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The Utility of Rescue Antenatal Corticosteroids in Patients With Preterm Prelabor Rupture of Membranes [A222]

INTRODUCTION: The benefit of rescue antenatal corticosteroids (ACS) in patients with preterm prelabor rupture of membranes (PPROM) is unknown. We investigated whether rescue ACS is associated with a lower rate of adverse neonatal outcomes in patients with PPROM. METHODS: Retrospective cohort of all patients admitted with PPROM within a university health system from October 2015 to May 2020. Patients with singleton gestations and PPROM between 23 0/7 and 32 6/7 weeks of gestation who remained undelivered seven days after admission, and thus were eligible for a second course of ACS, were included. Missing outcome data were excluded. Cases were stratified into two groups based on the number of ACS courses administered: one course (n=52) versus a second, rescue course (n=20). The primary outcome was the incidence of respiratory distress syndrome (RDS). Secondary outcomes included mechanical ventilation (MV), neonatal intensive care unit (NICU) length of stay, and composite neonatal morbidity. Statistical analysis included use of chi-square and Wilcoxon rank sum tests. RESULTS: Patient characteristics such as gestational ages at PPROM and delivery, time interval from PPROM to delivery, rate of chorioamnionitis, magnesium exposure prior to delivery, and mode of delivery were similar between the two groups. The incidence of RDS in neonates was similar between the two groups. Secondary outcomes were also similar between the two groups. CONCLUSION: Our data did not show improvement in respiratory morbidity in neonates exposed to rescue ACS following PPROM. This remains an understudied clinical scenario, and future studies with larger cohorts are needed before determining clinical guidelines regarding rescue ACS for this select population.