Grand Rounds

Is There Value to the Use of Corticosteroids in Women with Short Cervix Who Are Asymptomatic?

BACKGROUND AND PURPOSE:

ACOG recommends antenatal corticosteroids between 24 and 34 weeks for women “at risk” for delivery within 7 days
While there is demonstrated benefit to antenatal corticosteroids, there are also potential harms, especially with multiple doses
A short cervix is a risk factor for preterm birth
Richards et al. (Amer J Perinatol, 2017) sought to evaluate the number of asymptomatic women with a short cervix who would benefit from antenatal corticosteroids based on the recommended treatment window
The authors also assessed whether waiting until patients were asymptomatic would allow for a full course prior to delivery

Retrospective chart review
Inclusion: Patients with short cervix between 23w0d and 33w6d who had a cervical length < 2.5 cm and were asymptomatic
Antenatal corticosteroids were administered at the discretion of the MFM

367 asymptomatic patients were included, with only two delivering within 7 days from the time a short cervix was identified
2/3 of asymptomatic patients with a short cervix received antenatal corticosteroids based on additional risk factors such as prior history of preterm birth
Number needed to treat (NNT): 184 asymptomatic patients would need to be treated at the time a short cervix is identified for one patient to benefit
If a more stringent cervical length criteria was used, e.g., 2.0 cm cutoff, NNT would be 130
6% of patients delivered within 48 hours after onset of symptoms with a median time to delivery of 4 hours
- Waiting for symptoms would not have provided benefit due to short interval until delivery

The authors conclude that unless future studies demonstrate neonatal benefit of administration, antenatal corticosteroids should not be given to women solely because of shortened cervix

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