Question 54

Antenatal corticosteroid treatment should not be withheld merely because preterm birth appears likely within 24 hours. Benefit can occur even after a short interval between the first dose and birth. Observational evidence demonstrates reduced neonatal mortality when corticosteroids are given before preterm birth, with the largest effect generally seen when birth occurs between approximately 24 hours and seven days after treatment. However, a significant mortality reduction has also been demonstrated at shorter intervals, including within 24 hours. Consequently, the opportunity to provide some fetal exposure should not be lost simply because a full course is unlikely to be completed. At 30+1 weeks this woman is well within the gestational range for which corticosteroids are recommended. The correct approach is therefore to administer the first dose promptly while continuing appropriate obstetric management. Treatment should not depend on fetal lung maturity testing or on the ability to postpone birth for an arbitrary minimum interval.

A) Benefit may occur even when birth follows corticosteroid administration within 24 hours.

B) A seven-day delay is neither required nor appropriate before treatment.

C) Antenatal corticosteroids must be given before birth to provide fetal benefit.

D) Fetal lung maturity testing is not required before treatment.

E) Treatment should not be withheld because a 24-hour interval cannot be guaranteed.

F) Antenatal corticosteroids benefit spontaneous as well as planned preterm birth.

G) A routine repeat course regardless of subsequent risk is not recommended.

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.