(202) Neonatal and maternal outcomes after betamethasone administration for late-preterm premature rupture of membranes (PROM).

Assess the impact of betamethasone administration in the management of late-preterm premature rupture of membranes (PROM).

Study Design:

Retrospective review of singleton pregnancies with PROM delivering at 34 to 36 weeks gestation within a health maintenance organization, 2017 to 2019. Treatment with one or two doses of betamethasone prior to delivery was compared with no treatment.  The primary outcome was a composite of neonatal respiratory complications of one or more: respiratory distress syndrome, respiratory arrest, transient tachypnea, use of CPAP or HFNC. Statistical analysis utilized Chi-square and multivariate logistic regression.

Results:

The primary composite outcome occurred in 44 of 328 (13.4%) in the betamethasone group versus 122 of 699 (17.5%) in the control group (relative risk 0.77; 95% CI, 0.5 to 1.1; P=0.1). The primary outcome occurred more often following cesarean than spontaneous vaginal delivery (OR 2.5; 95% CI, 1.7 to 3.7, p < .001).  The mean gestational age (35.4 wks) and median time from ROM to delivery (17 hours), did not differ between groups, indicating immediate delivery management. The rate of chorioamnionitis was lower in the betamethasone group, 3.4% versus 6.6%, (relative risk 0.51; 95% CI 0.2 to 0.97, p=0.04). Endometritis following delivery did not differ between groups. Neonatal sepsis occurred more often in the betamethasone group, 1.5 % versus 0.3%, (relative risk 5.3; 95% CI, 1 to 27, p=0.04). A higher rate of neonatal hypoglycemia was also observed in the betamethasone group (15.5% vs. 10.7%; relative risk 1.4, 95% CI, 1.0 to 2.0; p=0.03).

Conclusion:

Betamethasone administration with immediate delivery management for late-preterm PROM was associated with a reduction in the rate of neonatal respiratory complications, although not statistically significant.  Maternal infectious morbidity was not increased, although higher rates of neonatal sepsis and hypoglycemia were observed following betamethasone exposure. Cesarean delivery remains a significant risk factor for neonatal respiratory morbidity in the late preterm, regardless of steroid administration.