Question 49

When preterm birth is considered imminent in a pregnancy complicated by a small or growth-restricted fetus, antenatal corticosteroids should be offered within the usual recommended gestational range, while the woman is counselled that evidence specifically relating to growth-restricted fetuses is limited. This woman is at 31+3 weeks and an expedited preterm birth is planned because of abnormal fetal surveillance. She therefore has a clear risk of imminent preterm delivery. Fetal growth restriction is not itself a contraindication to antenatal corticosteroid treatment. Equally important, delivery that is required because of fetal compromise should not be delayed solely to complete a corticosteroid course or achieve an optimal treatment-to-birth interval. The clinical indication for delivery remains paramount. There is no requirement for fetal weight to exceed a particular centile before treatment is offered. The appropriate approach is therefore to administer antenatal corticosteroids when feasible, explain the limitations of the evidence in growth-restricted pregnancies, and proceed with delivery according to the fetal condition.

A) Fetal growth restriction is not itself a contraindication to antenatal corticosteroids when preterm birth is imminent.

C) Clinically indicated delivery should not be delayed solely to achieve an optimal corticosteroid interval.

B) Eligibility for antenatal corticosteroids does not require estimated fetal weight to be above the tenth centile.

E) Treatment should not be withheld on the basis that corticosteroids acutely worsen fetal growth restriction.

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.