Practice patterns in the timing of antenatal corticosteroids for fetal lung maturity

Abstract

Objective: To determine the practice patterns of antenatal corticosteroid (AS) administration in women with threatened preterm labor.

Methods: This was a retrospective cohort of patients who received betamethasone between 2009 and 2010, identified through a pharmacy database. Patients with high order multiples; incomplete records and indicated preterm delivery were excluded. Demographic and obstetrical factors were compared between women with an AS to delivery latency of ≤7 days versus >7 days. Parametric and non-parametric tests were used as appropriate. p < 0.05 denotes statistical significance; relative risks with 95% confidence intervals were calculated.

Results: Three-hundred forty-five patients were included. Sixty-eight patients (20%) received AS within 7 days of delivery. Women who received AS ≤7 days before delivery (optimal timing) were more likely to have a transvaginal cervical length ≤2 cm (RR:2.53, CI: 1.2–5.6), cervical dilation ≥2 cm (RR: 3.86, CI: 2.7–5.6) and positive fFN (RR: 2.59, CI: 1.1–6.3). Preterm premature ruptured membranes were also associated with optimal timing of AS (RR: 4.86, CI: 3.4–6.8).

Conclusions: Eighty percent of patients receive suboptimal timing of AS administration. Factors associated with suboptimal timing are: cervical length >2 cm, cervical dilation <2 cm and negative fFN. Cervical assessment should be a key factor in the decision for AS administration. More research is needed for accurate timing of AS in women with threatened preterm labor.

• Antenatal corticosteroids
• decision to administer antenatal corticosteroids
• timing of antenatal corticosteroids

Acknowledgements

Authors thank Elyana Matayeva, DO, Nassau University Medical Center.

Declaration of interest

The authors report no declarations of interest. There is no financial compensation disclosure to be made.