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Question 48
Feto-maternal medicine → Maturity
Classification
Question
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A woman at 30+4 weeks’ gestation received a course of antenatal corticosteroids 9 days ago because of threatened preterm birth. She remains pregnant but is again considered to be at imminent risk of delivery.
What is the most appropriate approach?
What is the most appropriate approach?
Question Stem
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Options
A
Consider a further course because she remains at imminent risk more than 7 days after the initial treatment
B
Never administer any further corticosteroids after an initial course
C
Commence routine weekly corticosteroid courses until delivery
D
Give daily corticosteroids until the risk of preterm birth has passed
E
Repeat treatment only after fetal lung maturity testing
Explanation
The evidence supporting repeat antenatal corticosteroid treatment is less certain than that supporting the initial course. If a woman remains at imminent risk of preterm birth more than 7 days after her first course, a further course may be considered because it may reduce the need for neonatal respiratory support. However, repeat treatment should not become an automatic schedule of weekly or daily courses. Evidence has not demonstrated a clear reduction in serious neonatal morbidity or a long-term benefit from repeated courses, and repeat exposure has been associated with smaller neonatal size and lower birthweight. The decision should therefore be individualised according to the continuing likelihood of preterm birth and the interval since the previous course. Fetal lung maturity testing is not a prerequisite for this decision. In this case 9 days have elapsed and she is again considered at imminent risk of preterm birth, so consideration of a further course is appropriate rather than either prohibiting repeat therapy completely or beginning routine serial administration.
Option Validity
C) Routine scheduled weekly repeat courses are not recommended because benefit and long-term safety are uncertain.
B) A further course may be considered when imminent preterm birth risk persists or recurs more than 7 days after the first course.
D) Daily corticosteroid administration until delivery is not recommended.
E) Fetal lung maturity testing is not required before considering a repeat course.
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.