ANTENATAL CORTICOSTEROID PRESCRIBING - SETTING STANDARDS OF CARE

Objective Despite widespread recognition that prenatal administration of corticosteroids dramatically reduces perinatal mortality and morbid ity, clinical practice in this area remains less than ideal. We theref ore reviewed our practice to identify reasons for this and to determin e attainable standards of care. Design Retrospective case record revie w. Setting Level three maternity unit in Edinburgh, UK. Population All women admitted at gestations of 24 to 34 weeks and 6 days inclusive, and all women receiving corticosteroids in one institution, over a 10- month period. Main outcome measures The number and clinical features o f women delivering before and after 35 weeks of pregnancy who had rece ived corticosteroids. Results Seven hundred and two women were admitte d during the study period; case records were available for 688 of thes e. One hundred and ninety-two women (28%) delivered before 35 weeks of gestation, of whom 123 (64%) had received dexamethasone. Of 69 women who received no steroids 30 (43%) were in hospital for more than 24 ho urs before delivery. Overall, 29% of women receiving dexamethasone del ivered after 35 weeks of gestation and 42 (24%) women treated with dex amethasone received more than one course. While the grade of admitting doctor did not affect prescribing, there were other significant diffe rences that may help guide future practice. Conclusions This study pro vides some guidance for optimising corticosteroid prescribing and for the development of clinical practice guidelines. Approximately 80% of women should be able to receive at least some corticosteroids prior to delivery before 35 completed weeks of pregnancy.