial, American Journal of Obstetrics and Gynecology, 195, 1031–1037, 2006</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population outside of scope; women not on long-term steroid medication</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kuprys-Lipinska, I., Tworek, D., Kuna, P., Omalizumab in pregnant women treated due to severe asthma: two case reports of good outcomes of pregnancies, Postepy Dermatologii I Alergologii, 31, 104–7, 2014</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design; case report</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lebbe, M., Arlt, W., What is the best diagnostic and therapeutic management strategy for an Addison patient during pregnancy?, Clinical Endocrinology, 78, 497–502, 2013</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design; non-systematic review</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Leung, Y. P. Y., Kaplan, G. G., Coward, S., Tanyingoh, D., Kaplan, B. J., Johnston, D. W., Barkema, H. W., Ghosh, S., Panaccione, R., Seow, C. H., Field, C. J., Dewey, D., Bell, R. C., Bernier, F. P., Cantell, M., Casey, L. M., Eliasziw, M., Farmer, A., Gagnon, L., Giesbrecht, G. F., Goonewardene, L., Kooistra, L., Letourneau, N., Leung, B. M., Manca, D. P., Martin, J. W., McCargar, L. J., O’Beirne, M., Pop, V. J., Singhal, N., Intrapartum corticosteroid use significantly increases the risk of gestational diabetes in women with inflammatory bowel disease, Journal of Crohn’s and Colitis, 9, 223–230, 2015</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population outside of scope; mixed population (18.1% of women used intrapartum corticosteroid therapy)</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lockshin, M. D., Sammaritano, L. R., Corticosteroids during pregnancy, Scandinavian Journal of Rheumatology - Supplement, 107, 136–8, 1998</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design; non-systematic review</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Petersen, E., Frey, H., Benninger, C., Phillips, G., Shellhaas, C., McCallister, J. W., Comparison of the emergency department with labor and delivery in the treatment of pregnant women with acute asthma exacerbations, American Journal of Respiratory and Critical Care Medicine. Conference: American Thoracic Society International Conference, ATS, 185, 2012</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference proceedings</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Plauborg, A. V., Hansen, A. V., Garne, E., Use of azathioprine and corticosteroids during pregnancy and birth outcome in women diagnosed with inflammatory bowel disease, Birth Defects Research, 106, 494–9, 2016</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design; non-comparative study</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Plauborg, Anne Veie, Hansen, Anne Vinkel, Garne, Ester, Use of azathioprine and corticosteroids during pregnancy and birth outcome in women diagnosed with inflammatory bowel disease, Birth defects research. Part A, Clinical and molecular teratology, 106, 494–9, 2016</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison outside of scope; women with ulcerative colitis vs. women with Crohn’s disease vs. women with no IBD diagnosis</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pollard,J.K., Scott,J.R., Branch,D.W., Outcome of children born to women treated during pregnancy for the antiphospholipid syndrome, Obstetrics and Gynecology, 80, 365–368, 1992</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison outside of scope; women in the control group did not have any medical condition indicated for long-term steroid therapy</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Powrie,R.O., Larson,L., Miller,M., Managing asthma in expectant mothers, Treatments in Respiratory Medicine, 5, 1–10, 2006</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Full text unavailable</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ravenscraft, S. A., Lupo, V. R., Asthma: Management during pregnancy, Seminars in Respiratory and Critical Care Medicine, 19, 221–230, 1998</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design; non-systematic review</td></tr><tr><td headers="hd_h_ch5.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ruiz-Irastorza, G., Khamashta, M. A., Managing lupus patients during pregnancy, Best Practice & Research in Clinical Rheumatology, 23, 575–82, 2009</td><td headers="hd_h_ch5.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design; non-systematic review</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">IBD: inflammatory bowel disease</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch5appgtab1"><div id="ch5.appg.tab1" class="table"><h3><span class="label">Table 3</span><span class="title">Clinical evidence profile for high dose versus low dose of top-up hydrocortisone therapy during labour, outcomes for the women</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576742/table/ch5.appg.