BMJ  2004;328 (1 May), doi:10.1136/bmj.328.7447.0-f

Filler

POEM^*

Use a single course of steroids for preterm rupture of membranes

Question Do weekly courses of corticosteroids given to women with preterm premature rupture of membranes lead to better neonatal outcomes than a single course?

Synopsis Weekly courses of corticosteroids are recommended for women at risk for preterm birth with membranes intact (PPROM). This report is a planned secondary analysis of 161 women with PPROM and gestation between 24 and 32 6/7 weeks' gestation enrolled in a randomised controlled trial of single versus weekly courses of corticosteroids. A course of corticosteroid was two doses of 12 mg betamethasone intramuscularly 24 hours apart. All women with PPROM received antibiotics, usually penicillin and a macrolide. There was no difference in the primary outcome of composite neonatal morbidity (defined as any of severe respiratory distress syndrome, bronchopulmonary dysplasia, severe intraventricular haemorrhage, periventricular leukomalacia, necrotising enterocolitis, sepsis proved by culture, and perinatal death). Chorioamnionitis was more frequent in the weekly course group (48% v 32%). There were no differences in the rates of endometritis or neonatal sepsis.

Bottom line A single course of antenatal corticosteroids is recommended for women with preterm premature rupture of membranes. Weekly courses do not improve neonatal outcomes and are associated with increased risk of chorioamnionitis.

Level of evidence 1b (see www.infopoems.com/levels.html). Individual randomised controlled trials (with narrow confidence interval).

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Lee MJ, Davies J, Guinn D, et al. Single versus weekly courses of antenatal corticosteroids in preterm premature rupture of membranes. Obstet Gynecol 2004;103: 274-81[Abstract/Free Full Text].

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^* Patient-Oriented Evidence that Matters. See editorial ( BMJ 2002;325: 983[Free Full Text])

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