Question 60

Routine repeated courses of antenatal corticosteroids are not recommended because repeated exposure has not demonstrated a clear reduction in serious long-term morbidity and is associated with smaller size at birth. Nevertheless, a further course may be considered when a woman remains at genuinely high risk of preterm birth and more than seven days have elapsed since the previous course. In this case, nine days have passed and the clinical assessment again suggests that birth is likely within the next few days, so a further course can reasonably be considered. The RCOG guideline advises limiting exposure, with a maximum of three courses based on expert opinion, while WHO guidance supports one rescue course in women who remain at high risk after more than seven days. Treatment should therefore remain targeted to renewed imminent risk rather than being scheduled automatically. Fetal lung maturity testing, doubled doses, daily dosing or repetition merely because 48 hours have passed are not appropriate.

A) Routine weekly courses regardless of ongoing risk are not recommended.

B) A further targeted course may be considered in selected women with renewed imminent risk.

D) Daily corticosteroid dosing until delivery is not recommended.

E) Fetal lung maturity testing is not required before considering a repeat course.

F) A further course is not restricted to pregnancies that have reached 35 weeks.

G) The repeat course is not given at double the standard dose.

H) Elapse of 48 hours alone is not an indication for repeat treatment.

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.