Skip to main content

Advertisement

SpringerLink
Log in

Approaching NIH Guideline Recommended Care for Maternal–Infant Health: Clinical Failures to Use Recommended Antenatal Corticosteroids

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

To assess the use of antenatal corticosteroids in clinical circumstances for which both the NIH Guideline and local experts recommend their use and to describe characteristics associated with failure to use recommended antenatal steroids. We convened local experts to adapt the NIH statement by identifying clinical circumstances for which they agree antenatal steroids should always be used. We conducted a retrospective chart review on a cohort study of mothers who delivered premature (24–34 weeks) infants between 2000 and 2002 at three New York City hospitals and investigated the association of failure to treat with antenatal steroids with characteristics of the mother, pregnancy, delivery, and hospital. Twenty percent (101/515) of eligible mothers failed to receive indicated antenatal corticosteroid therapy. Of these, 43% delivered more than 2 h after admission, and 33% delivered more than 4 h after admission, indicating sufficient time to have treated them. Lack of prenatal care, longer gestation, advanced cervical exam, and intact membranes at admission were associated with failure to receive the recommended therapy. Antenatal steroids were under-utilized in our sample. If our results our generalizable, opportunities for quality improvement in the antenatal management of mothers in preterm labor exist.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Crowley, P. A. (1995). Antenatal corticosteroid therapy: A meta-analysis of the randomized trials, 1972–1994. American Journal of Obstetrics and Gynecology, 173(1), 322–335. doi:10.1016/0002-9378(95)90222-8.

    Article  CAS  PubMed  Google Scholar 

  2. Roberts, D., & Dalziel, S. R. (2006). Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database of Systematic Reviews, (3). Art. No.: CD004454. doi:10.1002/14651858.CD004454.pub2.

  3. The Effect of Antenatal Steroids for Fetal Maturation on Perinatal Outcomes-Interim Draft Statement. NIH Consens Statement Online 1994 Feb 28–Mar 2 [cited August 4, 2008]. 12(2), 1–24.

  4. Elimian, A., Figueroa, R., Spitzer, A. R., et al. (2003). Antenatal corticosteroids: Are incomplete courses beneficial? Obstetrics and Gynecology, 102(2), 352–355. doi:10.1016/S0029-7844(03)00485-X.

    Article  CAS  PubMed  Google Scholar 

  5. Chien, L. Y., Ohlsson, A., Seshia, M. M., et al. (2002). Variations in antenatal corticosteroid therapy: A persistent problem despite 30 years of evidence. Obstetrics and Gynecology, 99(3), 401–408. doi:10.1016/S0029-7844(01)01732-X.

    Article  PubMed  Google Scholar 

  6. Sinclair, J. C. (1995). Meta-analysis of randomized controlled trials of antenatal corticosteroid for the prevention of respiratory distress syndrome. American Journal of Obstetrics and Gynecology, 173(1), 335–344. doi:10.1016/0002-9378(95)90223-6. discussion.

    Article  CAS  PubMed  Google Scholar 

  7. New York City Birth and Infant Mortality Trends. New York: New York City Department of Health and Mental Hygiene. 2006 Updated October 31, 2008. Accessed March 15, 2009 at http://www.nyc.gov/html/doh/html/ms/ms-bimt.shtml.

  8. Ohlsson, H., Lindblad, U., Lithman, T., et al. (2005). Understanding adherence to official guidelines on statin prescribing in primary health care––a multi-level methodological approach. European Journal of Clinical Pharmacology, 61(9), 657–665. doi:10.1007/s00228-005-0975-9.

    Article  CAS  PubMed  Google Scholar 

  9. Boyd, E. A. (1998). Bureaucratic authority in the “company of equals” “the interactional management of medical Peer review. American Sociological Review, 63(2), 200–224. doi:10.2307/2657323.

    Article  Google Scholar 

  10. Greco, P. J., & Eisenberg, J. M. (1993). Changing physicians’ practices. The New England Journal of Medicine, 329(17), 1271–1274.

    Google Scholar 

  11. Assessment of Risk Factors for Preterm Birth. (2001). ACOG practice bulletin no. 31. Obstetrics and Gynecology, 98, 709–716.

    Google Scholar 

  12. Murphy, K. E., Reuss, M. L., Leviton, A., et al. (1998). Variation in use of corticosteroids among infants ≤1, 500 g across hospitals in three states. The Journal of Maternal-Fetal Medicine, 7(3), 137–141. doi:10.1002/(SICI)1520-6661(199805/06)7:3<137::AID-MFM7>3.0.CO;2-L.

    Article  CAS  PubMed  Google Scholar 

  13. Wirtschafter, D. D., Danielsen, B. H., Main, E. K., et al. (2006). Promoting antenatal steroid use for fetal maturation: Results from the California perinatal quality care collaborative. The Journal of Pediatrics, 148(5), 606–612. doi:10.1016/j.jpeds.2005.12.058.

