Am J Perinatol 2015; 32(06): 537-544
DOI: 10.1055/s-0034-1396690
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Antenatal Corticosteroids for Preterm Premature Rupture of Membranes: Single or Repeat Course?

Kathleen F. Brookfield
1   Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Yasser Y. El-Sayed
1   Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Lisa Chao
1   Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Victoria Berger
1   Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Mariam Naqvi
1   Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Alexander J. Butwick
2   Department of Anesthesia, Stanford University School of Medicine, Stanford, California
› Author Affiliations
Further Information

Publication History

09 June 2014

07 October 2014

Publication Date:
29 December 2014 (online)

Abstract

Objective The aim of this article is to determine the risk of maternal chorioamnionitis and neonatal morbidity in women with preterm premature rupture of membranes (PPROM) exposed to one corticosteroid course versus a single repeat corticosteroid steroid course.

Study Design Secondary analysis of a cohort of women with singleton pregnancies and PPROM. The primary outcome was a clinical diagnosis of maternal chorioamnionitis. Using multivariate logistic regression, we controlled for maternal age, race, body mass index, diabetes, gestational age at membrane rupture, preterm labor, and antibiotic administration. Neonatal morbidities were compared between groups controlling for gestational age at delivery.

Results Of 1,652 women with PPROM, 1,507 women received one corticosteroid course and 145 women received a repeat corticosteroid course. The incidence of chorioamnionitis was similar between groups (single course = 12.3% vs. repeat course = 11.0%; p = 0.8). Women receiving a repeat corticosteroid course were not at increased risk of chorioamnionitis (adjusted odds ratio, 1.28; 95% confidence interval, 0.69–2.14). A repeat course of steroids was not associated with an increased risk of any neonatal morbidity.

Conclusion Compared with a single steroid course, our findings suggest that the risk of maternal chorioamnionitis or neonatal morbidity may not be increased for women with PPROM receiving a repeat corticosteroid course.

 
  • References

  • 1 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606) 75-84
  • 2 Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol 2003; 101 (1) 178-193
  • 3 Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006; (3) CD004454
  • 4 Vidaeff AC, Ramin SM. Antenatal corticosteroids after preterm premature rupture of membranes. Clin Obstet Gynecol 2011; 54 (2) 337-343
  • 5 Peltoniemi OM, Kari MA, Tammela O , et al; Repeat Antenatal Betamethasone Study Group. Randomized trial of a single repeat dose of prenatal betamethasone treatment in imminent preterm birth. Pediatrics 2007; 119 (2) 290-298
  • 6 Practice bulletins No. 139: premature rupture of membranes. Obstet Gynecol 2013; 122 (4) 918-930
  • 7 National Institutes of Health Consensus Development Panel. Antenatal corticosteroids revisited: repeat courses - National Institutes of Health Consensus Development Conference Statement, August 17-18, 2000. Obstet Gynecol 2001; 98 (1) 144-150
  • 8 American College of Obstetricians and Gynecologists; Committee on Practice Bulletins—Obstetrics. ACOG practice bulletin no. 127: Management of preterm labor. Obstet Gynecol 2012; 119 (6) 1308-1317
  • 9 Crowther CA, McKinlay CJ, Middleton P, Harding JE. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. Cochrane Database Syst Rev 2011; (6) CD003935
  • 10 Hui D, Liu G, Kavuma E, Hewson SA, McKay D, Hannah ME. Preterm labour and birth: a survey of clinical practice regarding use of tocolytics, antenatal corticosteroids, and progesterone. J Obstet Gynaecol Can 2007; 29 (2) 117-130
  • 11 Quinlivan JA, Evans SF, Dunlop SA, Beazley LD, Newnham JP. Use of corticosteroids by Australian obstetricians—a survey of clinical practice. Aust N Z J Obstet Gynaecol 1998; 38 (1) 1-7
  • 12 Rouse DJ, Hirtz DG, Thom E , et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008; 359 (9) 895-905
  • 13 Abbasi S, Hirsch D, Davis J , et al. Effect of single versus multiple courses of antenatal corticosteroids on maternal and neonatal outcome. Am J Obstet Gynecol 2000; 182 (5) 1243-1249
  • 14 Ikegami M, Jobe AH, Newnham J, Polk DH, Willet KE, Sly P. Repetitive prenatal glucocorticoids improve lung function and decrease growth in preterm lambs. Am J Respir Crit Care Med 1997; 156 (1) 178-184
  • 15 Lee MJ, Davies J, Guinn D , et al. Single versus weekly courses of antenatal corticosteroids in preterm premature rupture of membranes. Obstet Gynecol 2004; 103 (2) 274-281
  • 16 Guinn DA, Atkinson MW, Sullivan L , et al. Single vs weekly courses of antenatal corticosteroids for women at risk of preterm delivery: A randomized controlled trial. JAMA 2001; 286 (13) 1581-1587
  • 17 Murphy KE, Hannah ME, Willan AR , et al; MACS Collaborative Group. Multiple courses of antenatal corticosteroids for preterm birth (MACS): a randomised controlled trial. Lancet 2008; 372 (9656) 2143-2151
  • 18 Wapner RJ, Sorokin Y, Thom EA , et al; National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network. Single versus weekly courses of antenatal corticosteroids: evaluation of safety and efficacy. Am J Obstet Gynecol 2006; 195 (3) 633-642
  • 19 Horvath B, Lakatos F, Tóth C, Bödecs T, Bódis J. Silent chorioamnionitis and associated pregnancy outcomes: a review of clinical data gathered over a 16-year period. J Perinat Med 2014; 42 (4) 441-447
  • 20 Erdemir G, Kultursay N, Calkavur S , et al. Histological chorioamnionitis: effects on premature delivery and neonatal prognosis. Pediatr Neonatol 2013; 54 (4) 267-274
  • 21 McEvoy C, Schilling D, Peters D , et al. Respiratory compliance in preterm infants after a single rescue course of antenatal steroids: a randomized controlled trial. Am J Obstet Gynecol 2010; 202 (6) 544.e1-544.e9
  • 22 Garite TJ, Kurtzman J, Maurel K, Clark R ; Obstetrix Collaborative Research Network. Impact of a ‘rescue course’ of antenatal corticosteroids: a multicenter randomized placebo-controlled trial. Am J Obstet Gynecol 2009; 200 (3) 248.e1-248.e9
  • 23 Bloom SL, Sheffield JS, McIntire DD, Leveno KJ. Antenatal dexamethasone and decreased birth weight. Obstet Gynecol 2001; 97 (4) 485-490
  • 24 Thorp JA, Jones PG, Knox E, Clark RH. Does antenatal corticosteroid therapy affect birth weight and head circumference?. Obstet Gynecol 2002; 99 (1) 101-108
  • 25 Jobe AH, Soll RF. Choice and dose of corticosteroid for antenatal treatments. Am J Obstet Gynecol 2004; 190 (4) 878-881