Vignette and Discussion Questions Issue #64 Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth Vignette and Discussion Questions Created by William E Cayley, Jr Journal Club Editor Eau Claire Family Medicine Residency Vignette and Discussion Questions published 19th June, 2017

Obstetrics quality improvement You have just joined a small group practice providing obstetric care at a local hospital. While your hospital provides full-scope labor-and-delivery services for term pregnancies, you have no neonatology services and any mother with anticipated preterm delivery needs to be transported to a regional referral facility.

Obstetrics quality improvement You have been asked to join a committee to develop a uniform set of protocols for preterm pregnancies because there has been substantial variation in practice between the 3 physician groups who provide obstetric care at your hospital. Specifically, there has been substantial variation in the use of antenatal corticosteroids in mothers with preterm labor, and questions over the relative risks and benefits of corticosteroid use.

Obstetrics quality improvement Some physicians have questioned the safety of corticosteroids for preterm labor complicated by pre-eclampsia. Others have expressed concerns over the possible increased risk of neonatal or maternal infections There has also been disagreement over the appropriate upper and lower limits of preterm gestational age for administration of corticosteroids.

Obstetrics quality improvement Seeking to inform your committee’s work with the best current evidence, you recommend that the committee consider the recently updated Cochrane Review titled: Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth

Questions for discussion What new information does this review add to regarding: Perinatal risks and benefits of maternal corticosteroids? Long-term risks and benefits of corticosteroids? Specific groups for whom corticosteroids may have greater benefit? How do you recommend your committee use this Cochrane Review in developing your local protocols?

Further Information How to cite the Cochrane Review: Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD004454. DOI: 10.1002/14651858.CD004454.pub3. Find out more about Cochrane Journal Club: http://www.cochranelibrary.com/more-resources/cochrane-journal-club-.html Share your thoughts about this Journal Club: Email: CochraneJournalClub@wiley.com This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.