Timing of Antenatal Steroid Administration for Imminent Preterm Birth: Results of a Prospective Observational Study in Germany

Overview

Journal Arch Gynecol Obstet

Specialty Gynecology & Obstetrics

Date 2022 Aug 30

PMID 36042053

Authors

Charlotte Humbeck

Sinje Jonassen

Arne Bringewatt

Mascha Pervan

Achim Rody

Verena Bossung

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the timing of antenatal steroid administration and associated medical interventions in women with imminent preterm birth.

Methods: We performed a prospective observational study at a single tertiary center in Germany from September 2018 to August 2019. We included pregnant women who received antenatal steroids for imminent preterm birth and evaluated the interval from administration to birth. 120 women with antenatal steroid application were included into our analysis. Descriptive statistics were performed to analyze factors influencing the timing of antenatal steroids and to evaluate additional medical interventions which women with imminent preterm birth experience.

Results: Of the 120 women included into our study, 35.8% gave birth before 34/0 weeks and 64.2% before 37/0 weeks of gestation. Only 25/120 women (20.8%) delivered within the optimal time window of 1-7 days after antenatal steroid application. 5/120 women (4.2%) only received one dose of antenatal steroids before birth and 3/120 (2.5%) gave birth within 8 to 14 days after antenatal steroids. Most women gave birth more than 14 days after steroid application (72.5%, 87/120). Women with preeclampsia (60%), PPROM (31%), and FGR (30%) had the highest rates of delivery within the optimal time window. Women of all timing groups received additional interventions and medications like antibiotics, tocolytics, or anticoagulation.

Conclusion: Our observational data indicate that most pregnant women do not give birth within 7 days after the administration of antenatal steroids. The timing was best for preterm birth due to preeclampsia, PPROM, and FGR. Especially for women with symptoms of preterm labor and bleeding placenta previa, antenatal steroids should be indicated more restrictively to improve neonatal outcome and reduce untimely and unnecessary interventions.

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References

Owen J, Szychowski J, Hankins G, Iams J, Sheffield J, Perez-Delboy A . Does midtrimester cervical length ≥25 mm predict preterm birth in high-risk women?. Am J Obstet Gynecol. 2010; 203(4):393.e1-5. PMC: 2947582. DOI: 10.1016/j.ajog.2010.06.025. View

Melamed N, Asztalos E, Murphy K, Zaltz A, Redelmeier D, Shah B . Neurodevelopmental disorders among term infants exposed to antenatal corticosteroids during pregnancy: a population-based study. BMJ Open. 2019; 9(9):e031197. PMC: 6773295. DOI: 10.1136/bmjopen-2019-031197. View

Frandberg J, Sandblom J, Bruschettini M, Marsal K, Kristensen K . Antenatal corticosteroids: a retrospective cohort study on timing, indications and neonatal outcome. Acta Obstet Gynecol Scand. 2018; 97(5):591-597. DOI: 10.1111/aogs.13301. View

Sarri G, Davies M, Gholitabar M, Norman J . Preterm labour: summary of NICE guidance. BMJ. 2015; 351:h6283. DOI: 10.1136/bmj.h6283. View

. Committee Opinion No. 713: Antenatal Corticosteroid Therapy for Fetal Maturation. Obstet Gynecol. 2017; 130(2):e102-e109. DOI: 10.1097/AOG.0000000000002237. View

Levin H, Ananth C, Benjamin-Boamah C, Siddiq Z, Son M, Friedman A . Clinical indication and timing of antenatal corticosteroid administration at a single centre. BJOG. 2015; 123(3):409-14. DOI: 10.1111/1471-0528.13730. View

Ganzevoort W, Mensing Van Charante N, Thilaganathan B, Prefumo F, Arabin B, Bilardo C . How to monitor pregnancies complicated by fetal growth restriction and delivery before 32 weeks: post-hoc analysis of TRUFFLE study. Ultrasound Obstet Gynecol. 2017; 49(6):769-777. DOI: 10.1002/uog.17433. View

Rodriguez A, Wang Y, Ali Khan A, Cartwright R, Gissler M, Jarvelin M . Antenatal corticosteroid therapy (ACT) and size at birth: A population-based analysis using the Finnish Medical Birth Register. PLoS Med. 2019; 16(2):e1002746. PMC: 6390995. DOI: 10.1371/journal.pmed.1002746. View

Mori R, Kusuda S, Fujimura M . Antenatal corticosteroids promote survival of extremely preterm infants born at 22 to 23 weeks of gestation. J Pediatr. 2011; 159(1):110-114.e1. DOI: 10.1016/j.jpeds.2010.12.039. View

10.

Blencowe H, Cousens S, Oestergaard M, Chou D, Moller A, Narwal R . National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012; 379(9832):2162-72. DOI: 10.1016/S0140-6736(12)60820-4. View

11.

Crowther C, McKinlay C, Middleton P, Harding J . Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. Cochrane Database Syst Rev. 2015; (7):CD003935. PMC: 7104525. DOI: 10.1002/14651858.CD003935.pub4. View

12.

Norman M, Piedvache A, Borch K, Huusom L, Edstedt Bonamy A, Howell E . Association of Short Antenatal Corticosteroid Administration-to-Birth Intervals With Survival and Morbidity Among Very Preterm Infants: Results From the EPICE Cohort. JAMA Pediatr. 2017; 171(7):678-686. PMC: 5710338. DOI: 10.1001/jamapediatrics.2017.0602. View

13.

Carlo W, McDonald S, Fanaroff A, Vohr B, Stoll B, Ehrenkranz R . Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation. JAMA. 2011; 306(21):2348-58. PMC: 3565238. DOI: 10.1001/jama.2011.1752. View

14.

Liggins G, Howie R . A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics. 1972; 50(4):515-25. View

15.

Makhija N, Tronnes A, Dunlap B, Schulkin J, Lannon S . Antenatal corticosteroid timing: accuracy after the introduction of a rescue course protocol. Am J Obstet Gynecol. 2015; 214(1):120.e1-6. DOI: 10.1016/j.ajog.2015.08.018. View

16.

Baaren G, Vis J, Wilms F, Oudijk M, Kwee A, Porath M . Predictive value of cervical length measurement and fibronectin testing in threatened preterm labor. Obstet Gynecol. 2014; 123(6):1185-1192. DOI: 10.1097/AOG.0000000000000229. View

17.

Mercer B, Miodovnik M, Thurnau G, Goldenberg R, Das A, Ramsey R . Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. JAMA. 1997; 278(12):989-95. View

18.

Ring A, Garland J, Stafeil B, Carr M, Peckman G, Pircon R . The effect of a prolonged time interval between antenatal corticosteroid administration and delivery on outcomes in preterm neonates: a cohort study. Am J Obstet Gynecol. 2007; 196(5):457.e1-6. DOI: 10.1016/j.ajog.2006.12.018. View

19.

Villar J, Papageorghiou A, Knight H, Gravett M, Iams J, Waller S . The preterm birth syndrome: a prototype phenotypic classification. Am J Obstet Gynecol. 2011; 206(2):119-23. DOI: 10.1016/j.ajog.2011.10.866. View

20.

Berger R, Abele H, Bahlmann F, Bedei I, Doubek K, Felderhoff-Muser U . [Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/025, February 2019) - Part 1 with Recommendations on the Epidemiology, Etiology, Prediction, Primary and Secondary Prevention of...]. Z Geburtshilfe Neonatol. 2019; 223(5):304-316. DOI: 10.1055/a-0979-1028. View