Antenatal corticosteroid prescribing: setting standards of care.
OBJECTIVE
Despite widespread recognition that prenatal administration of corticosteroids dramatically reduces perinatal mortality and morbidity, clinical practice in this area remains less than ideal. We therefore reviewed our practice to identify reasons for this and to determine attainable standards of care.


METHODS
Retrospective case record review.


METHODS
Level three maternity unit in Edinburgh, UK.


METHODS
All women admitted at gestations of 24 to 34 weeks and 6 days inclusive, and all women receiving corticosteroids in one institution, over a 10-month period.


METHODS
The number and clinical features of women delivering before and after 35 weeks of pregnancy who had received corticosteroids.


RESULTS
Seven hundred and two women were admitted during the study period; case records were available for 688 of these. One hundred and ninety-two women (28%) delivered before 35 weeks of gestation, of whom 123 (64%) had received dexamethasone. Of 69 women who received no steroids 30 (43%) were in hospital for more than 24 hours before delivery. Overall, 29% of women receiving dexamethasone delivered after 35 weeks of gestation and 42 (24%) women treated with dexamethasone received more than one course. While the grade of admitting doctor did not affect prescribing, there were other significant differences that may help guide future practice.


CONCLUSIONS
This study provides some guidance for optimising corticosteroid prescribing and for the development of clinical practice guidelines. Approximately 80% of women should be able to receive at least some corticosteroids prior to delivery before 35 completed weeks of pregnancy.
Wallace
E M
EM
Department of Obstetrics and Gynaecology, Monash University, Australia.
Chapman
J
J
Stenson
B
B
Wright
S
S
D036861:Delivery, Obstetric; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D005865:Gestational Age; D005938:Glucocorticoids / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D008505:Medical Staff, Hospital; D010818:Practice Patterns, Physicians' / Q000592:standards; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000592:standards*; D011364:Professional Practice / Q000592:standards; D011787:Quality of Health Care; D012189:Retrospective Studies
D005938:Glucocorticoids; D003907:Dexamethasone