Corticosteroid administration before anticipated preterm birth is one of the most important antenatal therapies available to improve newborn outcomes. A single course of corticosteroids is recommended for pregnant women between 24 0/7 weeks and 33 6/7 weeks of gestation who are at risk of preterm delivery within 7 days, including for those with ruptured membranes and multiple gestations. It also may be considered for pregnant women starting at 23 0/7 weeks of gestation who are at risk of preterm delivery within 7 days, based on a family’s decision regarding resuscitation, irrespective of membrane rupture status and regardless of fetal number. Administration of betamethasone may be considered in pregnant women between 34 0/7 weeks and 36 6/7 weeks of gestation who are at risk of preterm birth within 7 days, and who have not received a previous course of antenatal corticosteroids. A single repeat course of antenatal corticosteroids should be considered in women who are less than 34 0/7 weeks of gestation who are at risk of preterm delivery within 7 days, and whose prior course of antenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario. Continued surveillance of long-term outcomes after in utero corticosteroid exposure should be supported. Quality improvement strategies to optimize appropriate and timely antenatal corticosteroid administration are encouraged.
For a comprehensive overview of these recommendations, the full-text version of this Committee Opinion is available at http://dx.doi.org/10.1097/AOG.0000000000002237.
INTERIM UPDATE: This Committee Opinion is updated as highlighted to reflect a limited focused change to clarify that, among specific populations, antenatal corticosteroids should be administered when a woman is at risk of preterm delivery within 7 days. For complete details on these updates, please see the full-text version.
Committee on Obstetric Practice: This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice in collaboration with committee members Yasser Y. El-Sayed, MD, Ann E.B. Borders, MD, MSc, MPH, and the Society for Maternal–Fetal Medicine’s liaison member Cynthia Gyamfi-Bannerman, MD, MSc.
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Official Citation: Antenatal corticosteroid therapy for fetal maturation. Committee Opinion No. 713. American College of Obstetricians and Gyne-cologists. Obstet Gynecol 2017;130:e102–9.
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Received July 04, 2017
Accepted July 04, 2017