Antenatal Corticosteroid Use <34 weeks Gestation

Treatment with antenatal corticosteroids is associated with a reduction in neonatal death, RDS, IVH, NEC, intensive care admissions, and systemic infections in the first 48 hours of life. This treatment does not increase the maternal risks for death, chorioamnionitis, or puerperal infections.

In accordance with the NIH Consensus Conference recommendations, all pregnant women at risk for preterm delivery within seven days who are 24 to 34 weeks gestation are candidates for a single course of corticosteroids.  This should include women with PPROM, preeclampsia, multiple gestations and women in whom delivery is likely in less than 24 hours.

Treatment should consist of either two doses of IM Betamethasone (12 mg) twenty-four hours apart or four doses of IM Dexamethasone (6 mg) twelve hours apart.  The literature suggests that Betamethasone may be preferred.

A large multi-center randomized clinical trial has found that weekly courses of antenatal Betamethasone or Dexamethasone are no more effective at improving neonatal outcomes than a single dose regimen, except possibly in a subgroup of very premature neonates (i.e. 24 to 27 weeks).  Currently, our department recommends the following: If a patient is treated with antenatal corticosteroids at 24-27 weeks gestation and later (greater than 3 weeks) threatens preterm delivery, she should receive a second full dose of steroids.  This should only occur once during any given pregnancy.  Discussions concerning these patients should be undertaken with the attending faculty.

References

1. Guinn DA, Atkinson MW, Sullivan L et al.  Single versus weekly courses of antenatal  corticosteroids for women at risk for preterm delivery:  A randomized controlled trial.  JAMA.   2001:286:1581-1587
2. Mercer B, Egerman R, Beazley D, et al.  Weekly antenatal steroids in women at risk for  preterm birthing: A randomized trial.  Am J Obstet Gynecol.  2001; 184:S6.  Abstract 0012
3. Antenatal corticosteroids revisited:  Repeat courses – National Institutes of Health  Consensus Development Conference Statement, August 17-18, 2000. Obstet Gynecol.   2001; 98:144-150
4. Roberts D, Dalziel S.  Antenatal corticosteroids for accelerating fetal lung maturation for  women at risk for preterm birth.  Cochrane Database of Systematic Reviews 2006,  Issue 3. Art. No.: CD004454.  DOI:  10.1002/14651858.  CD004454.pub2