Question 42

Antenatal corticosteroids should be offered when preterm birth is anticipated between 24+0 and 34+6 weeks, including when early birth is planned because of maternal or fetal indications such as hypertensive disease. Their use can reduce important neonatal complications associated with prematurity. However, corticosteroid administration must not delay delivery when maternal or fetal circumstances require expedited birth. In this case the woman is at 32+4 weeks and therefore lies within the gestational range in which antenatal corticosteroids should be offered. Treatment should be commenced if feasible, but the obstetric indication for birth takes priority. It is inappropriate to postpone necessary delivery simply to complete the corticosteroid course. Maternal hypertension or pre-eclampsia is not itself a contraindication to treatment, and fetal lung maturity testing is not required before administration. The appropriate management therefore combines antenatal corticosteroid treatment with timely delivery according to the maternal clinical condition.

A) Planned medically indicated preterm birth within the recommended gestational range is an indication for antenatal corticosteroids.

B) Delivery should not be delayed solely to complete a corticosteroid course when maternal or fetal condition requires expedited birth.

D) Fetal lung maturity testing is not required before giving antenatal corticosteroids in this situation.

C) Pre-eclampsia and maternal hypertension are not themselves contraindications to antenatal corticosteroid administration.

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.