Antenatal Corticosteroids in Preterm Premature Rupture of Membranes

• Published in: Clinical obstetrics and gynecology Vol. 41; no. 4; pp. 832 - 841
• Main Authors: CHEN, BRUCE, YANCEY, MICHAEL K
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins, Inc 01-12-1998
• Subjects: Adrenal Cortex Hormones - therapeutic use; Anti-Inflammatory Agents - therapeutic use; Cerebral Hemorrhage - etiology; Cerebral Ventricles; Female; Fetal Membranes, Premature Rupture - complications; Fetal Membranes, Premature Rupture - drug therapy; Humans; Infant, Newborn; Infection - etiology; Obstetric Labor, Premature - etiology; Pregnancy; Prenatal Care - methods; Respiratory Distress Syndrome, Newborn - etiology; Steroids
• ISSN: 0009-9201; 1532-5520
• DOI: 10.1097/00003081-199812000-00007

Premature rupture of membranes is an event that frequently precedes preterm delivery and presents a host of issues for the clinician about timing and mode of delivery as well as adjuvant therapies. The ultimate objective is the optimization of maternal and neonatal health, with the risks of infection for mother and baby weighed against neonatal sequelae related to prematurity. In the 1970's, expectant management became standard therapy in the attempt to allow further maturation of the fetus in utero. During the following decade, a large body of research into the use of corticosteroids for acceleration of fetal maturation was created, culminating in the recommendations by the National Institutes of Health (NIH) Consensus Development Conference and a committee opinion by the American College of Obstetricians and Gynecologists (ACOG) for general use of corticosteroids before anticipated preterm delivery. Although the NIH Consensus Statement supported the use of antenatal corticosteroids in pregnancies with anticipated preterm delivery at gestational ages between 24 and 34 weeks (up to 32 weeks with preterm premature rupture of membranes) in the absence of clinically overt chorioamnionitis, the ACOG committee gave only qualified recommendations for use in women with preterm premature rupture of membranes and those with intact membranes and extremely preterm (<28 weeks) gestations. These qualified recommendations for the use of antenatal corticosteroids were secondary to a paucity of data supporting efficacy in these situations. We review the existing data and arguments surrounding the use of corticosteroids for preterm premature rupture of membranes.