ANTENATAL STEROID-THERAPY BEFORE 33 WEEKS GESTATION

OBJECTIVE: The purpose of this study was to determine those factors in fluencing contemporary antenatal steroid use in pregnancies delivered prior to 33 weeks of gestation. METHOD: We analyzed the clinical circu mstances of 86 consecutive patients who delivered prior to 33 weeks of gestation and compared the 20 women who received dexamethasone prior to delivery with the remaining 66 untreated cases. RESULT: Known risk factors for preterm delivery (e.g. prior preterm birth, n = 17; prior admission and tocolysis during the index pregnancy, n = 15) did not di scriminate between treated and untreated subsets. Premature membrane r upture (3/20 vs. 34/166; P < 0.01) and documented preterm labor (1/20 vs. 23/66/ P < 0.01) were more common in the untreated cohort and a sh orter mean interval from admission to delivery was also observed (2.8 vs 11.2 days). However, a full course of steroids would have been poss ible in 22/66 untreated women, since delivery was delayed for at least 36 h in these patients. CONCLUSION: These observations reflect the fa ct that many preterm births cannot be anticipated, even among hospital ized patients. We would therefore suggest that universal steroid treat ment be considered for all women with documented preterm labor prior t o 33 weeks of gestation. Initiation of steroid therapy at the referral center, (prior to maternal transport) should also be considered. Sinc e both premature membrane rupture and early gestational age (24-28 wee ks') confounded many of these cases, steroid use in patients with thes e circumstances should be reevaluated.