Antenatal corticosteroids for short cervix: When is it indicated - a cohort study

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Pharmacovigilance

Background:

• Antenatal corticosteroids (ACS) are vital for improving outcomes in infants born before 34 weeks gestation.
• Optimal ACS benefits are seen when administered within seven days of delivery; benefits diminish and potential harm increases with longer intervals or term delivery.

Purpose of the Study:

• To assess the rate of optimally timed ACS administration across various indications.
• To explore strategies for improving the timing accuracy of ACS.

Main Methods:

• A 10-year retrospective cohort study (2014-2023) of patients receiving ACS.
• Categorization of ACS timing based on interval to birth: <2 days (late), 2-7 days (optimal), 7-14 days (suboptimal), >14 days (early).
• Modeling of four alternative administration strategies to evaluate potential timing improvements.

Main Results:

• Overall, only 33% of patients received ACS within 7 days, with no improvement over the decade.
• In patients with a short cervix (16% of cohort), 84% received ACS early (>14 days before birth).
• Targeted administration strategies, such as based on cervical status and symptoms, showed potential to significantly improve ACS timing accuracy.

Conclusions:

• Antenatal corticosteroids for asymptomatic short cervix are frequently administered outside the optimal window.
• Tailoring ACS administration based on cervical status and symptom development may substantially enhance timing accuracy and therapeutic benefit.