    Article  CAS  PubMed  Google Scholar 

  14. Leviton, L. C., Goldenberg, R. L., Baker, C. S., et al. (1999). Methods to encourage the use of antenatal corticosteroid therapy for fetal maturation: A randomized controlled trial. Journal of the American Medical Association, 281(1), 46–52. doi:10.1001/jama.281.1.46.

    Article  CAS  PubMed  Google Scholar 

  15. Wennberg, J. (1999). Understanding geographic variations in health care delivery. The New England Journal of Medicine, 340, 52–53. Jan. 7, No. 1.

    Article  CAS  PubMed  Google Scholar 

  16. Wennberg, J. E., & Barnis, B. A. (1982). Zubkopp. Professional uncertainty and the problem of supplier-induced demand. Social Science and Medicine, 16, 811–824. doi:10.1016/0277-9536(82)90234-9.

    Article  CAS  PubMed  Google Scholar 

  17. Davies, B. L., Stewart, P. J., Sprague, A. E., et al. (1998). Education of women about the prevention of preterm birth. Canadian Journal of Public Health, 89(4), 260–263.

    CAS  Google Scholar 

  18. Sprague, A., Stewart, P., Niday, P., et al. (2002). Community education on preterm birth. Does it change practice? Canadian Family Physician Medecin de Famille Canadien, 48(72), 7–734.

    Google Scholar 

  19. Antenatal Corticosteroids Revisited: Repeat Courses. NIH Consens Statement Online 2000 August 17–18; [March 15, 2009]. 17(2), 1–10.

Download references

Acknowledgements

Supported by the Agency for Healthcare Research and Quality (PO1 HS10859) the Commonwealth Fund (20030088), and the National Center for Minority Health and Health Disparities (P60 MD00270). The opinions, view, and conclusions expressed in this article are those of the authors and not necessarily those of the Agency for Healthcare Research and Quality or the Commonwealth Fund.

Author information

Authors and Affiliations

  1. Department of Health Policy, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York City, Box 1077, NY, USA

    Elizabeth A. Howell & Lawrence C. Kleinman

  2. Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York City, NY, USA

    Elizabeth A. Howell & Joanne Stone

  3. Department of Pediatrics, Mount Sinai School of Medicine, New York City, NY, USA

    Lawrence C. Kleinman

  4. Department of Pediatrics, Metropolitan Hospital, New York City, NY, USA

    Sarla Inamdar

  5. Department of Obstetrics and Gynecology, Harlem Hospital, New York City, NY, USA

    Stephen Matseoane

  6. The Joint Commission, Chicago, IL, USA

    Mark R. Chassin

Authors
  1. Elizabeth A. Howell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joanne Stone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lawrence C. Kleinman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sarla Inamdar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stephen Matseoane
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mark R. Chassin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elizabeth A. Howell.

Appendix

Appendix

Management of Prematurity Steering Committee Obstetric Interventions: Antenatal Corticosteroids

Guidelines

  1. 1.

    All women who present in preterm labor with intact membranes between 24 and 34 weeks gestation should receive a course of antenatal corticosteroids.

    Exceptions:

    1. 1.

      Patients with contraindications to corticosteroids (e.g. chorioamnionitis)

    2. 2.

      Patients who have already received a course of antenatal corticosteroids

    3. 3.

      Patients for whom antenatal corticosteroid administration is not feasible because immediate delivery is anticipated

  2. 2.

    All pregnant women between 24 and 34 weeks gestation who are not in labor but require delivery within 7 days secondary to maternal or infant indications * should receive a course of antenatal corticosteroids.

    Exceptions:

    1. 1.

      Patients with contraindications to corticosteroids

    2. 2.

      Patients who have already received a course of antenatal corticosteroids

    3. 3.

      Patients for whom antenatal corticosteroid administration is not feasible because immediate delivery is anticipated

  3. 3.

    A single course of antenatal corticosteroids should consist either of betamethasone 12 mg intramuscularly every 24 h for 2 doses or dexamethasone 6 mg intramuscularly every 12 h for 4 doses.

  4. 4.

    All patients with preterm premature rupture of membranes (PPROM) between 24 and 32 weeks gestation should receive a course of antenatal corticosteroids.

    Exceptions:

    1. 1.

      Patients with contraindications to corticosteroids

    2. 2.

      Patients who have already received a course of antenatal corticosteroids

    3. 3.

      Patients with documented fetal lung maturity

* Examples of maternal and infant indications that may require preterm delivery are preeclampsia, diabetes, intrauterine growth retardation, and hydrops.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Howell, E.A., Stone, J., Kleinman, L.C. et al. Approaching NIH Guideline Recommended Care for Maternal–Infant Health: Clinical Failures to Use Recommended Antenatal Corticosteroids. Matern Child Health J 14, 430–436 (2010). https://doi.org/10.1007/s10995-009-0480-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-009-0480-3

Keywords

Search

Navigation