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch5.appg.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch5.appg.tab1_1_1_1_1" colspan="7" rowspan="1" style="text-align:left;vertical-align:bottom;">Quality assessment</th><th id="hd_h_ch5.appg.tab1_1_1_1_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Number of women</th><th id="hd_h_ch5.appg.tab1_1_1_1_3" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Effect</th><th id="hd_h_ch5.appg.tab1_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch5.appg.tab1_1_1_1_4" style="text-align:left;vertical-align:bottom;">Quality</th><th id="hd_h_ch5.appg.tab1_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_ch5.appg.tab1_1_1_1_5" style="text-align:left;vertical-align:bottom;">Importance</th></tr><tr><th headers="hd_h_ch5.appg.tab1_1_1_1_1" id="hd_h_ch5.appg.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of studies</th><th headers="hd_h_ch5.appg.tab1_1_1_1_1" id="hd_h_ch5.appg.tab1_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Design</th><th headers="hd_h_ch5.appg.tab1_1_1_1_1" id="hd_h_ch5.appg.tab1_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th headers="hd_h_ch5.appg.tab1_1_1_1_1" id="hd_h_ch5.appg.tab1_1_1_2_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th headers="hd_h_ch5.appg.tab1_1_1_1_1" id="hd_h_ch5.appg.tab1_1_1_2_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th headers="hd_h_ch5.appg.tab1_1_1_1_1" id="hd_h_ch5.appg.tab1_1_1_2_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th headers="hd_h_ch5.appg.tab1_1_1_1_1" id="hd_h_ch5.appg.tab1_1_1_2_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Other considerations</th><th headers="hd_h_ch5.appg.tab1_1_1_1_2" id="hd_h_ch5.appg.tab1_1_1_2_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">High dose</th><th headers="hd_h_ch5.appg.tab1_1_1_1_2" id="hd_h_ch5.appg.tab1_1_1_2_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Low dose</th><th headers="hd_h_ch5.appg.tab1_1_1_1_3" id="hd_h_ch5.appg.tab1_1_1_2_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative (95% CI)</th><th headers="hd_h_ch5.appg.tab1_1_1_1_3" id="hd_h_ch5.appg.tab1_1_1_2_11" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_ch5.appg.tab1_1_1_1_1 hd_h_ch5.appg.tab1_1_1_2_1 hd_h_ch5.appg.tab1_1_1_2_2 hd_h_ch5.appg.tab1_1_1_2_3 hd_h_ch5.appg.tab1_1_1_2_4 hd_h_ch5.appg.tab1_1_1_2_5 hd_h_ch5.appg.tab1_1_1_2_6 hd_h_ch5.appg.tab1_1_1_2_7 hd_h_ch5.appg.tab1_1_1_1_2 hd_h_ch5.appg.tab1_1_1_2_8 hd_h_ch5.appg.tab1_1_1_2_9 hd_h_ch5.appg.tab1_1_1_1_3 hd_h_ch5.appg.tab1_1_1_2_10 hd_h_ch5.appg.tab1_1_1_2_11 hd_h_ch5.appg.tab1_1_1_1_4 hd_h_ch5.appg.tab1_1_1_1_5" id="hd_b_ch5.appg.tab1_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Acute adrenal insufficiency: adrenal insufficiency</th></tr><tr><td headers="hd_h_ch5.appg.tab1_1_1_1_1 hd_h_ch5.appg.tab1_1_1_2_1 hd_b_ch5.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>(<a class="bibr" href="#ch5.ref2" rid="ch5.ref2">Owa 2017</a>)</p>
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</td><td headers="hd_h_ch5.appg.tab1_1_1_1_1 hd_h_ch5.appg.tab1_1_1_2_2 hd_b_ch5.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Retrospective cohort study</td><td headers="hd_h_ch5.appg.tab1_1_1_1_1 hd_h_ch5.appg.tab1_1_1_2_3 hd_b_ch5.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>1</sup></td><td headers="hd_h_ch5.appg.tab1_1_1_1_1 hd_h_ch5.appg.tab1_1_1_2_4 hd_b_ch5.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not applicable</td><td headers="hd_h_ch5.appg.tab1_1_1_1_1 hd_h_ch5.appg.tab1_1_1_2_5 hd_b_ch5.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch5.appg.tab1_1_1_1_1 hd_h_ch5.appg.tab1_1_1_2_6 hd_b_ch5.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not estimable due to 0 events</td><td headers="hd_h_ch5.appg.tab1_1_1_1_1 hd_h_ch5.appg.tab1_1_1_2_7 hd_b_ch5.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch5.appg.tab1_1_1_1_2 hd_h_ch5.appg.tab1_1_1_2_8 hd_b_ch5.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0/47 (0%)</td><td headers="hd_h_ch5.appg.tab1_1_1_1_2 hd_h_ch5.appg.tab1_1_1_2_9 hd_b_ch5.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0/55 (0%)</td><td headers="hd_h_ch5.appg.tab1_1_1_1_3 hd_h_ch5.appg.tab1_1_1_2_10 hd_b_ch5.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not calculable<sup>2</sup></td><td headers="hd_h_ch5.appg.tab1_1_1_1_3 hd_h_ch5.appg.tab1_1_1_2_11 hd_b_ch5.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not calculable<sup>2</sup></td><td headers="hd_h_ch5.appg.tab1_1_1_1_4 hd_b_ch5.