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CC BY-NC-ND 4.0 · AJP Rep 2019; 09(02): e153-e159
DOI: 10.1055/s-0039-1687872
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Timing of Antenatal Corticosteroid Administration in Monoamniotic Twins

Carolina Bibbo
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
,
Sarah R. Easter
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
,
Michael Saadeh
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
,
Sarah E. Little
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
,
Julian N. Robinson
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

07 December 2018

11 December 2018

Publication Date:
30 April 2019 (online)

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Abstract

Objective This study was aimed to determine if different strategies of antenatal corticosteroid (ACS) administration in monoamniotic twins leads to receipt within 7 days of delivery.

Study Design This is a retrospective cohort of monoamniotic twins managed at a single institution from 2007 to 2017. Patients were classified as to whether ACS were administered upon admission or at a predetermined gestational age (grouped together as “routine”) or for a change in clinical status (“indicated”). We used univariate analyses to associate ACS administration strategies with our primary outcome: receipt of ACS within 7 days of delivery. We then used generalized estimating equations to examine associations between fetal monitoring patterns and delivery within 1 week.

Results Twenty-four patients were included: eighteen patients in the “routine” group and six patients in the “indicated” group. There was no difference in optimal timing of ACS administration. Women experiencing delivery within the week were thrice more likely to spend on average more than 3 hours/day on the fetal monitor when compared with those who remained undelivered.

Conclusion Administration of ACS on admission is not effective. Fetal heart rate tracing surveillance might be a better methodology to predict delivery and guide ACS administration.

Keywords

monoamniotic twins - antenatal corticosteroids - preterm delivery - antenatal fetal testing

Note

The study was performed at Brigham and Women's Hospital, Boston, MA.


Presentation

These findings were presented as a poster at the 38th Annual Scientific Meeting of the Society for Maternal–Fetal Medicine in Dallas, TX; February 2018.