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  • Title: Appropriate antenatal corticosteroid use in women at risk for preterm birth before 34 weeks of gestation.
    Author: Mahony R, McKeating A, Murphy T, McAuliffe F, O'Herlihy C, Foley M.
    Journal: BJOG; 2010 Jul; 117(8):963-7. PubMed ID: 20465556.
    Abstract:
    OBJECTIVE: To determine the utilisation of antenatal corticosteroid administration in women presenting at risk of preterm birth (PTB) in a centre where tocolytics are not prescribed. DESIGN: A prospective cohort study. SETTING: Tertiary referral centre, Dublin, Ireland. POPULATION: Four hundred and fourteen consecutive women presenting at risk of PTB. METHODS: Clinical details were collated prospectively on all booked patients who presented at risk of PTB (i.e. at <34 weeks of gestation) during 2008. MAIN OUTCOME MEASURE: Rate of administration of antenatal corticosteroids in PTB. RESULTS: Of 8985 deliveries, 414 women (5%) presented at <34 weeks of gestation with a clinical potential for PTB, of whom 277 (67%) received antenatal corticosteroids. Amongst women delivering at <34 weeks of gestation, 93% (80/86) received any corticosteroids and 76% (65/86) received a complete course. The ratio of women given a complete course of corticosteroids to the number who actually delivered before 34 weeks of gestation was 4:1 overall. Analysis by indication for PTB revealed this ratio to be 15:1 in suspected preterm labour (PTL), 8:1 in antepartum haemorrhage (APH), and 2:1 in both preterm prelabour rupture of membranes (PPROM) and medically indicated PTB (MIPTB). Seven of ten multiparae (70%) who delivered prematurely during the study period following PTL had a history of previous PTL before 34 weeks of gestation. CONCLUSION: The ratio of maternal antenatal corticosteroid administration for potential versus actual PTB at <34 weeks of gestation was high in categories such as PTL and substantial APH, whereas selection in PPROM and MIPTB approached 100%. There should be a low threshold for single course therapy for women with prior PTL before 34 weeks of gestation.
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