Question 50

The established antenatal corticosteroid regimens used to accelerate fetal maturation are administered intramuscularly. Intramuscular dexamethasone and betamethasone regimens are used, with the evidence base for neonatal benefit derived predominantly from these routes and schedules. Oral corticosteroid administration is not recommended as a substitute simply for convenience, and the route should not be regarded as interchangeable provided only that the same numerical total dose is administered. Routine intravenous administration is also not the standard antenatal corticosteroid approach. Direct fetal or so-called transplacental administration is not recommended. When corticosteroids are indicated because preterm birth is anticipated, treatment should therefore follow a recognised intramuscular regimen. The precise drug preparation and dosing schedule should conform to the available evidence and local protocol, but the woman should be advised that the standard treatment requires maternal intramuscular injections rather than tablets. The expected benefit relates to an evidence-based drug, dose, timing and route rather than total milligrams alone.

A) Oral corticosteroids are not preferred for antenatal fetal maturation and should not replace the established intramuscular regimens.

B) Routine intravenous administration is not the standard recommended route for antenatal corticosteroid therapy.

D) Direct fetal or transplacental administration is not the recommended method.

E) Route and regimen matter; an equivalent numerical total dose by an unsupported route cannot be assumed to provide the same benefit.

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.