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>⊕⊝⊝⊝</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_ch5.appg.tab1_1_1_1_5 hd_b_ch5.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch5.appg.tab1_1_1_1_1 hd_h_ch5.appg.tab1_1_1_2_1 hd_h_ch5.appg.tab1_1_1_2_2 hd_h_ch5.appg.tab1_1_1_2_3 hd_h_ch5.appg.tab1_1_1_2_4 hd_h_ch5.appg.tab1_1_1_2_5 hd_h_ch5.appg.tab1_1_1_2_6 hd_h_ch5.appg.tab1_1_1_2_7 hd_h_ch5.appg.tab1_1_1_1_2 hd_h_ch5.appg.tab1_1_1_2_8 hd_h_ch5.appg.tab1_1_1_2_9 hd_h_ch5.appg.tab1_1_1_1_3 hd_h_ch5.appg.tab1_1_1_2_10 hd_h_ch5.appg.tab1_1_1_2_11 hd_h_ch5.appg.tab1_1_1_1_4 hd_h_ch5.appg.tab1_1_1_1_5" id="hd_b_ch5.appg.tab1_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Adverse effects: endometriosis or hyperglycaemia or wound infection</th></tr><tr><td headers="hd_h_ch5.appg.tab1_1_1_1_1 hd_h_ch5.appg.tab1_1_1_2_1 hd_b_ch5.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>(<a class="bibr" href="#ch5.ref2" rid="ch5.ref2">Owa 2017</a>)</p>
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</td><td headers="hd_h_ch5.appg.tab1_1_1_1_1 hd_h_ch5.appg.tab1_1_1_2_2 hd_b_ch5.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Retrospective cohort study</td><td headers="hd_h_ch5.appg.tab1_1_1_1_1 hd_h_ch5.appg.tab1_1_1_2_3 hd_b_ch5.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>1</sup></td><td headers="hd_h_ch5.appg.tab1_1_1_1_1 hd_h_ch5.appg.tab1_1_1_2_4 hd_b_ch5.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not applicable</td><td headers="hd_h_ch5.appg.tab1_1_1_1_1 hd_h_ch5.appg.tab1_1_1_2_5 hd_b_ch5.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch5.appg.tab1_1_1_1_1 hd_h_ch5.appg.tab1_1_1_2_6 hd_b_ch5.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>3</sup></td><td headers="hd_h_ch5.appg.tab1_1_1_1_1 hd_h_ch5.appg.tab1_1_1_2_7 hd_b_ch5.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch5.appg.tab1_1_1_1_2 hd_h_ch5.appg.tab1_1_1_2_8 hd_b_ch5.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>6/47</p>
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<p>(12.7%)</p>
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</td><td headers="hd_h_ch5.appg.tab1_1_1_1_2 hd_h_ch5.appg.tab1_1_1_2_9 hd_b_ch5.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1/55 (1.8%)</td><td headers="hd_h_ch5.appg.tab1_1_1_1_3 hd_h_ch5.appg.tab1_1_1_2_10 hd_b_ch5.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 7.02 (0.88, 56.25)</td><td headers="hd_h_ch5.appg.tab1_1_1_1_3 hd_h_ch5.appg.tab1_1_1_2_11 hd_b_ch5.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">109 more per 1000 (from 2 fewer to 1000 more)</td><td headers="hd_h_ch5.appg.tab1_1_1_1_4 hd_b_ch5.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>⊕⊝⊝⊝</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_ch5.appg.tab1_1_1_1_5 hd_b_ch5.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">CI: confidence interval; HD: high dose; LD: low dose; RR: risk ratio</p></div></dd></dl><dl class="bkr_refwrap"><dt>1</dt><dd><div id="ch5.appg.tab1_1"><p class="no_margin">There were more women with ITP in HD than LD group and no adjustment was done in the analysis</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="ch5.appg.tab1_2"><p class="no_margin">This was not calculable as there were zero events</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="ch5.appg.tab1_3"><p class="no_margin">The quality of <u>t</u>he evidence was downgraded by 1 <u>level</u> because the 95% CI crosses 1 default MID <u>threshold</u></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch5appgtab2"><div id="ch5.appg.tab2" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence profile for high dose versus low dose of top-up hydrocortisone therapy during labour, outcomes for the baby</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576742/table/ch5.appg.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch5.appg.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch5.appg.tab2_1_1_1_1" colspan="7" rowspan="1" style="text-align:left;vertical-align:bottom;">Quality assessment</th><th id="hd_h_ch5.appg.tab2_1_1_1_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Number of babies</th><th id="hd_h_ch5.appg.tab2_1_1_1_3" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Effect</th><th id="hd_h_ch5.appg.tab2_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch5.appg.tab2_1_1_1_4" style="text-align:left;vertical-align:bottom;">Quality</th><th id="hd_h_ch5.appg.tab2_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_ch5.appg.tab2_1_1_1_5" style="text-align:left;vertical-align:bottom;">Importance</th></tr><tr><th headers="hd_h_ch5.appg.tab2_1_1_1_1" id="hd_h_ch5.appg.