Top

Archives of Gynecology and Obstetrics

Published in:

01-02-2018 | General Gynecology

Antenatal corticosteroids administration: are we giving them at the right time?

Authors: Tiffany Tuck Chin Wong, Janice Su Zhen Tung, Hester Chang Qi Lau, Shephali Tagore

Published in: Archives of Gynecology and Obstetrics | Issue 2/2018

Abstract

Objective

Antenatal corticosteroids before preterm births are considered to be most effective 48 h after and up to 1 week after the first dose. We aim to evaluate: (1) our practice of administration of antenatal corticosteroids in Singapore; (2) admission characteristics of women for discriminatory factors of spontaneous preterm delivery within 1 week.

Methods

This is a retrospective study in a tertiary obstetrics unit in Singapore. 3044 women who delivered live births (at term or preterm) from 1st November 2014 to 31st January 2015, who were at risk of spontaneous or induced preterm delivery, were included. Data related to the time of and indications for antenatal corticosteroids administration, characteristics assessed at the time of presentation, and time of delivery were collected and analysed.

Results

85.9% of women who delivered at gestational age ≤ 34⁺⁶ received at least one dose. 22.1% had delivered within the window of efficacy. Gestational age > 32 weeks at presentation, uterine activity on tocography and cervical dilation with effacement were associated with preterm delivery within 1 week of presentation.

Conclusion

Overall, our antenatal corticosteroids administration rate is comparable to that attained by centres in other developed countries. It is difficult but important to discriminate women who will benefit from this timely intervention.

Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R et al (2012) National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 379(9832):2162–2172CrossRefPubMed

Liggins GC, Howie RN (1972) A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Paediatrics 50(4):515–525

Sinclair JC et al (1995) Meta-analysis of randomized controlled trials of antenatal corticosteroid for the prevention of respiratory distress syndrome. Am J Obstet Gynecol 173(1):335–344CrossRefPubMed

Roberts D, Dalziel S (2006) Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 3:CD004454

Royal College of Obstetricians and Gynaecologist (2010) Green-top guideline No. 7: antenatal corticosteroids to reduce neonatal morbidity and mortality

ACOG Committee Opinion No. 475 (2011) Antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol 117(2 Pt 1):422–424

Society of Obstetricians and Gynecologists of Canada (2002) Preterm birth: making a difference. Clinical practice guidelines

Ministry of Health, Singapore (2001) Management of preterm labour. Clinical practice guidelines

National Institutes of Health Consensus Development Panel (2001) Antenatal corticosteroids revisited: repeat courses. National Institutes of Health Consensus Aug 17–18, 2000. Obstet Gynecol 98(1):144–150CrossRef

10.

French NP, Hagan R, Evans SF, Godfrey M, Newnham JP (1999) Repeated antenatal corticosteroids: size at birth and subsequent development. Am J Obstet Gynecol 180:114–121CrossRefPubMed

11.

Guinn DA, Atkinson MW, Sullivan L, Lee M, MacGregor S, Parilla BV et al (2001) Single vs weekly courses of antenatal corticosteroids for women at risk of preterm delivery: a randomized controlled trial. J Am Med Assoc 286:1581–1587CrossRef

12.

Dalziel SR, Walker NK, Parag V, Mantell C, Rea HH, Rodgers A et al (2005) Cardiovascular risk factors after antenatal exposure to betamethasone: 30-year follow-up of a randomized controlled trial. Lancet 365:1856–1882CrossRefPubMed

13.

Dalziel SR, Lim VK, Lambert A, McCarthy D, Parag V, Rodgers A et al (2005) Antenatal exposure to betamethasone: psychological functioning and health related quality of life 31 years after inclusion in randomized controlled trial. BMJ 331(7518):665CrossRefPubMedPubMedCentral

14.

Murphy KE, Hannah ME, Willan AR, Hewson SA, Ohlsson A, Kelly EN et al (2008) Multiple courses of antenatal corticosteroids for preterm birth (MACS): a randomized controlled trial. Lancet 372(9656):2143–2151CrossRefPubMed

15.

Surbek D, Drack G, Irion O, Nelle M, Huang D, Hoesli I (2012) Antenatal corticosteroids for fetal lung maturation in threatened preterm delivery: indications and administration. Arch Gynecol Obstet 286:277–281CrossRefPubMed

16.

Asztalos EV, Murphy KE, Willan AR, Matthews SG, Ohlsson A, Saigal S et al (2013) Multiple courses of antenatal corticosteroids for preterm birth study: outcomes in children at 5 years of age (MACS-5). JAMA Pediatr 167(12):1102–1110. https://doi.org/10.1001/jamapediatrics.2013.2764 PubMed

17.

Gyamfi-Bannerman C, Thom EA, Blackwell SC, Tita ATN, Reddy UM, Saade GR et al (2016) Antenatal betamethasone for women at risk for late preterm delivery. N Engl J Med 374:1311–1320CrossRefPubMedPubMedCentral

18.

