EMQ — Extended Matching Question · Review
Question 55
Feto-maternal medicine → Maturity
Classification
Question
EEMQAnswer Bank
Correct Answer
Explanation
Preterm prelabour rupture of membranes is an established clinical situation in which antenatal corticosteroids should be offered when the woman is at increased risk of preterm birth within the recommended gestational range. At 31+0 weeks, this woman is within the period in which neonatal benefits from corticosteroid treatment are well established. Rupture of the membranes does not remove the expected reduction in complications of prematurity, and fetal lung maturity testing is not required before treatment. A single course of antenatal corticosteroids does not invariably increase maternal infection. Management must nevertheless remain responsive to the overall clinical picture, particularly if infection or another indication for expedited birth develops. Evidence concerning repeat courses specifically after PPROM is more limited, so routine repeated weekly treatment is inappropriate. The correct approach is therefore a targeted course of antenatal corticosteroids because PPROM has placed this woman at significant risk of preterm birth.
Option Validity
A) PPROM does not abolish the neonatal benefit of antenatal corticosteroid exposure.
B) Fetal lung maturity testing is not required before treatment.
D) Corticosteroids are not restricted to women having planned caesarean birth.
E) Obstetric management should not be inappropriately delayed solely to complete corticosteroids.
F) Routine weekly repeat corticosteroid courses are not recommended.
G) A single course has not been shown to invariably increase maternal infection.
H) Recommended treatment extends well beyond 28 weeks of gestation.
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.