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)