SBA — Single Best Answer · Review
Question 44
Feto-maternal medicine → Maturity
Classification
Question
SSBAWhat is the most appropriate management?
Options
Explanation
Women with twin or triplet pregnancies should receive targeted antenatal corticosteroids when they meet the same clinical criteria used for singleton pregnancies. Multiple pregnancy alone is not an indication for routine or untargeted corticosteroid administration, but established preterm labour at 31+6 weeks creates a clear risk of imminent preterm birth. This woman therefore falls within the gestational range in which antenatal corticosteroids should be offered. The purpose is to reduce neonatal morbidity associated with prematurity, and the treatment decision should be based on the risk and timing of preterm birth rather than chorionicity or evidence from fetal lung maturity testing. Routine additional courses should not be given simply because two fetuses are present. The appropriate strategy is a targeted course when preterm birth is anticipated. This applies the general recommendations for antenatal corticosteroid use to women with multiple pregnancy while avoiding unnecessary exposure in women who are not genuinely at increased risk of imminent delivery.
Option Validity
A) Targeted antenatal corticosteroid treatment is recommended in multiple pregnancy when the usual criteria for anticipated preterm birth are met.
C) Multiple pregnancy is not an indication for routine additional or untargeted corticosteroid courses.
B) Corticosteroid eligibility is not restricted to monochorionic twin pregnancy.
E) Fetal lung maturity testing is not required before treatment when imminent preterm birth is anticipated.
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.