Jessica Smith1, Kellie E Murphy2, Sarah D McDonald3, Elizabeth Asztalos4, Amir Aviram1, Stefania Ronzoni1, Elad Mei-Dan5, Arthur Zaltz1, Jon Barrett1, Nir Melamed6. 1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. 2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada. 3. Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. 4. Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 5. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North York General Hospital, University of Toronto, Toronto, ON, Canada. 6. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. nir.melamed@sunnybrook.ca.
Abstract
PURPOSE: This study aimed at determining the proportion of women who receive antenatal corticosteroids (ACS) within the optimal time window before birth based on the indication for ACS, and to explore in more detail indications that are associated with suboptimal timing. METHODS: A retrospective cohort study of all women who received ACS in a single tertiary center between 2014 and 2017. The primary outcome was an ACS-to-birth interval ≤ 7 days. Secondary outcomes were ACS-to-birth interval of ≤ 14 days, and the proportion women who received ACS but ultimately gave birth at term (≥ 370/7 weeks). The study outcomes were stratified by the clinical indication for ACS. RESULTS: A total of 1261 women met the study criteria, of whom 401 (31.8%) and 569 (45.1%) received ACS within ≤ 7 days and ≤ 14 days before birth, respectively, and 203 (16.1%) ultimately gave birth at term. The proportion of women who received ACS within 7 days before birth was highest for women with preeclampsia (50.4%), and was lowest for women with an incidental finding of a short cervix (8.4%). In the subgroup of women with an incidental finding of a short cervix, the likelihood of optimal timing was not related to the magnitude of cervical shortening, history of preterm birth, multifetal gestation, presence of cervical funneling, or the presence of cervical cerclage. CONCLUSION: Over two-thirds of infants who are exposed to ACS do not get the maximal benefit from this intervention. The current study identified clinical indications for ACS that are associated with suboptimal timing of ACS where more research is needed to develop quantitative, indication-specific prediction models to guide the timing of ACS.
PURPOSE: This study aimed at determining the proportion of women who receive antenatal corticosteroids (ACS) within the optimal time window before birth based on the indication for ACS, and to explore in more detail indications that are associated with suboptimal timing. METHODS: A retrospective cohort study of all women who received ACS in a single tertiary center between 2014 and 2017. The primary outcome was an ACS-to-birth interval ≤ 7 days. Secondary outcomes were ACS-to-birth interval of ≤ 14 days, and the proportion women who received ACS but ultimately gave birth at term (≥ 370/7 weeks). The study outcomes were stratified by the clinical indication for ACS. RESULTS: A total of 1261 women met the study criteria, of whom 401 (31.8%) and 569 (45.1%) received ACS within ≤ 7 days and ≤ 14 days before birth, respectively, and 203 (16.1%) ultimately gave birth at term. The proportion of women who received ACS within 7 days before birth was highest for women with preeclampsia (50.4%), and was lowest for women with an incidental finding of a short cervix (8.4%). In the subgroup of women with an incidental finding of a short cervix, the likelihood of optimal timing was not related to the magnitude of cervical shortening, history of preterm birth, multifetal gestation, presence of cervical funneling, or the presence of cervical cerclage. CONCLUSION: Over two-thirds of infants who are exposed to ACS do not get the maximal benefit from this intervention. The current study identified clinical indications for ACS that are associated with suboptimal timing of ACS where more research is needed to develop quantitative, indication-specific prediction models to guide the timing of ACS.
Authors: Nir Melamed; Alex Pittini; Jon Barrett; Jyotsna Shah; Eugene W Yoon; Brigitte Lemyre; Shoo K Lee; Kellie E Murphy; Prakesh S Shah Journal: Obstet Gynecol Date: 2016-11 Impact factor: 7.661
Authors: Amanda Skoll; Amélie Boutin; Emmanuel Bujold; Jason Burrows; Joan Crane; Michael Geary; Venu Jain; Thierry Lacaze-Masmonteil; Jessica Liauw; William Mundle; Kellie Murphy; Suzanne Wong; K S Joseph Journal: J Obstet Gynaecol Can Date: 2018-09
Authors: Mikael Norman; Aurelie Piedvache; Klaus Børch; Lene Drasbek Huusom; Anna-Karin Edstedt Bonamy; Elizabeth A Howell; Pierre-Henri Jarreau; Rolf F Maier; Ole Pryds; Liis Toome; Heili Varendi; Tom Weber; Emilija Wilson; Arno Van Heijst; Marina Cuttini; Jan Mazela; Henrique Barros; Patrick Van Reempts; Elizabeth S Draper; Jennifer Zeitlin Journal: JAMA Pediatr Date: 2017-07-01 Impact factor: 16.193
Authors: Prakesh S Shah; Sarah D McDonald; Jon Barrett; Anne Synnes; Kate Robson; Jonathan Foster; Jean-Charles Pasquier; K S Joseph; Bruno Piedboeuf; Thierry Lacaze-Masmonteil; Karel O'Brien; Sandesh Shivananda; Nils Chaillet; Petros Pechlivanoglou Journal: CMAJ Open Date: 2018-01-18
Authors: Ashley N Battarbee; Stephanie T Ros; M Sean Esplin; Joseph Biggio; Radek Bukowski; Samuel Parry; Heping Zhang; Hao Huang; William Andrews; George Saade; Yoel Sadovsky; Uma M Reddy; Michael W Varner; Tracy A Manuck Journal: Am J Obstet Gynecol MFM Date: 2019-12-17