An updated
committee opinion from the American College of Obstetricians and Gynecologists
(ACOG), was published in the August issue of Obstetrics & Gynecology.
Liggins and
Howie published their landmark paper in 1972, that showed the benefits of
single course of antenatal corticosteroid therapy administered to women at risk
for preterm delivery in reducing RDS and mortality in offspring.
Since then
countless trials have confirmed these findings and also shown that timely steroid
administration reduces rates of intraventricular hemorrhage (IVH) and
necrotizing enterocolitis.
An updated ACOG
opinion published in October 2016 issue, expanded the use of steroids in women
at high risk for late preterm birth (34 0/7 - 36 6/7 weeks).
The current recommendations
are:
A single
course of corticosteroids is recommended for pregnant women between 24 0/7
weeks and 33 6/7 weeks of gestation who are at risk of preterm delivery within
7 days, irrespective of intact or ruptured membranes and single or multiple
gestations.
It could
also be given at 23 0/7 weeks of gestation to women at risk of preterm delivery
with 7 days based on discussion with family members regarding resuscitation of
the newborn.
A decision to
administer corticosteroids during the peri viable period (20 0/7 weeks to 25
6/7 weeks of gestation) should always be based on discussions with the patients
and family members regarding resuscitation of the newborn.
A single
course of betamethasone is recommended for pregnant women at risk of preterm
birth between 34 0/7 weeks and 36 6/7 weeks of gestation, provided they have
not received a previous course of antenatal corticosteroids.
A single
repeat course can be given to women who are less than 34 0/7 weeks of gestation
who are at risk of preterm delivery within 7 days, whose previous course was
administered more than 14 days earlier and in some clinical scenarios 7 days
earlier.
Repeated or
serial administration of more than 2 doses is not recommended.
At present, no
recommendation can be made for a repeat or rescue dose of corticosteroids in
patients with preterm prelabor rupture of membranes (PROM).
ACOG also
recommends long term follow up and surveillance of babies who received in utero
corticosteroids administration.
It also
advocates ongoing development of strategies to support timely administration of
corticosteroids to women at risk of delivering with 7 days and avoid overuse in
low risk patients.
The committee
opinion full text can be accessed here.
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