Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Acta Obstet Gynecol Scand. 2018 Dec;97(12):1508-1514. doi: 10.1111/aogs.13439. Epub 2018 Sep 25.
Previous reports have shown that suboptimal antenatal corticosteroids administration occurs in most cases. However, as multifetal gestations were either excluded or constituted a small proportion of the participants in these studies, little is known about the patterns of use of antenatal corticosteroids in twin pregnancies.
We reviewed the records of women who received antenatal corticosteroids and delivered between 24 and 34 weeks of gestation during 2015-2017 at 2 university hospitals. Optimal antenatal corticosteroids timing was defined as delivery ≥24 hours ≤7 days from the previous antenatal corticosteroids course.
Of 424 pregnancies, 307 (72.4%) were singleton and 117 were (27.6%) twin. For twin compared with singleton pregnancies, gestational age at initial antenatal corticosteroids administration was lower (P = 0.02), the proportion of deliveries within the optimal window of the initial antenatal corticosteroids course was lower (19.7% vs 33.2%, P = 0.001), and the proportion of women eligible for a rescue antenatal corticosteroids course was higher (58.1% vs 32.9%, P < 0.0001). However, despite similar rates of rescue antenatal corticosteroids administration (P = 0.64), the overall rate of delivery within any optimal window (either initial or rescue course) was lower in twin than singleton pregnancies (26.5% vs 42.3%, P = 0.004), and the antenatal corticosteroids-to-delivery interval was longer (median 6.9 vs 4.2 days, P = 0.0009). In multivariate analysis, optimal antenatal corticosteroids administration was negatively associated with twin pregnancy (P = 0.04) and preterm labor (P = 0.05), and positively associated with the presence of gestational hypertensive disorders (P = 0.03).
Twin pregnancy is an independent risk factor for suboptimal antenatal corticosteroids administration. Directed efforts should be made to improve the utilization of antenatal corticosteroids in this vulnerable group of women.
之前的报告表明，大多数情况下产前皮质类固醇的使用并不理想。然而，由于多胎妊娠在这些研究中要么被排除在外，要么只占参与者的一小部分，因此对于双胎妊娠中产前皮质类固醇的使用模式知之甚少。
我们回顾了 2015 年至 2017 年期间在 2 所大学医院接受产前皮质类固醇治疗并在 24 至 34 周之间分娩的女性的记录。最佳产前皮质类固醇时机定义为距前一次产前皮质类固醇疗程≥24 小时≤7 天分娩。
在 424 例妊娠中，307 例（72.4%）为单胎，117 例（27.6%）为双胎。与单胎妊娠相比，双胎妊娠初始产前皮质类固醇治疗的胎龄较低（P=0.02），初始产前皮质类固醇疗程的最佳时间窗内分娩的比例较低（19.7%对 33.2%，P=0.001），有资格接受挽救性产前皮质类固醇疗程的女性比例较高（58.1%对 32.9%，P<0.0001）。然而，尽管挽救性产前皮质类固醇治疗的比例相似（P=0.64），但在双胎妊娠中，任何最佳时间窗（初始或挽救疗程）内分娩的总比例均低于单胎妊娠（26.5%对 42.3%，P=0.004），产前皮质类固醇至分娩的间隔时间也更长（中位数为 6.9 对 4.2 天，P=0.0009）。多变量分析表明，最佳产前皮质类固醇治疗与双胎妊娠（P=0.04）和早产（P=0.05）呈负相关，与妊娠高血压疾病的存在呈正相关（P=0.03）。
双胎妊娠是产前皮质类固醇治疗不理想的独立危险因素。应努力改善该脆弱人群中产前皮质类固醇的应用。
