Antenatal Corticosteroid Therapy for Fetal 

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      Recommendations for Use of Antenatal Corticosteroids [2]

    • The benefits of antenatal administration of corticosteroids to fetuses at risk of preterm delivery vastly outweigh the potential risks. These benefits include not only a reduction in the risk of RDS but also a substantial reduction in mortality and IVH.
    • All fetuses between 24 and 34 weeks' gestation at risk of preterm delivery should be considered candidates for antenatal treatment with corticosteroids.
    • The decision to use antenatal corticosteroids should not be altered by fetal race or gender or by the availability of surfactant replacement therapy.
    • Patients eligible for therapy with tocolytics should also be eligible for treatment with antenatal corticosteroids.
    • Treatment consists of two doses of 12 mg of betamethasone given intramuscularly 24 hours apart or four doses of 6 mg of dexamethasone given intramuscularly 12 hours apart. Optimal benefit begins 24 hours after initiation of therapy and lasts 7 days.
    • Because treatment with corticosteroids for less than 24 hours is still associated with significant reductions in neonatal mortality, RDS, and IVH, antenatal corticosteroids should be given unless immediate delivery is anticipated.
    • In preterm premature rupture of membranes at less than 30 to 32 weeks' gestation in the absence of clinical chorioamnionitis, antenatal corticosteroid use is recommended because of the high risk of IVH at these early gestational ages.
    • In complicated pregnancies where delivery prior to 34 weeks' gestation is likely, antenatal corticosteroid use is recommended unless there is evidence that corticosteroids will have an adverse effect on the mother or delivery is imminent."  

    • Any actively tocolysed patient.[1]
    • EGA > 34 weeks in the presence of an immature lung profile.[2]


      • Betamethasone 12 mg IM q 24 h X 2 doses OR
      • Dexamethasone 6 mg IM q 12 h X 4 [2]

      If betamethasone and dexamethasone are not available, hydrocortisone 500mg given IV q12h x 4 doses may help to reduce the incidence of repiratory distress syndrome [3,4].

      1.ACOG Committee Opinion Committee on Obstetric Practice Number 210, October 1998 Antenatal Corticosteroid Therapy for Fetal Maturation
      2.NIH Consensus Statement Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes1994 Feb 28-Mar 2;12(2):1-24
      3. Morrison JC, Whybrew WD, Bucovaz ET, Schneider JM. Injection of corticosteroids into mother to prevent neonatal respiratory distress syndrome. Am J Obstet Gynecol 131:358,1978. MEDLINE
      4. Morrison JC, Schneider JM, Whybrew WD, Bucovaz ET. Effect of corticosteroids and Fetomaternal disorders on the L:S ratio. Obstet Gynecol 56:583, 1980 MEDLINE

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    Created: 11/30/2002
    Update: 11/30/2002
    Update: 4/15/2008