PPROM Prior to 33 0/7 Weeks: When Should Rescue Course Corticosteroids Be Given? [23R]

Abstract

INTRODUCTION: Timely administration of corticosteroids reduces RDS of the newborn, IVH, necrotizing enterocolitis, and perinatal mortality. Corticosteroids are optimally effective 1-7 days after the first dose. A single rescue course of steroids may be given at least 1-2 weeks after the initial course. We sought to determine the optimal timing for administration of rescue course corticosteroids in women with PPROM prior to 33 weeks. METHODS: This was an IRB-approved retrospective cohort from 2013-2017 of 66 singleton gravidas with PPROM at 23 0/7-32 6/7 weeks. Observing when these women spontaneously labored or underwent indicated delivery, we compared hypothetical strategies for timing of rescue corticosteroids. This included administration of corticosteroids at 1, 2, 3, or 4 weeks after PPROM, versus withholding until spontaneous labor or indicated delivery. A Chi-squared test was used to compare the likelihood of delivery within the optimal window of the first dose of either the initial or rescue corticosteroids. RESULTS: The median interval from PPROM to delivery was 6.6 (3.3-16.4) days. Giving rescue corticosteroids 1 week after PPROM had the greatest number of deliveries occurring in the optimal window compared to 2, 3, or 4 weeks. Withholding rescue corticosteroids until spontaneous labor or indicated delivery was statistically less likely to result in deliveries during the optimal window compared to routinely giving corticosteroids 1 week after PPROM (45.5% vs 63.6%, p=0.04). CONCLUSION: In women with PPROM prior to 33 weeks, routinely administering rescue course corticosteroids 1 week after PPROM improves the likelihood of delivery within the optimal window for corticosteroid benefit.