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Maternal Infectious Morbidity and Antenatal Corticosteroid Therapy in Women with Preterm Premature Rupture of Membranes.
Abstract Number: F-42
Abstract Type: Original Research
Introduction:Preterm premature rupture of membranes (PPROM) precedes 25% of all preterm births, a leading cause of major perinatal morbidity and mortality.(1) Antenatal corticosteroids are integral to the clinical management of PPROM. However, it is unclear whether the risk of maternal chorioamnionitis is increased in women with PPROM who receive multiple courses of corticosteroids compared to women receiving a single corticosteroid course.(2) Among women with PPROM, we investigated whether a single corticosteroid course vs. repeat corticosteroid course influences the risk of maternal chorioamnionitis.
Methods:This is a secondary analysis from a multicenter trial in women at risk of preterm delivery who received antenatal magnesium sulphate versus placebo.(3) We identified a cohort of women with singleton pregnancies with PPROM between 24 and 31+6 weeks’ gestation, and compared the risk of chorioamnionitis in women who received one course of antenatal steroids with those receiving a single repeat steroid course. For secondary analysis, we compared neonatal anthroprometric indices and morbidities (sepsis, RDS, NEC, IVH and NICU admission) in babies born to women receiving a single course vs. repeat steroid course. Chi-square test, Fisher’s Exact test, Student’s t-test and the Mann-Whitney U test were used for between group analyses, as appropriate. We used univariate and multiple logistic regression to assess the association between steroid courses and maternal chorioamnionitis; P <0.05 as statistically significant.
Results:Within a cohort of 1652 women, 1507 women and 145 women received a single steroid course and a repeat steroid course respectively. The incidence of chorioamnionitis was similar among those who received a single and a repeat steroid course (12.3% vs. 11.0%; P=0.8). After adjustment for maternal and obstetric confounders, we observed no increased risk of chorioamnionitis in women receiving a repeat steroid course vs. a single steroid course (aOR = 1.18; 95% CI = 0.97-1.02) (Table). We observed no significant differences between the two groups for neonatal anthroprometric characteristics or morbidities.
Conclusion:Compared to women with PPROM who receive a single course of antenatal steroids, women who receive a repeat course of steroids may not be at increased risk of chorioamnionitis or adverse neonatal morbidity.
References:(1)Obstet Gynecol 2003;101:178-93 (2)Obstet Gynecol 2013;122:918-30;178-93 (3)N Engl J Med 2008;359:895-905.