Use Single Course of Corticosteroids for PPROM
Clinical Question: Do weekly courses of corticosteroids given to women with preterm premature rupture of membranes (PPROM) lead to better neonatal outcomes than a single course?
Setting: Other
Study Design: Randomized controlled trial (double-blinded)
Synopsis: Weekly courses of corticosteroids are recommended for women at risk of preterm birth with membranes intact. This report is a planned secondary analysis of 161 women with PPROM and gestation between 24 and 32-6/7 weeks of gestation who were enrolled in a randomized controlled trial of a single course versus weekly courses of corticosteroids.
A course of corticosteroids was two 12-mg doses of betamethasone given intramuscularly 24 hours apart. All women with PPROM received antibiotics, usually penicillin and a macrolide. The groups did not differ in the primary outcome of composite neonatal morbidity, which was defined as any of the following: severe respiratory distress syndrome, bronchopulmonary dysplasia, severe intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, culture-proven sepsis, and perinatal death. Chorioamnionitis occurred more often in the weekly-course group (48 percent versus 32 percent in the single-course group). No differences in the rates of endometritis or neonatal sepsis were noted between the two groups.
Bottom Line: A single course of antenatal corticosteroids is recommended for women with PPROM. Weekly courses do not improve neonatal outcomes and are associated with increased risk of chorioamnionitis. (Level of Evidence: 1b)
linda french, m.d.
study reference: Lee MJ, et al. Single versus weekly courses of antenatal corticosteroids in preterm premature rupture of membranes. Obstet Gynecol February 2004; 103:274-81.
Used with permission from French L. Use single course of corticosteroids for PPROM. Accessed online March 29, 2004, at: http://www.InfoPOEMs.com.
Copyright © 2004 by the American Academy of
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