title: Antenatal corticosteroids for preterm premature rupture of membranes: single or repeat course?
abstract: OBJECTIVE
  The aim of this article is to determine the risk of maternal chorioamnionitis and neonatal morbidity in women with preterm premature rupture of membranes (PPROM) exposed to one corticosteroid course versus a single repeat corticosteroid steroid course.
  
  
  METHODS
  Secondary analysis of a cohort of women with singleton pregnancies and PPROM. The primary outcome was a clinical diagnosis of maternal chorioamnionitis. Using multivariate logistic regression, we controlled for maternal age, race, body mass index, diabetes, gestational age at membrane rupture, preterm labor, and antibiotic administration. Neonatal morbidities were compared between groups controlling for gestational age at delivery.
  
  
  RESULTS
  Of 1,652 women with PPROM, 1,507 women received one corticosteroid course and 145 women received a repeat corticosteroid course. The incidence of chorioamnionitis was similar between groups (single course = 12.3% vs. repeat course = 11.0%; p = 0.8). Women receiving a repeat corticosteroid course were not at increased risk of chorioamnionitis (adjusted odds ratio, 1.28; 95% confidence interval, 0.69-2.14). A repeat course of steroids was not associated with an increased risk of any neonatal morbidity.
  
  
  CONCLUSIONS
  Compared with a single steroid course, our findings suggest that the risk of maternal chorioamnionitis or neonatal morbidity may not be increased for women with PPROM receiving a repeat corticosteroid course.
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Brookfield
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
authors.forename: Yasser Y
authors.initials: YY
authors.lastname: El-Sayed
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
authors.forename: Lisa
authors.initials: L
authors.lastname: Chao
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
authors.forename: Victoria
authors.initials: V
authors.lastname: Berger
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
authors.forename: Mariam
authors.initials: M
authors.lastname: Naqvi
authors.affiliation: Department of Anesthesia, Stanford University School of Medicine, Stanford, California.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Butwick
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D011247:Pregnancy; D055815:Young Adult; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D002821:Chorioamnionitis / Q000188:drug therapy; D015331:Cohort Studies; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy; D005865:Gestational Age; D016015:Logistic Models; D015999:Multivariate Analysis; D007752:Obstetric Labor, Premature; D016017:Odds Ratio; D011256:Pregnancy Outcome; D000094422:Secondary Data Analysis
chemical_list: D000305:Adrenal Cortex Hormones