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of studies</th><th headers="hd_h_ch5.appg.tab2_1_1_1_1" id="hd_h_ch5.appg.tab2_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Design</th><th headers="hd_h_ch5.appg.tab2_1_1_1_1" id="hd_h_ch5.appg.tab2_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th headers="hd_h_ch5.appg.tab2_1_1_1_1" id="hd_h_ch5.appg.tab2_1_1_2_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th headers="hd_h_ch5.appg.tab2_1_1_1_1" id="hd_h_ch5.appg.tab2_1_1_2_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th headers="hd_h_ch5.appg.tab2_1_1_1_1" id="hd_h_ch5.appg.tab2_1_1_2_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th headers="hd_h_ch5.appg.tab2_1_1_1_1" id="hd_h_ch5.appg.tab2_1_1_2_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Other considerations</th><th headers="hd_h_ch5.appg.tab2_1_1_1_2" id="hd_h_ch5.appg.tab2_1_1_2_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">High dose</th><th headers="hd_h_ch5.appg.tab2_1_1_1_2" id="hd_h_ch5.appg.tab2_1_1_2_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Low dose</th><th headers="hd_h_ch5.appg.tab2_1_1_1_3" id="hd_h_ch5.appg.tab2_1_1_2_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative (95% CI)</th><th headers="hd_h_ch5.appg.tab2_1_1_1_3" id="hd_h_ch5.appg.tab2_1_1_2_11" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_ch5.appg.tab2_1_1_1_1 hd_h_ch5.appg.tab2_1_1_2_1 hd_h_ch5.appg.tab2_1_1_2_2 hd_h_ch5.appg.tab2_1_1_2_3 hd_h_ch5.appg.tab2_1_1_2_4 hd_h_ch5.appg.tab2_1_1_2_5 hd_h_ch5.appg.tab2_1_1_2_6 hd_h_ch5.appg.tab2_1_1_2_7 hd_h_ch5.appg.tab2_1_1_1_2 hd_h_ch5.appg.tab2_1_1_2_8 hd_h_ch5.appg.tab2_1_1_2_9 hd_h_ch5.appg.tab2_1_1_1_3 hd_h_ch5.appg.tab2_1_1_2_10 hd_h_ch5.appg.tab2_1_1_2_11 hd_h_ch5.appg.tab2_1_1_1_4 hd_h_ch5.appg.tab2_1_1_1_5" id="hd_b_ch5.appg.tab2_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Long-term neuro-developmental outcomes: oesophageal atresia or cleft lip or congenital cystic adenomatoid malformations</th></tr><tr><td headers="hd_h_ch5.appg.tab2_1_1_1_1 hd_h_ch5.appg.tab2_1_1_2_1 hd_b_ch5.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>(<a class="bibr" href="#ch5.ref2" rid="ch5.ref2">Owa 2017</a>)</p>
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</td><td headers="hd_h_ch5.appg.tab2_1_1_1_1 hd_h_ch5.appg.tab2_1_1_2_2 hd_b_ch5.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Retrospective cohort study</td><td headers="hd_h_ch5.appg.tab2_1_1_1_1 hd_h_ch5.appg.tab2_1_1_2_3 hd_b_ch5.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>1</sup></td><td headers="hd_h_ch5.appg.tab2_1_1_1_1 hd_h_ch5.appg.tab2_1_1_2_4 hd_b_ch5.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not applicable</td><td headers="hd_h_ch5.appg.tab2_1_1_1_1 hd_h_ch5.appg.tab2_1_1_2_5 hd_b_ch5.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch5.appg.tab2_1_1_1_1 hd_h_ch5.appg.tab2_1_1_2_6 hd_b_ch5.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>2</sup></td><td headers="hd_h_ch5.appg.tab2_1_1_1_1 hd_h_ch5.appg.tab2_1_1_2_7 hd_b_ch5.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch5.appg.tab2_1_1_1_2 hd_h_ch5.appg.tab2_1_1_2_8 hd_b_ch5.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1/47</p>
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<p>(2.1%)</p>
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</td><td headers="hd_h_ch5.appg.tab2_1_1_1_2 hd_h_ch5.appg.tab2_1_1_2_9 hd_b_ch5.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2/55 (3.6%)</td><td headers="hd_h_ch5.appg.tab2_1_1_1_3 hd_h_ch5.appg.tab2_1_1_2_10 hd_b_ch5.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.59 (0.05, 6.25)</td><td headers="hd_h_ch5.appg.tab2_1_1_1_3 hd_h_ch5.appg.tab2_1_1_2_11 hd_b_ch5.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 fewer per 1000 (from 35 fewer to 191 more)</td><td headers="hd_h_ch5.appg.tab2_1_1_1_4 hd_b_ch5.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>⊕⊝⊝⊝</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_ch5.appg.tab2_1_1_1_5 hd_b_ch5.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">CI: confidence interval; HD: high dose; LD: low dose; RR: risk ratio</p></div></dd></dl><dl class="bkr_refwrap"><dt>1</dt><dd><div id="ch5.appg.tab2_1"><p class="no_margin">There were more women with ITP in HD than LD group and no adjustment was done in the analysis</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="ch5.appg.tab2_2"><p class="no_margin">The quality of <u>t</u>he evidence was downgraded by 2 <u>levels</u> because the 95% CI crosses 2 default MID <u>thresholds</u></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch5appltab1"><div id="ch5.appl.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576742/table/ch5.appl.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch5.appl.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch5.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Research question</th><th id="hd_h_ch5.