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Am J Perinatol 2024; 41(S 01): e1917-e1924
DOI: 10.1055/s-0043-1769794
Original Article

Analysis of Factors Contributing to Antenatal Corticosteroid Administration in Patients Presenting with Threatened Preterm Labor

Leah Bode
1   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
,
Alexandra H. McKinzie
1   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
,
Nadia M. Gidia
1   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
,
Sherrine A. Ibrahim
1   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
,
David M. Haas 
1   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations Funding This study was supported by the Indiana Clinical and Translational Sciences Institute's Indiana Medical Student Program for Research and Scholarship (IMPRS), funded in part by (UL1TR002529) from the National Institutes of Health, and by R01HD088014.
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Abstract

Objective This study aimed to analyze characteristics of those seen for threatened preterm labor (tPTL) who receive antenatal corticosteroids (ACS) to better understand clinical decision-making.

Study Design This retrospective cohort study consisted of patients seen in triage at an urban county hospital in 2021 for tPTL during pregnancy. Demographic variables (maternal age, race/ethnicity, and prior preterm delivery) and obstetrical variables (cervical dilation, effacement, membrane rupture, and tocolytic administration) were evaluated against the primary outcome of ACS administration.

Results After exclusions, a cohort of 290 pregnant people with 372 unique encounters for tPTL remained. The mean maternal age was 26.7, and 15.6% of patients had a history of prior preterm birth. A total of 107 patients in 111 encounters received ACS, which were associated with lower body mass index (BMI), greater cervical dilation, greater effacement, membrane rupture, and more frequent contractions (all ps < 0.01). The mean presentation was at 33.5 weeks. Only 44% of those receiving ACS delivered within 7 days, compared with 11% of those who did not receive ACS (p < 0.001). Half (50%) of the patients receiving ACS delivered at >37 weeks. Adjusting for significant factors in the univariable analysis and limited to first encounter in triage, BMI (odds ratio: 0.91, 95% confidence interval: 0.87–0.95), cervical dilation ≥ 2 cm (2.49, 1.12–5.35), and cervical effacement ≥ 50% (4.80, 2.25–10.24) were significantly associated with patients receiving ACS.

Conclusion Greater cervical dilation and effacement and a lower BMI were associated with ACS administration, although most patients receiving ACS still did not deliver within 7 days.

Key Points

  • In a cohort of 290 patients with 373 encounters for threatened preterm labor, 37% received ACS.

  • We found that only 40% of those who received ACS delivered within 7 days and half went on to deliver at term.

  • Cervical dilation ≥2 cm (odds ratio, 95% confidence interval: 2.49, 1.12–5.35) and effacement ≥50% (4.80, 2.25–10.24) were independently associated with receiving ACS.

Keywords

antenatal corticosteroids - cervix - preterm birth - threatened preterm labor

Note

This work has been presented as a poster presentation abstract to the 2023 American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting.


Authors' Contributions

L.B.: Conceptualization, data acquisition, analysis, original draft writing, review, editing; A.H.M.: conceptualization, data acquisition, analysis, draft review, editing; N.M.G.: data acquisition, analysis, draft review, editing; S.A.I.: conceptualization, analysis, draft review, editing; D.M.H.: conceptualization, data acquisition, analysis, draft writing, review, editing. All authors approve of this final draft for submission.




Publication History

Received: 24 February 2023

Accepted: 03 May 2023

Article published online:
06 June 2023

© 2023. Thieme. All rights reserved.

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