Glucocorticoid use in patients with preterm premature rupture of the fetal membranes

Antenatal glucocorticoid use in patients with preterm premature rupture of membranes (PPROM) is controversial. The majority of prospective, randomized studies on antenatal glucocorticoid use evaluate the effect of this intervention on preterm infants delivered due to multiple, diverse etiologies, only one of which is PPROM [corrected]. These studies present a variety of conflicting conclusions; meta-analysis indicates a potential benefit of steroids in the reduction of RDS, intraventricular hemorrhage, and mortality. Meta-analysis of studies specifically evaluating pregnancies complicated by PPROM demonstrates a significant reduction in RDS; however, this effect is primarily due to the work of a single author with a potentially atypical study population [corrected]. The remaining studies fail to show a benefit of steroids. The strongest argument for steroid use in patients with PPROM is extrapolation of data from studies of patients delivered preterm due to a variety of etiologies, not just PPROM. While such an extrapolation is currently recommended by the NIH Consensus Development Panel, it may be premature to assume that the same pathophysiological mechanisms and the same propensity for benefit from steroids occur in these different populations. Further studies are necessary before glucocorticoids can be confidently recommended in pPROM.