Evaluatıon of the timing and indications of antenatal corticosteroid administration

Abstract

Abstract Objective: To investigate the timing of antenatal corticosteroid administration for pregnant women who were anticipated for preterm birth. Material 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 31.0% of cases (n=35). Totally, this period was 7 days or below in 69.0% 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. Keywords:antenatal corticosteroid, preterm birth, indication, optimal timing, administration

Keywords

• antenatal corticosteroid,preterm birth,indication,optimal timing,administration

References

1. Huddy CL, Johnson A, Hope PL. Educational and behavioural problems in babies of 32-35 weeks gestation. Arch Dis Child Fetal Neonatal Ed 2001; 85: 23-8.
2. Wang ML, Dorer DJ, Fleming MP, Catlin EA. Clinical outcomes of near-term infants. Pediatrics 2004; 114: 372-6.
3. Beck S, Wojdyla D, Say L, et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ 2010; 88: 31-8.
4. American College of Obstetricians and Gynecologists, Practice Bulletin No. 171: Management of Preterm Labor. Obstet Gynecol 2016; 128: e155-64.
5. Haas DM, Imperiale TF, Kirkpatrick PR, Klein RW, Zollinger TW, Golichowski AM. Tocolytic therapy: a meta-analysis and decision analysis. Obstet gynecol 2009; 113: 585-94.
6. Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; 3: Cd004454.
7. Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 1972; 50: 515-25.
8. ACOG Committee Opinion No. 475: antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol 2011; 117: 422-4.

9. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006: CD004454.
10. Adams TM, Kinzler WL, Chavez MR, Vintzileos AM. The timing of administration of antenatal corticosteroids in women with indicated preterm birth. Am J Obstet Gynecol 2015; b212: 645.
11. Makhija NK, Tronnes AA, Dunlap BS, Schulkin J, Lannon SM. Antenatal corticosteroid timing: accuracy after the introduction of a rescue course protocol. Am J Obstet Gynecol 2016; 214: 120.e1-120.e1206.
12. Vis JY, Wilms FF, Kuin RA, et al. Time to delivery after the first course of antenatal corticosteroids: a cohort study. Am J Perinatol 2011; 28: 683-8.
13. Boesveld M, Heida KY, Oudijk MA, Brouwers HA, Koenen SV, Kwee A. Evaluation of antenatal corticosteroid prescribing patterns among 984 women at risk for preterm delivery. J Matern Fetal Neonatal Med 2014; 27: 516-9.
14. Boesveld M, Heida KY, Oudijk MA, Brouwers HA, Koenen SV, Kwee A. Evaluation of antenatal corticosteroid prescribing patterns among 984 women at risk for preterm delivery. J Maternal Fetal Neonatal Med 2014; 27: 516-9.
15. Adams TM, Kinzler WL, Chavez MR, Fazzari MJ, Vintzileos AM. Practice patterns in the timing of antenatal corticosteroids for fetal lung maturity. J Maternal Fetal Neonatal Med 2015; 28: 1598-601.
16. Rottenstreich A, Elchalal U, Haj Yahya R, et al. Missed opportunities for optimal antenatal corticosteroid timing in medically indicated preterm births. J Maternal Fetal Neonatal Med 2019; 3: 1-7.
17. Collaborative OPQ, Committee W. 521: A statewide project to promote optimal use of antenatal corticosteroids (ANCS). Am J Obstet Gynecol 2013; 208: S224.
18. Mc Goldrick EL, Crawford T, Brown JA, Groom KM, Crowther CA. Identifying the barriers and enablers in the implementation of the New Zealand and Australian Antenatal Corticosteroid Clinical Practice Guidelines. BMC Health Serv Res 2016; 16: 617-30.
19. Sweet DG, Carnielli V, Greisen G, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome-2019 Update. Neonatology 2019; 115: 432-50.
20. Räikkönen K, Gissler M, Kajantie E. Associations between maternal antenatal corticosteroid treatment and mental and behavioral disorders in Children. JAMA 2020; 323: 1924-33.