ANTENATAL CORTICOSTEROIDS FOR THE PREVENTION OF NEONATAL RESPIRATORY-DISTRESS IN A PREDOMINANTLY RURAL STATE MEDICAID POPULATION

Objective: To examine the use of prenatal intramuscular steroids in a community setting as outlined in:National Institutes of Health (NIH) g uidelines to reduce respiratory distress syndrome in premature infants . Methods: We performed a complete chart review for 1 year of deliveri es to Medicaid mothers at 25-34 weeks' gestation at all obstetric unit s in Arkansas, analyzing time of arrival to the hospital, time of deli very, and dosage, and route of steroid administration to compare proce sses between community and teaching center sites, and general performa nce with NIH guidelines. Results: Of 191 deliveries at 25-34 weeks' ge station, 63.4% of mothers received at least one dose of corticosteroid s before delivery. Only 124 (65%) of these mothers presented to the ho spital more than 4 hours before delivery and 87% of these mothers rece ived at least one dose of corticosteroids before delivery. Ninety perc ent of women who were transferred after presenting in labor and 94.9% of women who delivered at the tertiary care referral center received c orticosteroids. There was no statistically significant difference in c orticosteroid administration rates for women with or without preterm p remature rupture of membranes. Many women received corticosteroids at dosages and intervals disparate with NIH guidelines. Conclusion: Obste tric providers in Arkansas administered antenatal steroids to Medicaid women in preterm labor at a rate higher than stated in previous liter ature. Delivery at a nonreferral center or within 4 hours of arrival t o the hospital were associated with reduced antenatal corticosteroid a dministration. Improved performance efforts should target institutiona l usage and behavior of mothers at risk for premature delivery. (Obste t Gynecol 1998; 92:837-41. (C) 1998 by The American College of Obstetr icians and Gynecologists.).