Antenatal Corticosteroids for Preterm Premature Rupture of Membranes: Single or Repeat Course?

Brookfield, Kathleen; El‐Sayed, Yasser Y.; Chao, Lisa; Berger, Victoria; Naqvi, Mariam; Butwick, Alexander J.

doi:10.1055/s-0034-1396690

Cited by 9 publications

(8 citation statements)

References 30 publications

(39 reference statements)

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“…The rate of neonatal sepsis was similar whether the woman had received one compared with two courses of steroids (16.2 versus 17.2%) 44 . A further secondary analysis of the BEAM dataset found no increased risk of chorioamnionitis between the groups (single course incidence 12.3% and repeat course, 11.0%) 45 Evidence level 2+ …”

Section: In What Particular Circumstances Should Antenatal Corticoste...mentioning

confidence: 83%

“…44 A further secondary analysis of the BEAM dataset found no increased risk of chorioamnionitis between the groups (single course incidence 12.3% and repeat course, 11.0%). 45 Evidence level 2+ Antenatal corticosteroids are designed to cross the placenta. They are given at high doses that have been unchanged since Liggins' and Howie's original experiments in the 1970s and have not been optimised for human pregnancy.…”

Section: + Cmentioning

confidence: 99%

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Antenatal corticosteroids to reduce neonatal morbidity and mortality

Stock¹,

Thomson²,

Papworth³

2022

BJOG

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Section: In What Particular Circumstances Should Antenatal Corticoste...mentioning

confidence: 83%

Section: + Cmentioning

confidence: 99%

Antenatal corticosteroids to reduce neonatal morbidity and mortality

Stock¹,

Thomson²,

Papworth³

2022

BJOG

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“…There is strong evidence to support the safety of a single repeat course of antenatal corticosteroids in women in preterm labor or with PPROM if 7 days have passed after the initial course and there is a high risk of preterm birth in the next 7 days. 50,59,60 This is because the optimal benefits of antenatal corticosteroids last for 7 days. 48 More than two courses is not recommended owing to the deleterious effects of multiple corticosteroid doses on fetal growth and neurodevelopment.…”

Section: Considering Antenatal Corticosteroid Administration At 22-36 +6mentioning

confidence: 99%

“…PPROM or proven preterm labor if preterm birth does not occur and there is a high risk of preterm birth in the next 7 days 50,59,60 8. Maximum of two courses of antenatal corticosteroids with PPROM or those at risk of preterm birth 13,61 9.…”

Section: Antenatal Corticosteroids Repeat After 7 Days Withmentioning

confidence: 99%

“…This is because the optimal benefits of antenatal corticosteroids are already seen 24 hours after administration, and are maximal at 48 hours; therefore, delaying preterm birth until this time point is optimal, if feasible and safe. There is strong evidence to support the safety of a single repeat course of antenatal corticosteroids in women in preterm labor or with PPROM if 7 days have passed after the initial course and there is a high risk of preterm birth in the next 7 days 50,59,60 . This is because the optimal benefits of antenatal corticosteroids last for 7 days 48 .…”

Section: Corticosteroid Use In Pprom and Preterm Labormentioning

confidence: 99%

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FIGO good practice recommendations for preterm labor and preterm prelabor rupture of membranes: Prep‐for‐Labor triage to minimize risks and maximize favorable outcomes

Ubom,

Vatish,

Barnea

2023

Intl J Gynecology & Obste

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Preterm labor occurs in around 10% of pregnancies worldwide. Once diagnosed, significant efforts must be made to reduce the likelihood of morbidity and mortality associated with preterm birth. In high‐resource settings, access to hospitals with a neonatal intensive care unit (NICU) is readily available, whereas access to NICU care is limited in low‐ and middle‐income countries (LMICs) and many rural settings. Use of FIGO's Prep‐for‐Labor triage method rapidly identifies low‐ and high‐risk patients with preterm labor to enable clinicians to decide whether the patient can be managed on site or if transfer to a level II–IV facility is needed. The management steps described in this paper aim to minimize the morbidity and mortality associated with preterm labor and in the setting of preterm labor with preterm premature rupture of membranes (PPROM). The methods for accurate diagnosis of PPROM and chorioamnionitis are described. When the risk of preterm birth is high, antenatal corticosteroids should be administered for lung maturation combined with limited tocolysis for 48 hours to permit the corticosteroid course to be completed. Magnesium sulfate is also administered for fetal neuroprotection. Implementation of FIGO's Prep‐for‐Labor triage method in an LMIC setting will help improve maternal and neonatal outcomes.

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Administration of Antenatal Corticosteroids: Optimal Timing

Berger,

Stelzl,

Maul

2024

Geburtshilfe Frauenheilkd

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The effectiveness of antenatal corticosteroids (ACS) in significantly reducing respiratory distress syndrome (RDS) depends crucially on the timing. It is successful if delivery takes place between 24 hours and seven days following administration; after this period, the side effects seem to predominate. In addition, an increased rate of mental impairment and behavioral disorders are observed in children born full-term after ACS administration. The optimal timing of ACS administration depends crucially on the given indication; to date, it has been achieved in only 25–40% of cases. ACS administration is always indicated in PPROM, in severe early pre-eclampsia, in fetal IUGR with zero or reverse flow in the umbilical artery, in placenta previa with bleeding, and in patients experiencing premature labor with a cervical length < 15 mm. The risk of women with asymptomatic cervical insufficiency giving birth within seven days is very low. In this case, ACS should not be administered even if the patient’s cervical length is less than 15 mm, provided that the cervix is closed and there are no other risk factors for a premature birth. The development of further diagnostic methods with improved power to predict premature birth is urgently needed in order to optimize the timing of ACS administration in this patient population. Caution when administering ACS is also indicated in women experiencing premature labor who have a cervical length ≥ 15 mm. Further studies using amniocentesis are needed in order to identify the patient population with microbial invasion of the amniotic cavity/intra-amniotic infection (MIAC/IAI), and to define threshold values at which delivery is indicated. ACS administration is not performed as an emergency measure, usually not even before transfer to a perinatal center. Therefore, whenever possible, the indication for ACS administration should be determined by a clinician who is highly experienced in perinatology.

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Antenatal Corticosteroids for Preterm Premature Rupture of Membranes: Single or Repeat Course?

Cited by 9 publications

References 30 publications

Antenatal corticosteroids to reduce neonatal morbidity and mortality

Antenatal corticosteroids to reduce neonatal morbidity and mortality

FIGO good practice recommendations for preterm labor and preterm prelabor rupture of membranes: Prep‐for‐Labor triage to minimize risks and maximize favorable outcomes

Administration of Antenatal Corticosteroids: Optimal Timing

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