Recommendations for use of antenatal corticosteroids

Recommendations for use of antenatal corticosteroids

The benefits of antenatal administration of corticosteroids to fetuses at risk of preterm delivery vastly outweigh the potential risks. These benefits include not only a reduction in the risk of RDS, but also a substantial reduction in mortality and IVH.

All fetuses between 24 and 34 weeks of gestation at risk of preterm delivery should be considered candidates for antenatal treatment with corticosteroids.

The decision to use antenatal corticosteroids should not be altered by fetal race or gender or by the availability of surfactant replacement therapy.

Patients eligible for therapy with tocolytics should also be eligible for treatment with antenatal corticosteroids.

Treatment consists of either two doses of 12 mg of betamethasone given intramuscularly 24 hours apart or four doses of 6 mg of dexamethasone given intramuscularly 12 hours apart. Optimal benefit begins 24 hours after initiation of therapy and lasts seven days.

Because treatment with corticosteroids for less than 24 hours is still associated with significant reductions in neonatal mortality, RDS, and IVH, antenatal corticosteroids should be given unless immediate delivery is anticipated.

In premature rupture of membranes at less than 30 to 32 weeks of gestation in the absence of clinical chorioamnionitis, antenatal corticosteroid use is recommended because of the high risk of IVH at these early gestational ages.

In complicated pregnancies where delivery prior to 34 weeks of gestation is likely, antenatal corticosteroid use is recommended unless there is evidence that corticosteroids will have an adverse effect on the mother or delivery is imminent.

RDS: respiratory distress syndrome; IVH: intraventricular hemorrhage.

Adapted from: data in the Report of the Consensus Development Conference on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes. National Institute of Child Health and Human Development. November 1994. NIH Publication No. 95-3784.
Antenatal Corticosteroids Revisited: Repeat Courses—National Institutes of Health Consensus Development Conference Statement, August 17–18, 2000. Obstet Gynecol 2001; 98:144-150.