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Single Versus Weekly Courses of Antenatal Corticosteroids in Preterm Premature Rupture of Membranes

From the Department of Obstetrics and Gynecology, New York University, New York, New York; University of Colorado Health Sciences Center and Denver Health Medical Center, Denver, Colorado; Boston University, Boston, Massachusetts; University of Washington, Seattle Washington; Evanston Hospital, Evanston, Illinois; Northwestern University, Chicago, Illinois; University of Michigan, Ann Arbor, Michigan; Columbia University, New York, New York; Mount Sinai Medical Center, New York, New York; University Southern California, Los Angeles, California; Kapi’Olani Medical Center, Honolulu, Hawaii; Loyola University, Maywood, Illinois.

Address reprint requests to: Men-Jean Lee, MD, NYU Medical Center, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, 550 First Avenue, Room 9E2, New York, NY, 10016; e-mail: mjl5{at}nyu.edu.

OBJECTIVE: This study was performed to evaluate the efficacy of weekly courses of antenatal corticosteroids compared with a single course in women with preterm premature rupture of membranes (PROM).

METHODS: A planned secondary analysis of women with preterm PROM who participated in a multicenter, randomized trial of weekly courses of antenatal corticosteroids versus single-course therapy was performed. After their first course of standard antenatal steroid therapy, administered between 24 to 32–6/7 weeks of gestation, consenting women were randomly assigned to receive betamethasone versus placebo injections weekly until 34–0/7 weeks of gestation. Maternal and neonatal morbidities were compared between the 2 groups.

RESULTS: Of the 161 women with preterm PROM, 81 women were assigned to receive weekly courses of steroids and 80 to the single-course group. There were no significant differences in composite morbidity between the groups (27 [34.2%] of 81 patients versus 33 [41.8%] of 80 patients, P = .41). Chorioamnionitis was higher in patients who received weekly courses of antenatal steroids (39 [49.4%] of 81 patients versus 25 [31.7%] of 80 patients, P = .04).

CONCLUSION: Weekly courses of antenatal steroids in women with preterm PROM did not improve neonatal outcomes beyond that achieved with single-course therapy and was associated with an increased risk of chorioamnionitis. Antenatal steroid therapy should not be routinely repeated in patients with preterm PROM.

LEVEL OF EVIDENCE: I

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