Evaluation of strategies regarding management of imminent preterm delivery before 32 weeks of gestation: a regional cohort study among 1375 women in the Netherlands

• Published in: American journal of obstetrics and gynecology 2015-03, Vol.212 (3), p.348.e1-348.e7
• Main Authors: Boesveld, Merel, MD, Oudijk, Martijn A., PhD, Koenen, Steven V., PhD, Brouwers, Hens A.A., PhD, Van Beek, Erik, PhD, Boon, Janine, PhD, Drogtrop, Addy, PhD, Euser, Robert, MD, Evers, Inge M., PhD, Fiedeldeij, Cora A., MD, Heida, Karst Y., MD, Huisjes, Anjoke J.M., MD, Muijsers, Guido J.J.M., PhD, Schierbeek, Jaap M., MD, Kwee, Anneke, PhD
• Format: Article
• Language: English
• Subjects: Adult; antenatal corticosteroids; Betamethasone - therapeutic use; Drug Administration Schedule; Female; Fetal Membranes, Premature Rupture - drug therapy; Follow-Up Studies; Gestational Age; Glucocorticoids - therapeutic use; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - prevention & control; Kaplan-Meier Estimate; Male; Netherlands; Obstetric Labor, Premature - drug therapy; Obstetrics and Gynecology; Practice Patterns, Physicians' - statistics & numerical data; Pregnancy; Premature Birth; Prenatal Care - methods; Prenatal Care - statistics & numerical data; preterm birth; Referral and Consultation - statistics & numerical data; referral policy; Retrospective Studies; Secondary Care Centers; Tertiary Care Centers; Time Factors; time interval
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2014.10.014

Objective To evaluate the management of imminent preterm delivery with respect to prescription of antenatal corticosteroids (ACS) and referral to a tertiary center. Study Design A retrospective cohort study existing of 1 perinatal center and 9 referring hospitals. All women who received their first dose of ACS in 1 of the 10 hospitals between 24+0 and 32+0 weeks of gestation and/or delivered before 32 weeks of gestation from 2005 until 2010. Patients were identified using the electronic database of hospital pharmacies. Main outcome measures were time interval from administration to delivery for different indications and number of women who were not referred in time to a tertiary center. Results In total, 1375 women received ACS. Main indications were suspected preterm labor (44.7%), preterm prelabor rupture of membranes (15.9%), maternal indication (12.8%), fetal indication (9.2%) and vaginal blood loss (8.4%). Overall, 467 (34.0%) women delivered ≤7 days after ACS administration; 8.7% of women with vaginal blood loss and 54.5% of women with maternal indication. Among the 931 women who received ACS in the secondary hospitals, 452 (48.5%) women were referred to a tertiary hospital and 89 (6.5%) women delivered in a secondary hospital with a gestational age of less than 32 weeks. Conclusion One-third of all women receiving ACS delivered within 7 days and half of the women who received ACS in a secondary hospital were referred to a tertiary center. There seems to be room for improvement regarding the timing of ACS administration and subsequently referral to a tertiary center.