Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel.
J Matern Fetal Neonatal Med. 2021 Aug;34(15):2522-2528. doi: 10.1080/14767058.2019.1670159. Epub 2019 Oct 1.
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.
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.
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 ( = 38) received a rescue ACS course. Among women who did not receive rescue ACS course despite their eligibility ( = 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), = .01) and decision to deliver made at first hospitalization (OR [95% CI]: 2.27 (1.04, 4.76), = .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), = .02).
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.
尽管在有指征的早产分娩中分娩时机由医生决定，但在大多数情况下，产前皮质类固醇（ACS）的应用并不理想。我们旨在描述有指征的早产分娩中 ACS 的应用模式，并确定错过最佳 ACS 给药时机的情况。
我们回顾了 2015 年至 2017 年期间在一所大学医院因母亲或胎儿指征在 24-34 周时接受 ACS 治疗并分娩的女性的记录。最佳 ACS 时机定义为上次 ACS 疗程后≥24 小时且≤7 天分娩。
共有 188 例妊娠纳入研究。分娩时的中位孕龄为 32 周。仅考虑初始 ACS 疗程，最佳时机的比例为 32.4%。在 105 名（55.8%）符合条件的女性中（初始 ACS 疗程后>7 天分娩），仅有 38 名（36.2%）接受了挽救性 ACS 疗程。尽管符合条件（初始 ACS 疗程后>7 天分娩）但未接受挽救性 ACS 疗程的 67 名女性中，有 36 名（53.7%）的决策到分娩的时间间隔≥3 小时，有 20 名（29.9%）的决策到分娩的时间间隔≥24 小时，分别占整个队列的 19.1%和 10.6%。决策分娩的紧迫性（即在接下来的 24 小时内和之后分娩）和允许试产均与决策到分娩的时间间隔≥3 小时和≥24 小时呈正相关。在任何最佳时间窗内（初始或挽救性疗程）分娩的比例为 40.4%，妊娠高血压疾病（比值比[95%可信区间]：2.40（1.23，4.72），.01）和首次住院时决定分娩（比值比[95%可信区间]：2.27（1.04，4.76），.04）是 ACS 最佳时机的独立正预测因素。与 ACS 给药时机不理想的新生儿相比，ACS 给药时机最佳的新生儿复合不良结局发生率显著降低（32.9%比 50.9%，比值比[95%可信区间]：0.47（0.26，0.87），.02）。
大多数有指征的早产分娩中 ACS 应用并不理想。我们发现，挽救性 ACS 疗程利用不足以及错过最佳 ACS 给药时机的情况较多，这可能是改善 ACS 时机的可改变因素。
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