What are the ACOG guidelines on the treatment of preterm labor?

Updated: Dec 17, 2018
  • Author: Michael G Ross, MD, MPH; Chief Editor: Carl V Smith, MD  more...
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Answer

Answer

A 2016 clinical study [21] suggested a benefit of late preterm (34 0/7 to 36 6/7 weeks) steroids in women with singleton pregnancies at imminent risk of preterm delivery within 7 days, though tocolysis should not be used in order to delay delivery. The benefits were primarily a reduction in respiratory complications, though there was a marked increase in neonatal hypoglycemia in the treatment cohort. The American Congress of Obstetricians and Gynecologists (ACOG) issued a practice advisory (Practice Advisory: Antenatal Corticosteroid Administration in the Late Preterm Period, 2016) [22] that indicated that “administration of betamethasone may be considered in women with a singleton pregnancy between 34 0/7 and 36 6/7 weeks gestation at imminent risk of preterm birth within 7 days.”

ACOG further clarified the bulletin as follows:

  • Monitoring of neonatal blood glucose is recommended for late preterm infants since late preterm birth is a risk factor for hypoglycemia; these same guidelines should be followed for infants exposed to antenatal corticosteroids administered during the late preterm period.

  • Late preterm antenatal corticosteroid administration should not be used in women diagnosed with chorioamnionitis (intrauterine infection).

  • Tocolysis should not be used in order to delay delivery to allow for administration of late preterm antenatal corticosteroids, nor should an indicated late preterm delivery (such as for preeclampsia with severe features) be postponed for steroid administration.

  • Administration of late preterm antenatal corticosteroids should not be given if the pregnancy was already exposed to antenatal corticosteroids.

  • Because the ALPS trial excluded pregnant women with diabetes, multifetal gestations, previous exposure to steroids during pregnancy, or pregnancies with major non-lethal fetal malformations, ACOG is reviewing these topics and will issue any updated clinical guidance as appropriate.

A subanalysis of the results indicates that the significant benefit was observed in the patients with a planned late preterm cesarean section. In view of the incidence of neonatal hypoglycemia and the ACOG option to “consider” betamethasone, a reasonable clinical approach may be to limit the administration of late preterm betamethasone to those patients having late preterm planned cesarean sections.


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