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Are supplemental steroids required in the intrapartum period for women taking regular antenatal steroids?</th></tr></thead><tbody><tr><td headers="hd_h_ch5.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Importance to ‘patients’ or the population</td><td headers="hd_h_ch5.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current treatment recommendations are not based on evidence from studies in pregnancy. Supplementation with hydrocortisone for all pregnant women taking 5mg prednisolone or more, may lead to a large number of women being treated unnecessarily and their intrapartum experience being unnecessarily over medicalised. Benefits and harms to woman and neonate have not been assessed.</td></tr><tr><td headers="hd_h_ch5.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relevance to NICE guidance</td><td headers="hd_h_ch5.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High Priority: Recommendations are based on clinical consensus. A clinical trial to assess endogenous adrenal function in women on different doses of prednisolone and the necessary hydrocortisone supplementation will give evidence to guide a NICE recommendation in this area.</td></tr><tr><td headers="hd_h_ch5.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relevance to NHS</td><td headers="hd_h_ch5.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ensuring appropriate evidence-based treatment of pregnant women during the intrapartum period.</td></tr><tr><td headers="hd_h_ch5.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">National priorities</td><td headers="hd_h_ch5.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This research will guide clinical practise.</td></tr><tr><td headers="hd_h_ch5.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current evidence base</td><td headers="hd_h_ch5.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No clinical trials informed current NICE recommendations which were based on the guideline committee’s experience and expertise.</td></tr><tr><td headers="hd_h_ch5.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Equalities</td><td headers="hd_h_ch5.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">N/A: not applicable; NICE: National Institute for Health and Care Excellence</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch5appltab2"><div id="ch5.appl.tab2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576742/table/ch5.appl.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch5.appl.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch5.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Criterion</th><th id="hd_h_ch5.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Explanation</th></tr></thead><tbody><tr><td headers="hd_h_ch5.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</td><td headers="hd_h_ch5.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pregnant women taking regular steroid treatment shortly before childbirth</td></tr><tr><td headers="hd_h_ch5.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</td><td headers="hd_h_ch5.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Offering intrapartum steroid supplementation to those with evidence of suppressed endogenous adrenal function (determined by endogenous adrenal function in pregnant women taking regular steroid treatment shortly before childbirth)</td></tr><tr><td headers="hd_h_ch5.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator</td><td headers="hd_h_ch5.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Care guided by new NICE recommendation</td></tr><tr><td headers="hd_h_ch5.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</td><td headers="hd_h_ch5.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch5.l38"><li id="ch5.lt104" class="half_rhythm"><div>Number of women in each group receiving intrapartum hydrocortisone supplementation</div></li><li id="ch5.lt105" class="half_rhythm"><div>Acceptability of both regimes to women</div></li><li id="ch5.lt106" class="half_rhythm"><div>Pregnancy and neonatal outcomes.</div></li></ul></td></tr><tr><td headers="hd_h_ch5.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</td><td headers="hd_h_ch5.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td></tr><tr><td headers="hd_h_ch5.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Timeframe</td><td headers="hd_h_ch5.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 years</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">NICE: National Institute for Health and Care Excellence; RCT: randomised controlled trial</p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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