Missed opportunities for optimal antenatal corticosteroid timing in medically indicated preterm births

被引:4
作者
Rottenstreich, Amihai [1 ]
Elchalal, Uriel [1 ]
Yahya, Rani Haj [1 ]
Mankuta, David [1 ]
Rottenstreich, Misgav [2 ]
Yagel, Simcha [1 ]
Levin, Gabriel [1 ]
机构
[1] Hadassah Hebrew Univ, Med Ctr, Dept Obstet & Gynecol, POB 12000, IL-191120 Jerusalem, Israel
[2] Shaare Zedek Med Ctr, Dept Obstet & Gynecol, Jerusalem, Israel
关键词
Antenatal corticosteroids; betamethasone; medically-indicated preterm delivery; steroid-to-delivery interval; timing of antenatal corticosteroids; ASSOCIATION; TRENDS;
D O I
10.1080/14767058.2019.1670159
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective: Although delivery timing is physician dictated in indicated preterm births, suboptimal antenatal corticosteroids (ACS) administration occurs in most cases. We aimed to characterize the patterns of use of ACS in indicated preterm births and identify missed opportunities of optimal ACS administration. Methods: We reviewed the records of women who received ACS and were delivered due to maternal or fetal indications at 24?34?weeks of gestation during 2015?2017 at a university hospital. Optimal ACS timing was defined as delivery ?24?h ?7?d from the previous ACS course. Results: Overall, 188 pregnancies were included. The median gestational age at delivery was 32?weeks. Considering only the initial ACS course, the rate of optimal timing was 32.4%. Of 105 (55.8%) women eligible (delivery >7?d since the initial ACS course), only a third (n?=?38) received a rescue ACS course. Among women who did not receive rescue ACS course despite their eligibility (n?=?67), the decision-to-delivery was ?3?h in 36 (53.7%), and ?24?h in 20 (29.9%), representing 19.1 and 10.6% of the entire cohort, respectively. The urgency of the decision to deliver (i.e. in the upcoming 24?h and later) and allowing a trial of labor, were both positively associated with decision-to-delivery interval ?3?h and ?24?h. The rate of delivery within any optimal window (either initial or rescue course) was 40.4%, with gestational hypertensive disorders (OR [95% CI]: 2.40 (1.23, 4.72), p = .01) and decision to deliver made at first hospitalization (OR [95% CI]: 2.27 (1.04, 4.76), p = .04) as independent positive predictors of optimal ACS timing. The rate of composite adverse neonatal outcome was significantly lower in those with optimal ACS administration as compared to those with suboptimal timing (32.9 versus 50.9%, OR [95% CI]: 0.47 (0.26, 0.87), p = .02). Conclusions: Suboptimal ACS administration occurred in most indicated preterm births. Underutilization of rescue ACS course and a substantial rate of missed opportunities for optimal ACS administration were identified as potentially modifiable contributors to improve ACS timing.
引用
收藏
页码:2522 / 2528
页数:7
相关论文
共 26 条
  • [1] The timing of administration of antenatal corticosteroids in women with indicated preterm birth
    Adams, Tracy M.
    Kinzler, Wendy L.
    Chavez, Martin R.
    Vintzileos, Anthony M.
    [J]. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2015, 212 (05) : 645.e1 - 645.e4
  • [2] Maternal-fetal conditions necessitating a medical intervention resulting in preterm birth
    Ananth, Cande V.
    Vintzileos, Anthony M.
    [J]. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2006, 195 (06) : 1557 - 1563
  • [3] Trends in preterm birth and perinatal mortality among singletons: United States, 1989 through 2000
    Ananth, CV
    Joseph, KS
    Oyelese, Y
    Demissie, K
    Vintzileos, AM
    [J]. OBSTETRICS AND GYNECOLOGY, 2005, 105 (05) : 1084 - 1091
  • [4] Approximately one-third of medically indicated late preterm births are complicated by fetal growth restriction
    Carreno, Carlos A.
    Costantine, Maged M.
    Holland, Marium G.
    Ramin, Susan M.
    Saade, George R.
    Blackwell, Sean C.
    [J]. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2011, 204 (03)
  • [5] Committee on Obstetric Practice, 2017, Obstet Gynecol, V130, P210
  • [6] Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes
    Crowther, Caroline A.
    McKinlay, Christopher J. D.
    Middleton, Philippa
    Harding, Jane E.
    [J]. COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2011, (06):
  • [7] Antenatal corticosteroids: a retrospective cohort study on timing, indications and neonatal outcome
    Frandberg, Julia
    Sandblom, Johan
    Bruschettini, Matteo
    Marsal, Karel
    Kristensen, Karl
    [J]. ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, 2018, 97 (05) : 591 - 597
  • [8] Annual Summary of Vital Statistics: 2010-2011
    Hamilton, Brady E.
    Hoyert, Donna L.
    Martin, Joyce A.
    Strobino, Donna M.
    Guyer, Bernard
    [J]. PEDIATRICS, 2013, 131 (03) : 548 - 558
  • [9] Howson CP, 2012, BORN TOO SOON THE GL
  • [10] Antenatal corticosteroid prescribing: A complete audit cycle
    Khoo, C.
    Welsh, J.
    Owen, P.
    [J]. JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 2007, 27 (01) : 33 - 36