Use, misuse, and overuse of antenatal corticosteroids. A retrospective cohort study
Author:
Cojocaru Liviu1ORCID, Chakravarthy Shruti1, Tadbiri Hooman2ORCID, Reddy Rishika1, Ducey James1, Fruhman Gary1
Affiliation:
1. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine , Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health , New York , NY , USA 2. Department of Obstetrics, Gynecology, and Reproductive Science, Division of Maternal-Fetal Medicine, University of Maryland School of Medicine , Baltimore , MD , USA
Abstract
Abstract
Objectives
To evaluate the timing of antenatal corticosteroids (ACS) administration in relation to the delivery timing based on indications and risk factors for preterm delivery.
Methods
We conducted a retrospective cohort study to understand what factors predict the optimal timing of ACS administration (ACS administration within seven days). We reviewed consecutive charts of adult pregnant women receiving ACS from January 1, 2011, to December 31, 2019. We excluded pregnancies under 23 weeks, incomplete and duplicate records, and patients delivered outside our health system. The timing of ACS administration was categorized as optimal or suboptimal. These groups were analyzed regarding demographics, indications for ACS administration, risk factors for preterm delivery, and signs and symptoms of preterm labor.
Results
We identified 25,776 deliveries. ACS were administered to 531 pregnancies, of which 478 met the inclusion criteria. Of the 478 pregnancies included in the study, 266 (55.6 %) were delivered in the optimal timeframe. There was a higher proportion of patients receiving ACS for the indication of threatened preterm labor in the suboptimal group as compared to the optimal group (85.4 % vs. 63.5 %, p<0.001). In addition, patients who delivered in the suboptimal timeframe had a higher proportion of short cervix (33 % vs. 6.4 %, p<0.001) and positive fetal fibronectin (19.8 % vs. 1.1 %, p<0.001) compared to those who delivered in the optimal timeframe.
Conclusions
More emphasis should be placed on the judicious use of ACS. Emphasis should be placed on clinical assessment rather than relying solely on imaging and laboratory tests. Re-appraisal of institutional practices and thoughtful ACS administration based on the risk-benefit ratio is warranted.
Publisher
Walter de Gruyter GmbH
Subject
Obstetrics and Gynecology,Pediatrics, Perinatology and Child Health
Reference26 articles.
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