Oral or Poster Presentation
Concurrent Session 3B - Maternal Fetal Medicine
Introduction: The administration of multiple repeat courses of antenatal corticosteroids (ACS) in pregnant patients who remain undelivered after initial ACS administration for threatened preterm labour has not been shown to have clear benefit, and may have associated harms. This study aims to review the literature on the impact of a single “rescue” course or dose of ACS in patients who remain undelivered >7 days following administration of an initial course.
Methods: We conducted a comprehensive search of electronic databases, clinical trial registries, and the reference lists of relevant publications. RCTs and observational studies published from 1972 were included if they assessed neonatal outcomes after administration of a rescue course or dose of ACS for deliveries at <34 weeks’ gestation. Two reviewers independently screened studies for inclusion and assessed risk of bias. Data was extracted by one reviewer and results were synthesized narratively.
Results: A total of 1978 references were screened; three RCTs and four observational studies met the inclusion criteria. The included studies were all of a low risk of bias. These studies differed in gestational ages included (range: 24 to 34 weeks), time elapsed between initial and rescue ACS (>7, >14, or unspecified number of days), and inclusion of singleton and/or multiple pregnancies. Four studies investigated a rescue course and two studied a rescue dose; one study combined those groups. One study showed a significant decrease in mortality with rescue ACS, and two studies (both RCTs) found decreased respiratory distress syndrome with a rescue course. None of the studies showed a significant difference in birthweight with rescue ACS compared to a single course.
Conclusion: While these results suggest that rescue ACS may be beneficial and not harmful compared to a single course, the results are limited due to the heterogeneity of the literature. Further well-designed studies are needed.