Single versus weekly courses of antenatal corticosteroids in preterm premature rupture of membranes.
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).


CONCLUSIONS
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.


METHODS
I
Lee
Men-Jean
MJ
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, New York University, 550 First Avenue, Room 9E2, New York, NY 10016, USA. mjl5@nyu.edu
Davies
Jill
J
Guinn
Debra
D
Sullivan
Lisa
L
Atkinson
M Wendy
MW
McGregor
Scott
S
Parilla
Barbara V
BV
Hanlon-Lundberg
Kathleen
K
Simpson
Lynn
L
Stone
Joanne
J
Wing
Deborah
D
Ogasawara
Keith
K
Muraskas
Jonathon
J
D000328:Adult; D001623:Betamethasone / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy* / Q000517:prevention & control; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007273:Injections, Intramuscular; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D011295:Prenatal Care / Q000379:methods; D011336:Probability; D018570:Risk Assessment; D016896:Treatment Outcome
D003907:Dexamethasone; D001623:Betamethasone