Question 52

Antenatal corticosteroids should be offered when preterm birth is anticipated between 24+0 and 34+6 weeks, including when early birth is planned because of maternal or fetal indications such as hypertensive disease. Their administration can reduce important neonatal complications associated with prematurity. However, treatment must not delay delivery when maternal or fetal circumstances require expedited birth. This woman is at 33+2 weeks and therefore lies within the recommended gestational range. Corticosteroid treatment should be commenced if feasible, but the maternal indication for birth takes priority. It is inappropriate to postpone necessary delivery solely to complete the corticosteroid course. Pre-eclampsia is not itself a contraindication to treatment, fetal lung maturity testing is not required, and benefit is not confined to spontaneous preterm labour. The appropriate management therefore combines antenatal corticosteroid administration with timely delivery according to the maternal clinical condition.

A) Pre-eclampsia is not itself a contraindication to antenatal corticosteroid administration.

B) Necessary delivery should not be delayed solely to complete a corticosteroid course.

C) Fetal lung maturity testing is not required before treatment in this setting.

E) Antenatal corticosteroids are appropriate for planned as well as spontaneous preterm birth.

F) Medically indicated preterm birth can still benefit from antenatal corticosteroid exposure.

G) Routine untargeted weekly corticosteroid courses are not recommended.

H) The recommended gestational range extends beyond 28 weeks.

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.