Question 43

Antenatal corticosteroids should be offered to women with PPROM who are at increased risk of preterm birth. Evidence supports neonatal respiratory benefit in this setting. A meta-analysis of randomised trials in women with PPROM demonstrated reductions in respiratory distress syndrome and intraventricular haemorrhage following antenatal corticosteroid administration. Treatment does not need to wait until established labour has developed; the relevant consideration is an increased likelihood of preterm birth. In this case the pregnancy is at 30+2 weeks, well within the gestational range in which corticosteroids should normally be offered when imminent preterm birth is anticipated. Corticosteroid use in PPROM is appropriate in the absence of clinical evidence of infection. PPROM itself is therefore not a reason to withhold treatment, and evidence does not support withholding corticosteroids on the basis that they increase neonatal sepsis. She should be offered antenatal corticosteroids as part of her management.

B) PPROM does not render antenatal corticosteroids ineffective; evidence supports benefit in this group.

C) Established labour is not required; increased risk of preterm birth with PPROM is sufficient indication.

D) At 30+2 weeks, corticosteroids should not be deferred until 34 weeks when preterm birth risk is increased.

E) The evidence reviewed did not demonstrate an increase in neonatal sepsis sufficient to justify withholding treatment.

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.