Question 59

When a fetus is small for gestational age or growth restricted and preterm birth is considered imminent, antenatal corticosteroids should generally still be offered within the recommended gestational range. At 29+5 weeks, this pregnancy falls well within that range. Evidence specifically addressing the balance of benefit and harm in fetal growth restriction is more limited than the broader evidence base for preterm birth. This uncertainty should form part of counselling, but it does not make fetal growth restriction an absolute contraindication. Neither a fetal-weight threshold above the 10th centile nor fetal lung maturity testing is required before treatment. There is also no basis for doubling the corticosteroid dose. Most importantly, if fetal or maternal condition ultimately requires expedited birth, delivery should not be delayed solely to complete treatment. The appropriate approach is therefore to offer a standard targeted course while explaining the limitations of the evidence specific to growth-restricted fetuses.

A) Fetal growth restriction is not an absolute contraindication to antenatal corticosteroids.

B) Treatment is not conditional on the fetus exceeding the 10th centile.

C) The standard corticosteroid dose is not doubled because of fetal growth restriction.

D) Clinically indicated delivery should not be delayed solely to maximise corticosteroid exposure.

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

G) Routine weekly repeat corticosteroid courses are not recommended.

H) Maternal hypertension does not need to be absent before corticosteroids can be offered.

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.