TITLE

Antenatal Corticosteroids Administration: Better Timed in Spontaneous vs Iatrogenic Preterm Birth

 

OUR PROJECT IN SHORT

STUDY DESIGN: Retrospective analysis

COHORT: All singleton preterm (16+0 – 33+6 weeks) deliveries at Queen

Elizabeth Hospital (Lewisham & Greenwich NHS Trust, London)

TIME PERIOD: March to October 2021

AIM: Assess timing of antenatal corticosteroids (ACS) administration

RESULT: Appropriate (between 24 hours and 7 days prior to delivery) ACS

administration was highest in the spontaneous preterm labour group

without preterm premature rupture of membranes (PPROM)

CONCLUSION: Improvement of the management of women at high risk of

imminent delivery since implementation of Saving Babies Live Care

Bundle 2

 

1. AIM

To assess whether appropriate timing of antenatal corticosteroids (ACS) in singleton preterm births, at our inner-city

secondary care maternity hospital, had improved since the implementation of new NHS Guidance (Saving Babies Lives

Care Bundle 2)

 

2. METHOD

STUDY DESIGN

Retrospective analysis of digital records of all preterm deliveries (< 34 week’s gestation) at Queen Elizabeth Hospital

(Lewisham & Greenwich NHS Trust, London), between March and October 2021 using the maternity and neonatal

notes software PowerChart and BadgerNet. The preterm births were classified into iatrogenic, preterm premature

rupture of membranes (PPROM) and spontaneous preterm birth without PPROM.

INCLUSION CRITERIA

Singleton pregnancies

Gestation at delivery: 16+0 – 33+6 weeks

EXCLUSION CRITERIA

Multiple pregnancies

Termination of pregnancy for fetal indication

CONTROL

Control provided by local EQUIPTT trial cohort, which evaluated preterm birth management in the same region prior to

the new NHS guidance2.

PRIMARY OUTCOMES

ACS administration between 24 hrs and 7 days prior to delivery between 22+0 and 33+6 for all iatrogenic preterm births,

preterm birth after PPROM and spontaneous preterm births without PPROM.

 

3. RESULTS

Overall, the rate of appropriate ACS administration (> 24hrs and < 7 days prior to delivery) was 26%, relative to 21% in

the EQUIPTT controls. Appropriate ACS administration was highest in the spontaneous preterm labour group at 30%, vs

27% in the iatrogenic group, and 24% in the PPROM birth group. 40% of all preterm birth did not receive a first dose

within 24 hours, 50% within the spontaneous preterm births without PPROM, 47% within the iatrogenic group and 29%

within the PPROM birth group.

 

4. CONCLUSION

Following Saving Babies’ Lives Care Bundle Version 2 implementation, ACS administration has improved and

is timed more accurately for our spontaneous preterm births than iatrogenic or PPROM cases. This may be

partly attributable to better identification of women at high risk of imminent delivery. However, the surprisingly

low rates of appropriately timed ACS in planned preterm deliveries owes also to the complexity and severity of

our current obstetric population.

 

5. REFERENCES

https://www.england.nhs.uk/wp-content/uploads/2019/03/Saving-Babies-Lives-Care-Bundle-Version-Two-

Updated-Final-Version.pdf

2 Evaluating the use of the QUiPP app and its impact on the management of threatened preterm labour: A

cluster randomised trial, Watson H.A., Carlisle N., Seed Paul T., Carter J., Kuhrt K., Tribe R.M., Shennan A.H.

PLoS Med 2021 Jul 6;18(7):e1003689.