Preterm

Question 1

Glucocorticoid guideline

Answer 1

Single course of corticosteroids (betamethasone 24mg in divided doses 12-36hrs)

• gestation <35 weeks
• preterm delivery planned or expected within next 7 days
• optimal to deliver when expected within 48 hours

Repeat antenatal steroids following single course when

• gestation <33 weeks
• delivery expected in next 7 days
• not less than 7 days before initial course

Other indications

• elective LSCS >35 weeks if known lung immaturity
• at women with DM <37 weeks

Question 2

Gestation of viability

Answer 2

No resuscitation: <22 weeks

Always resuscitate: >25 weeks

Grey zone

• existing guidelines lag behind improved prognosis
• mortality <26 weeks fallen from 80% to 28%
• however unable to accurately determine neurodev outcome
• other factors: BW, sex, steroids, multiple births