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Antenatal Corticosteroid Therapy for Fetal Maturation

Obstet Gynecol; ePub 2016 Oct; ACOG

The American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice has issued recommendations for the administration of antenatal corticosteroid therapy for fetal maturation. According to the committee opinion, corticosteroid administration before anticipated preterm birth is one of the most important antenatal therapies available to improve newborn outcomes. ACOG recommendations include:

  • A single course of corticosteroids is recommended for pregnant women between 24 0/7 weeks and 33 6/7 weeks of gestation, including for those with ruptured membranes and multiple gestations. It also may be considered for pregnant women starting at 23 0/7 weeks of gestation who are at risk of preterm delivery within 7 days, based on a family’s decision regarding resuscitation, irrespective of membrane rupture status and regardless of fetal number.
  • Administration of corticosteroids for pregnant women during the periviable period who are at risk of preterm delivery within 7 days is linked to a family’s decision regarding resuscitation and should be considered in that context.
  • A single course of betamethasone is recommended for pregnant women between 34 0/7 weeks and 36 6/7 weeks of gestation at risk of preterm birth within 7 days, and who have not received a previous course of antenatal corticosteroids.
  • Regularly scheduled repeat courses or serial courses (more than 2) are not currently recommended.
  • A single repeat course of antenatal corticosteroids should be considered in women who are less than 34 0/7 weeks of gestation who have an imminent risk of preterm delivery within the next 7 days, and whose prior course of antenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario.
  • Continued surveillance of long-term outcomes after in utero corticosteroid exposure should be supported.
  • Quality improvement strategies to optimize appropriate and timely antenatal corticosteroid administration are effective and should be encouraged.

Citation:

Antenatal corticosteroid therapy for fetal maturation. Committee Opinion No. 677. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016;128:e187–94.