Brownfoot FC, Gagliardi DI, Bain E, Middleton P, Crowther CA (2013) Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 8:CD006764

19.

Wilms FF, Vis JY, Pattinaja DA, Kuin RA, Stam MC, Reuvers JM et al (2011) Relationship between the time interval from antenatal corticosteroid administration until preterm birth and the occurrence of respiratory morbidity. Am J Obstet Gynecol 205(1):49.e1–7CrossRefPubMed

20.

Pattanittum P, Ewens MR, Laopaiboon M, Lumbiganon P, McDonald SJ, Crowther CA, The SEA-ORCHID Study Group (2008) Use of antenatal corticosteroids prior to preterm birth in four South East Asian countries within the SEA-ORCHID project. BMC Pregnancy Childbirth 8:47. https://doi.org/10.1186/1471-2393-8-47 CrossRefPubMedPubMedCentral

21.

Polyakov A, Cohen S, Baum M, Trickey D, Jolley D, Wallace EM (2007) Patterns of antenatal corticosteroid prescribing 1998–2004. Aust N Z J Obstet Gynaecol 47(1):42–45CrossRefPubMed

22.

Boesveld M, Heida KY, Oudikj MA, Brouwers HA, Koenen SV, Kwee A (2014) Evaluation of antenatal corticosteroid prescribing patterns among 984 women at risk of preterm delivery. J Matern Fetal Neonatal Med 27(5):516–519CrossRefPubMed

23.

Mahony R, McKeating A, Murphy T, McAuliffe F, O’Herlihy C, Foley M (2010) Appropriate antenatal corticosteroid use in women at risk for preterm birth before 34 weeks of gestation. BJOG 117:963–967CrossRefPubMed

24.

Levin HI, Ananth CV, Benjamin-Boamah C, Siddiq Z, Son M, Friedman AM (2016) Clinical indication and timing of antenatal corticosteroid administration at a single centre. BJOG 123(3):409–414CrossRefPubMed

25.

Khoo C, Welsh J, Owen P (2007) Perinatal Effectiveness Committee, Glasgow (PEC). Antenatal corticosteroid prescribing: a complete audit cycle. J Obstet Gynaecol 27(1):33–36CrossRefPubMed

26.

Sotiriadis A, Papatheodorou S, Kavvadias A, Makrydimas G (2010) Transvaginal cervical length measurement for prediction of preterm birth in women with threatened preterm labour: a meta-analysis. Ultrasound Obstet Gynaecol 35:54–64CrossRef

27.

Sanchez-Ramos L, Delke I, Zamora J, Kaunitz AM (2009) Fetal fibronectin as a short-term predictor of preterm birth in symptomatic patients: a meta-analysis. Obstet Gynaecol 114:631–640CrossRef

28.

Cooper S, Lange I, Wood S, Tang S, Miller L, Ross S (2012) Diagnostic accuracy of rapid phIGFBP-1 assay for predicting preterm labour in symptomatic patients. J Perinatol 32(6):460–465CrossRefPubMed

29.

Iams JD (2003) Prediction and early detection of preterm labour. Obstet Gynecol 101(2):402–412PubMed

30.

Jackson GM, Ludmir J, Bader TJ (1992) The accuracy of digital examination and ultrasound in the evaluation of cervical length. Obstet Gynecol 79:214–218CrossRefPubMed

31.

Allouche M, Huissoud C, Guyard-Boileau B, Rouzier R, Parant O (2011) Development and validation of nomograms for predicting preterm delivery. Am J Obstet Gynecol 204(3):242.e1–8CrossRefPubMed

32.

Mailath-Pokorny M, Polterauer S, Kohl M et al (2015) Individualized assessment of preterm birth risk using two modified prediction models. Eur J Obstet Gynecol Reprod Biol 186:42–48CrossRefPubMed

Title: Antenatal corticosteroids administration: are we giving them at the right time?
Authors: Tiffany Tuck Chin Wong
Janice Su Zhen Tung
Hester Chang Qi Lau
Shephali Tagore
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 2/2018
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-017-4577-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Antenatal corticosteroids administration: are we giving them at the right time?

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2018

Maternal hemodynamics in late gestation and immediate postpartum in singletons vs. twin pregnancies

Bipolar vessel-sealing devices in laparoscopic hysterectomies: a multicenter randomized controlled clinical trial

Effect of intramural fibroid on uterine and endometrial vascularity in infertile women scheduled for in-vitro fertilization

Laparoscopic-assisted vaginal hysterectomy versus vaginal hysterectomy for benign uterine diseases: a prospective, randomized, multicenter, double-blind trial (LAVA)

Vacuum extraction in low birth weight (< 2500 g) neonates

Hyperandrogenemia and ovarian reserve in patients with Mayer–Rokitansky–Küster–Hauser syndrome type 1 and 2: potential influences on ovarian stimulation