Question 58

For planned caesarean birth between 37+0 and 38+6 weeks, antenatal corticosteroid administration requires individualised informed discussion rather than routine treatment. Available evidence suggests that corticosteroids may reduce admission to a neonatal unit for respiratory morbidity, but the magnitude and consistency of benefit for specific outcomes such as respiratory distress syndrome, transient tachypnoea of the newborn and overall neonatal-unit admission remain uncertain. Treatment can also increase neonatal hypoglycaemia, and observational data raise uncertainty about possible longer-term developmental effects when children exposed to antenatal corticosteroids are ultimately born at term. Consequently, corticosteroids should not be presented as providing a proven net benefit for every planned early-term caesarean birth. At 38+0 weeks the woman should receive balanced counselling about these uncertainties and potential trade-offs. Fetal lung maturity testing, routine repeated courses and claims of established long-term safety are not appropriate substitutes for informed shared decision-making.

A) A definitive reduction in respiratory distress syndrome at early term has not been established.

B) Possible respiratory benefit has been reported after 37 weeks in planned caesarean birth.

C) Fetal lung maturity testing is not required as the basis for treatment.

D) Routine repeated weekly corticosteroid courses are not recommended.

E) Long-term childhood safety after term exposure is not definitively established.

F) Caesarean birth should not be delayed solely to permit multiple corticosteroid courses.

H) Consideration of treatment is not restricted to women with diabetes.

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.