Fillion Alexandre, Boutin Amélie, Gareau-Léonard Audrée, Labine Laurence, Gasse Cédric, Gaudreau Caroline, Demers Suzanne, Bujold Emmanuel
Reproduction, Mother and Child Health Unit, CHU de Québec - Université Laval Research Centre, Université Laval, Québec City, QC.
Reproduction, Mother and Child Health Unit, CHU de Québec - Université Laval Research Centre, Université Laval, Québec City, QC; Department of Gynecology, Obstetrics and Reproduction, Faculty of Medicine, Université Laval, Québec City, QC.
J Obstet Gynaecol Can. 2019 Mar;41(3):300-305. doi: 10.1016/j.jogc.2018.06.001. Epub 2018 Oct 23.
Antenatal corticosteroids (ACS) received within 7 days of delivery reduce perinatal morbidity and mortality associated with preterm birth. We aimed to describe the trends of ACS administration over the last decade.
A cohort study of women who received ACS in 2006, 2011, and 2016 at the CHU de Québec-Université Laval was conducted. The indication, GA at ACS, and GA at birth, were collected in 150 women randomly selected in each studied year. Our main endpoints were the frequency of ACS administration within 7 days of delivery and between 48 hours and 7 days before delivery.
We included 447 women who received ACS at a median GA of 31.4 (range 23.6-39.0) weeks. No women received ACS after 35 weeks in 2006 and 2011. The administration of ACS for indicated delivery between 35 and 39 weeks occurred only in the last study period. Among women for whom ACS was initiated before 35 weeks, 31% received ACS in the 7 days before delivery, and only 13% received ACS between 48 hours and 7 days before birth (varying from 12% to 16%, P = 0.57). Threatened preterm labour or short cervix were the indication for ACS initiation in 39% women who received ACS before 35 weeks, but less than 5% of these women delivered between 2 and 7 days and more than 90% delivered after 14 days.
Administration of ACS remains suboptimal. Threatened preterm labour and short cervix are poorly related to optimal use of ACS therapy.
分娩前7天内使用产前糖皮质激素（ACS）可降低与早产相关的围产期发病率和死亡率。我们旨在描述过去十年中ACS给药的趋势。
对2006年、2011年和2016年在魁北克大学拉瓦尔大学中心医院接受ACS治疗的女性进行了一项队列研究。在每个研究年份随机选择150名女性，收集其ACS使用指征、接受ACS时的孕周以及出生时的孕周。我们的主要终点是分娩前7天内以及分娩前48小时至7天之间ACS的给药频率。
我们纳入了447名接受ACS治疗的女性，她们接受ACS时的孕周中位数为31.4周（范围23.6 - 39.0周）。2006年和2011年，没有女性在35周后接受ACS治疗。35至39周因指征性分娩而使用ACS仅发生在最后一个研究期间。在35周前开始使用ACS的女性中，31%在分娩前7天内接受了ACS治疗，而只有13%在出生前48小时至7天之间接受了ACS治疗（从12%到16%不等，P = 0.57）。有早产风险或宫颈短是39%在35周前接受ACS治疗的女性开始使用ACS的指征，但这些女性中不到5%在2至7天内分娩，超过90%在14天后分娩。
ACS的使用仍不理想。有早产风险和宫颈短与ACS治疗的最佳使用相关性较差。
