Trends in Optimal, Suboptimal, and Questionably Appropriate Receipt of Antenatal Corticosteroid Prophylaxis

Razaz, Neda; Skoll, Amanda; Fahey, John; Allen, Victoria M.; Joseph, K. S.

doi:10.1097/aog.0000000000000629

Cited by 78 publications

(85 citation statements)

References 24 publications

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“…Among all live births in Nova Scotia, Canada, optimal ACS receipt increased from 10% in 1988 to 23% in 2012 [10]. Among Dutch women with singleton, twin or triplet pregnancies, and preterm labor who completed a first course of ACS, 32% delivered with optimal timing of ACS.…”

Section: Commentmentioning

confidence: 99%

Can We Accurately Time the Administration of Antenatal Corticosteroids for Preterm Labor?

Aghajanian

Nguyen

Greene

et al. 2016

Obstetrics and Gynecology International

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Background. Accurate timing of antenatal corticosteroids (ACS) has resulted in improved neonatal outcomes. Objectives. Our primary objective was to determine predictors for optimal timing of ACS in women presenting with spontaneous preterm labor. Study Design. A retrospective cohort study of women receiving ACS for spontaneous preterm birth was conducted. Women were included if they presented with preterm labor or preterm premature rupture of membranes. Accurate timing of ACS was defined as administration within 7 days of delivery. Maternal demographic and obstetrics characteristics were compared between the groups receiving ACS ≤7 days and >7 days from delivery. Statistical analyses were performed using parametric and nonparametric tests. P < 0.05 was considered significant. Results. The study included 215 subjects. Median latency from ACS administration to delivery was 6 days (IQR 32). Accurate timing of ACS occurred in 113 (53%) women and was associated with rupture of membranes (OR 13.8, 95% CI 5.9–32.6), cervical change (OR 7.1, 95% CI 3.0–17.1), and cervical dilation ≥ 2 cm (OR 3.9, 95% CI 1.5–10.3). Conclusions. Rupture of membranes, cervical change, and cervical dilation ≥ 2 cm were strong predictors of optimal timing. 53% of women with preterm labor received ACS optimally.

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Section: Commentmentioning

confidence: 99%

Can We Accurately Time the Administration of Antenatal Corticosteroids for Preterm Labor?

Aghajanian

Nguyen

Greene

et al. 2016

Obstetrics and Gynecology International

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“…This makes it difficult to maximise ‘optimal’ use of corticosteroids (i.e., administration to women who go on to deliver within the next 7 days and not administering them to women who do not deliver within the next 7 days). A recent study from Nova Scotia, Canada, showed that between 1988 and 2012, the proportion of women with suboptimal antenatal corticosteroid treatment (i.e., more than 7 days prior to delivery) increased approximately 5 times (from 7% to 34%) whereas optimal treatment doubled (from 10% to 23%) [10]. …”

Section: Introductionmentioning

confidence: 99%

Timing of delivery in a high-risk obstetric population: a clinical prediction model

Silva

Lisonkova

Dadelszen

et al. 2017

BMC Pregnancy Childbirth

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BackgroundThe efficacy of antenatal corticosteroid treatment for women with threatened preterm birth depends on timely administration within 7 days before delivery. We modelled the probability of delivery within 7 days of admission to hospital among women presenting with threatened preterm birth, using routinely collected clinical characteristics.MethodsData from the Canadian Perinatal Network (CPN) were used, 2005–11, including women admitted to hospital with preterm labour, preterm pre-labour rupture of membranes, short cervix without contractions, or dilated cervix or prolapsed membranes without contractions at preterm gestation. Women with fetal anomaly, intrauterine fetal demise, twin-to-twin transfusion syndrome, and quadruplets were excluded. Logistic regression was undertaken to create a predictive model that was assessed for its calibration capacity, stratification ability, and classification accuracy (ROC curve).ResultsWe included 3012 women admitted at 24–28 weeks gestation, or readmitted at up to 34 weeks gestation, to 16 tertiary-care CPN hospitals. Of these, 1473 (48.9%) delivered within 7 days of admission. Significant predictors of early delivery included maternal age, parity, gestational age at admission, smoking, preterm labour, prolapsed membranes, preterm pre-labour rupture of membranes, and antepartum haemorrhage. The area under the ROC curve was 0.724 (95% CI 0.706–0.742).ConclusionWe propose a useful tool to improve prediction of delivery within 7 days after admission among women with threatened preterm birth. This information is important for optimal corticosteroid treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1390-9) contains supplementary material, which is available to authorized users.

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“…In all live births in Nova Scotia from 1998-2012, the rates of suboptimal treatment were 34% (odds ratio 6.7, 95% CI 3.9-11.6) and questionably appropriate treatment of 1.7% (odds ratio 7.5, 95% CI 4.9-11.3). 37 In fact, in 2012, more than half the newborns whose mothers received ANCS were born at 35 weeks gestation, and thus were unnecessarily exposed. 37 Another study demonstrated that of 692 women receiving ANCS at a single institution, 35.7% delivered at or >34 weeks gestation, and 17.9% remained pregnant beyond a week after ANCS and were still <34 weeks.…”

Section: A N U S C R I P Tmentioning

confidence: 99%

“…37 In fact, in 2012, more than half the newborns whose mothers received ANCS were born at 35 weeks gestation, and thus were unnecessarily exposed. 37 Another study demonstrated that of 692 women receiving ANCS at a single institution, 35.7% delivered at or >34 weeks gestation, and 17.9% remained pregnant beyond a week after ANCS and were still <34 weeks. 38 A rescue dose of steroids is often used in these situations; however, multiple courses of ANCS are not recommended due to poor fetal head growth and increased risk of neurodevelopmental impairment by 5 years.…”

Section: A N U S C R I P Tmentioning

confidence: 99%

Antenatal corticosteroids beyond 34 weeks gestation: What do we do now?

Kamath‐Rayne

Rozance

Goldenberg

et al. 2016

American Journal of Obstetrics and Gynecology

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Trends in Optimal, Suboptimal, and Questionably Appropriate Receipt of Antenatal Corticosteroid Prophylaxis

Abstract: Temporal increases in optimal exposure to antenatal corticosteroids have been matched by increases in suboptimal and questionably appropriate receipt of antenatal corticosteroids, highlighting the need for accurate preterm delivery prognostic models.

Cited by 78 publications

References 24 publications

Can We Accurately Time the Administration of Antenatal Corticosteroids for Preterm Labor?

Can We Accurately Time the Administration of Antenatal Corticosteroids for Preterm Labor?

Timing of delivery in a high-risk obstetric population: a clinical prediction model

Antenatal corticosteroids beyond 34 weeks gestation: What do we do now?

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