SBA — Single Best Answer · Review
Question 39
Feto-maternal medicine → Maturity
Classification
Question
SSBAWhat is the most appropriate approach to antenatal corticosteroid administration?
Options
Explanation
At 35+0 to 36+6 weeks of gestation, antenatal corticosteroids are not routinely recommended for every woman at risk of preterm birth. The potential benefits and risks should be considered with the woman. In the late-preterm period, antenatal corticosteroids reduce the need for neonatal respiratory support, but increase neonatal hypoglycaemia. In the principal late-preterm trial, respiratory support occurred in 11.6% of infants exposed to antenatal corticosteroids compared with 14.4% receiving placebo, while neonatal hypoglycaemia occurred in 24.0% compared with 15.0%, respectively. Treatment should not be withheld solely because birth is expected within 24 hours, as benefit may still occur even when corticosteroids are administered shortly before birth.
Option Validity
A) Routine offering is recommended between 24+0 and 34+6 weeks when imminent preterm birth is anticipated. At 35+0 to 36+6 weeks, the potential benefits and risks should instead be considered.
B) Antenatal corticosteroids are not absolutely contraindicated after 34+6 weeks. At 35+0 to 36+6 weeks, an individualised assessment of potential benefit and risk is appropriate.
D) Treatment should not be withheld solely because delivery cannot be delayed for 48 hours.
E) Antenatal corticosteroids may still provide benefit when administered within 24 hours before birth.
Further Reading
Stock SJ, Thomson AJ, Papworth S, on behalf of the Royal College of Obstetricians and Gynaecologists. Antenatal corticosteroids to reduce neonatal morbidity and mortality. BJOG. 2022;129:e35–e60. RCOG Green-top Guideline No. 74. doi:10.1111/1471-0528.17027.