Missed opportunities for optimal antenatal corticosteroid timing in medically indicated preterm births

Rottenstreich, Amihai; Elchalal, Uriel; Yahya, Rani Haj; Mankuta, David; Rottenstreich, Misgav

doi:10.1080/14767058.2019.1670159

Cited by 3 publications

(5 citation statements)

References 21 publications

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“…By contrast, in cases of hypertensive disorders of pregnancy, such as gestational hypertension and pre‐eclampsia, the ACOG 20 set guidelines for situations in which delaying delivery until after completion of the ACS course is not advisable. Therefore, it is only reasonable that we found a higher percentage of the optimally timed than the suboptimally timed treatment group (20.6% vs. 15%) in this particular indication, similar to previous studies (62% vs. 23%–37%) 12,15 …”

Section: Discussionsupporting

confidence: 91%

“…ACS timing was optimal in the majority of women in this cohort (58%), a rate higher than previously reported in the medical literature (23% to 40.4%) 9,12 . However, in many studies, it was unclear whether the reported administration rate referred to a partial or complete course of ACS, and whether patients who did not receive ACS were included.…”

Section: Discussionmentioning

confidence: 66%

“…23%-37%). 12,15 The association of asymptomatic short cervical length with suboptimal timing of ACS administration is in line with the fact that cervical shortening is a risk factor for PTB, although it does not necessarily imply imminent PTB. Women with previous PTB and cervical length shortening are at the highest risk of preterm labor, 21 but, in our study, only 17% of women had a history of prior PTB.…”

Section: Discussionmentioning

confidence: 82%

“…ACS timing was optimal in the majority of women in this cohort (58%), a rate higher than previously reported in the medical literature (23% to 40.4%). 9,12 However, in many studies, it was unclear whether the reported administration rate referred to a partial or complete course of ACS, and whether patients who did not receive ACS were included. Therefore, we explicitly excluded two subgroups of patients from our analysis: women who gave birth <24 h after receiving ACS, and women who did not receive ACS at all.…”

Section: Discussionmentioning

confidence: 99%

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Optimizing the timing of antenatal corticosteroid administration prior to anticipated preterm birth: A retrospective cohort study

Danieli-Gruber

Levy

Gomez

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo examine suboptimal antenatal corticosteroid (ACS) administration based on indications and maternal‐obstetrical factors.MethodsWomen who prematurely delivered (24 + 0 to 36 + 6 gestational weeks) a viable neonate following ACS treatment between 2012 and 2019 were identified by a retrospective database review. The cohort was divided into patients in whom ACS administration was optimally timed (≥24 h to ≤7 days) or suboptimally timed (>7 days). The groups were compared for ACS indications and maternal, obstetrical, and neonatal parameters.ResultsThe cohort included 399 women. ACS timing was optimal in 233 patients (58%) and was associated with nulliparity (109 [46.8%] vs. 54 [32.5%], P = 0.004) and preterm premature rupture of membranes (89 [38.2%] vs. 45 [27.1%], P = 0.021). Suboptimal timing was associated with chronic hypertension (22 [9.4%] vs. 36 [21.7%], P < 0.001) and asymptomatic cervical shortening (23 [9.9%] vs. 26 [15.7%], P = 0.020). Optimal ACS timing was associated with higher neonatal intensive care unit admission (135 [58%] vs. 71 [42.8%], P = 0.003). On multivariate analysis, the adjusted odds ratio (aOR) of neonatal intensive care unit admission was 0.69 (95% confidence interval [CI], 0.58–0.83, P < 0.001) and 0.99 (95% CI, 0.99–1, P = 0.003) when adjusted for gestational age and birth weight, respectively. When adjusting for maternal age, the aOR for suboptimal ACS administraion due to chronic hypertension was 2.65 (95% CI, 1.49–4.72; P < 0.001).ConclusionOptimal timing of ACS varies based on different maternal characteristics and clinical indications. In the presence of certain parameters physicians tend to administer ACS suboptimally, diminishing its beneficial effect.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Optimizing the timing of antenatal corticosteroid administration prior to anticipated preterm birth: A retrospective cohort study

Danieli-Gruber

Levy

Gomez

et al. 2023

Intl J Gynecology & Obste

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“…Similarly, another study reported that rate of women receiving steroid administration within the 2-14 day period was 45% (16). In the present study, this rate (11.5%) was considerably lower compared to other studies.…”

Section: Discussioncontrasting

confidence: 70%

Evaluatıon of the timing and indications of antenatal corticosteroid administration

Tulmaç

Öztürk

Yaman

et al. 2020

Journal of Health Sciences and Medicine

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Objective: To investigate the timing of antenatal corticosteroid administration for pregnant women who were anticipated for preterm birth. Material and Method: This retrospective cohort study was conducted between September 2016 and September 2017 on cases treated with antenatal steroids and then performed birth in our hospital. The first 113 patients with 23-37 weeks of singleton or twin pregnancy, whose birth records could be accessed, were included in the study. Those who gave birth in another hospital, patients with incomplete records, and those carrying more than one of the indication types were excluded from the study. Results: The median interval between antenatal steroid administration and childbirth was 1.00 (0.02-97.00, IQR: 17.77) days. The interval from the first dose until birth was less than 2 days in 57.5% of cases (n=65), 2-7 days in 11.5% of cases (n=13), and more than 7 days in 31% of cases (n=35). Totally, this period was 7 days or below in 69% of cases (n=78). A significant correlation was found between spontaneous preterm labour as indication of steroid administration and appropriate timing (p=0.001, Odds Ratio:4.62, Confidence Interval: 1.90-11.19). Conclusion: The number of patients giving birth within optimal 2-7 days following the first dose of antenatal steroid administration, is very low. Attempts to improve timing are needed.

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One vs 2 courses of antenatal corticosteroids in pregnancies at risk of preterm birth: a secondary analysis of the MACS trial

Baghlaf

Snelgrove

et al. 2023

American Journal of Obstetrics & Gynecology MFM

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Missed opportunities for optimal antenatal corticosteroid timing in medically indicated preterm births

Cited by 3 publications

References 21 publications

Optimizing the timing of antenatal corticosteroid administration prior to anticipated preterm birth: A retrospective cohort study

Optimizing the timing of antenatal corticosteroid administration prior to anticipated preterm birth: A retrospective cohort study

Evaluatıon of the timing and indications of antenatal corticosteroid administration

One vs 2 courses of antenatal corticosteroids in pregnancies at risk of preterm birth: a secondary analysis of the MACS trial

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