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25: Chorioamnionitis and antenatal steroid therapy: single vs repeat course?

      Objective

      To date, the literature examining the risk of maternal infectious morbidity in the setting of ruptured membranes after administration of antenatal corticosteroids has been limited to single versus weekly repeat courses. We sought to evaluate whether one course versus a single repeat course of antenatal corticosteroids given in the setting of premature rupture of the membranes (PROM) increases the risk of maternal chorioamnionitis.

      Study Design

      Women given antenatal corticosteroids in the setting of PROM were sourced from the MFMU BEAM registry of 17 academic centers between 1997-2004. We compared the incidence of chorioamnionitis among women with ruptured membranes and singleton gestations who received one course versus a repeat course of antenatal corticosteroids. Multivariate logistic regression was also used to identify whether the number of steroid courses received was an independent predictor of maternal chorioamnionitis. We controlled for maternal age, duration of membrane rupture, race, delivery route, antibiotic administration, and BMI; P < 0.05 was considered statistically significant.

      Results

      Our cohort comprised 1669 women with PROM who received antenatal corticosteroids; (n=1522 women for a single course; n=147 for two courses). The incidence of chorioamnionitis was similar in the single and repeat course steroid groups (12.4% vs. 10.9%; P=0.69). On univariate analysis, repeat course steroids was not associated with an increased risk of chorioamnionitis. The risk of chorioamnionitis remained unchanged after accounting for other obstetric and perinatal covariates (RR(95% CI) = 0.87(0.54,1.42); p=0.292).

      Conclusion

      Our data suggest women who receive a single repeat course of antenatal corticosteroids in the setting of ruptured membranes are not at increased risk of developing chorioamnionitis.
      Tabled 1Maternal and clinical characteristics of women with PROM receiving steroids
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      Categorical variables are represented as N(%). Continuous variables are represented as mean+/- SD. p-values obtained with Fisher's exact test, Chi-square test, or t-test, where appropriate.