Role of Antenatal Steroids

Antenatal steroids are given to pregnant women at risk of preterm delivery to accelerate fetal lung maturation, reduce neonatal complications, and improve survival.

Key Roles of Antenatal Steroids

• Fetal lung maturation: Stimulates surfactant production, reducing risk of respiratory distress syndrome (RDS).
• Reduction in neonatal mortality: Decreases risk of death in preterm infants.
• Prevention of complications: Lowers incidence of intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and systemic infections.
• Neurodevelopmental benefit: Associated with improved long-term neurological outcomes.
• Benefit across gestational ages: Most effective between 24–34 weeks, but can be considered as early as 23 weeks and up to 36+6 weeks in selected cases.

Clinical Indications

• Threatened preterm labor (before 34 weeks).
• Preterm premature rupture of membranes (PPROM).
• Elective early delivery for maternal/fetal indications (e.g., severe preeclampsia, IUGR).
• Multiple gestations at risk of early birth.

Regimens

• Betamethasone: 12 mg IM every 24 hours × 2 doses.
• Dexamethasone: 6 mg IM every 12 hours × 4 doses.
• Both are equally effective; choice depends on availability and local guidelines.

Repeat Courses

• Single repeat course may be considered if risk of preterm birth persists after 14 days from initial course (<34 weeks).
• Rescue course can be given as early as 7 days after prior dose if clinically indicated.

Limitations & Considerations

• Not recommended routinely after 37 weeks.
• Caution in maternal infection (may mask signs).
• Long-term safety: Generally safe, but ongoing surveillance of neurodevelopmental outcomes is advised.