title: Evaluation of strategies regarding management of imminent preterm delivery before 32 weeks of gestation: a regional cohort study among 1375 women in the Netherlands.
abstract: OBJECTIVE
  To evaluate the management of imminent preterm delivery with respect to prescription of antenatal corticosteroids (ACS) and referral to a tertiary center.
  
  
  METHODS
  A retrospective cohort study existing of 1 perinatal center and 9 referring hospitals. All women who received their first dose of ACS in 1 of the 10 hospitals between 24+0 and 32+0 weeks of gestation and/or delivered before 32 weeks of gestation from 2005 until 2010. Patients were identified using the electronic database of hospital pharmacies. Main outcome measures were time interval from administration to delivery for different indications and number of women who were not referred in time to a tertiary center.
  
  
  RESULTS
  In total, 1375 women received ACS. Main indications were suspected preterm labor (44.7%), preterm prelabor rupture of membranes (15.9%), maternal indication (12.8%), fetal indication (9.2%) and vaginal blood loss (8.4%). Overall, 467 (34.0%) women delivered ≤7 days after ACS administration; 8.7% of women with vaginal blood loss and 54.5% of women with maternal indication. Among the 931 women who received ACS in the secondary hospitals, 452 (48.5%) women were referred to a tertiary hospital and 89 (6.5%) women delivered in a secondary hospital with a gestational age of less than 32 weeks.
  
  
  CONCLUSIONS
  One-third of all women receiving ACS delivered within 7 days and half of the women who received ACS in a secondary hospital were referred to a tertiary center. There seems to be room for improvement regarding the timing of ACS administration and subsequently referral to a tertiary center.
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Merel
authors.initials: M
authors.lastname: Boesveld
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Oudijk
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Steven V
authors.initials: SV
authors.lastname: Koenen
authors.affiliation: Department of Pediatrics, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Hens A A
authors.initials: HA
authors.lastname: Brouwers
authors.affiliation: St. Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Van Beek
authors.affiliation: Departments of Obstetrics and Gynecology, Diakonessen Hospital, Utrecht, the Netherlands.
authors.forename: Janine
authors.initials: J
authors.lastname: Boon
authors.affiliation: Twee Steden Hospital, Tilburg, the Netherlands.
authors.forename: Addy
authors.initials: A
authors.lastname: Drogtrop
authors.affiliation: Beatrix Hospital, Gorinchem, the Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Euser
authors.affiliation: Meander Medical Center, Amersfoort, the Netherlands.
authors.forename: Inge M
authors.initials: IM
authors.lastname: Evers
authors.affiliation: St. Elisabeth Hospital, Tilburg, the Netherlands.
authors.forename: Cora A
authors.initials: CA
authors.lastname: Fiedeldeij
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Karst Y
authors.initials: KY
authors.lastname: Heida
authors.affiliation: Gelre Hospital, Apeldoorn, the Netherlands.
authors.forename: Anjoke J M
authors.initials: AJ
authors.lastname: Huisjes
authors.affiliation: Rivierenland Hospital, Tiel, the Netherlands.
authors.forename: Guido J J M
authors.initials: GJ
authors.lastname: Muijsers
authors.affiliation: Deventer Hospital, Deventer, the Netherlands.
authors.forename: Jaap M
authors.initials: JM
authors.lastname: Schierbeek
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands. Electronic address: a.kwee@umcutrecht.nl.
authors.forename: Anneke
authors.initials: A
authors.lastname: Kwee
mesh_terms: D000328:Adult; D001623:Betamethasone / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy*; D005500:Follow-Up Studies; D005865:Gestational Age; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D053208:Kaplan-Meier Estimate; D008297:Male; D009426:Netherlands; D007752:Obstetric Labor, Premature / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D047928:Premature Birth; D011295:Prenatal Care / Q000379:methods* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D063728:Secondary Care Centers; D062606:Tertiary Care Centers; D013997:Time Factors
chemical_list: D005938:Glucocorticoids; D001623:Betamethasone
keywords: antenatal corticosteroids; pregnancy; preterm birth; referral policy; time interval