Analysis of clinical diagnosis for all patients receiving antenatal betamethasone in a community hospital

Abstract

Objective: Identify which obstetrical diagnoses are associated with suboptimal antenatal betamethasone administration.

Methods: We present a retrospective, cohort study of patients who received betamethasone due to a risk for preterm delivery, between 7/2013 and 9/2016 at our institution. Details of betamethasone administration were recorded including the diagnosis leading to betamethasone. Optimal administration was defined as two doses of betamethasone given 24 hours apart, with delivery occurring at greater than 24 hours but less than seven days after completion of the second dose of betamethasone. Suboptimal administration included any betamethasone dosing that did not meet the optimal criteria.

Results: 428 patients were identified for the study with 20.1% of patients receiving optimal betamethasone. Patients presenting with hypertensive disorders of pregnancy (36.1%) and preterm premature rupture of membranes (PPROM) (22.1%) were more likely to receive optimal betamethasone, while patients presenting with preterm labor (PTL) (41.8%) and placental abruption (24.6%) were more likely to receive suboptimal betamethasone (p-value < 0.0001). Among PTL patients, those presenting with contractions and cervical dilation/short cervix (19.15%) were more likely to receive optimal betamethasone (p-value 0.0349). Optimal betamethasone decreased the incidence of respiratory distress syndrome (RDS) among 32.1 to 34 week neonates.

Conclusion: Hypertensive disorders of pregnancy and PPROM are associated with optimal betamethasone, whereas PTL and placental abruption are associated with suboptimal betamethasone.

Keywords: Betamethasone; antenatal corticosteroids; betamethasone and neonatal outcomes; optimal betamethasone administration; rescue steroid use; suboptimal betamethasone administration.