Do antenatal corticosteroids help in the setting of preterm rupture of membranes?

OBJECTIVE: It is now accepted that corticosteroid administration before pre term delivery reduces neonatal mortality and morbidity. However, corticoste roid use in the setting of rupture of membranes remains controversial. STUDY DESIGN: We reviewed data from the first and largest randomized trial in this area and included them in a new meta-analysis. RESULTS: Data from 318 women with rupture of membranes in the Auckland Tria l showed that there was a trend toward reduction of the risk of respiratory distress syndrome with corticosteroids but that this trend did not reach s tatistical significance. There was little effect on the risks of neonatal d eath, intraventricular hemorrhage, and fetal, neonatal, or maternal infecti on. Combined data from 15 controlled trials involving >1400 women with rupt ure of membranes confirmed that corticosteroids reduce the risks of respira tory distress syndrome (relative risk, 0.56; 95% confidence interval, 0.46- 0.70), intraventricular hemorrhage (relative risk, 0.47; 95% confidence int erval, 0.31-0.70), and necrotizing enterocolitis (relative risk, 0.21;95% c onfidence interval, 0.05-0.82). They also may reduce the risk of neonatal d eath (relative risk, 0.68; 95% confidence interval, 0.43-1.07). They do not appear to increase the risk of infection in either mother (relative risk, 0.86; 95% confidence interval, 0.61-1.20) or baby (relative risk, 1.05; 95% confidence interval, 0.66-1.68). The duration of rupture of membranes does not alter these outcomes. CONCLUSION: The available data indicate that corticosteroid administration is beneficial in the setting of rupture of membranes. In our opinion furthe r trials to address this question cannot be justified.