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Use, misuse, and overuse of antenatal corticosteroids. A retrospective cohort study
Liviu Cojocaru1, Shruti Chakravarthy1, Hooman Tadbiri2
1Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA.
Insights
Antenatal corticosteroids (ACS) are crucial for preterm birth but optimal timing is key. Judicious use based on clinical assessment, not just tests, is recommended for better outcomes in high-risk pregnancies.
Area of Science:
- Perinatal medicine
- Maternal-fetal medicine
- Obstetrics
Background:
- Antenatal corticosteroids (ACS) improve neonatal outcomes for preterm birth.
- Optimal timing of ACS administration relative to delivery is critical for efficacy.
- Understanding factors influencing ACS timing is essential for improving clinical practice.
Approach:
- Retrospective cohort study analyzing 478 pregnancies receiving ACS.
- Categorized ACS administration as optimal (within 7 days) or suboptimal.
- Examined demographics, indications, risk factors, and labor signs in relation to timing.
Key Points:
- 55.6% of pregnancies received ACS within the optimal timeframe.
- Suboptimal timing was associated with higher rates of threatened preterm labor, short cervix, and positive fetal fibronectin.
- Clinical assessment appears more critical than solely relying on imaging and lab tests for ACS timing.
Conclusions:
- Judicious use of antenatal corticosteroids is emphasized.
- Clinical assessment should guide ACS administration over sole reliance on tests.
- Re-evaluation of institutional practices for thoughtful ACS administration based on risk-benefit is warranted.
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.
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