OB Guideline 11: Use of Antenatal Corticosteroids for Fetal Maturation

All birthing people between 24 and 34 weeks gestation who are at risk for delivery within seven days, should receive corticosteroids. This includes patients with rupture of membranes, unless individual circumstances affect this decision. Steroids may be considered between 22 weeks 0 days, and 23 weeks 6 days gestational age in a shared decision making approach. Consultation with neonatology and/or maternal-fetal medicine should be considered if steroids are to be administered prior to 24 weeks.

Steroids between 34 0/7 and 36 6/7 weeks should be offered to patients at high risk of preterm birth within the next 7 days in a shared decision-making approach, weighing immediate benefits against uncertain long-term risks.¹
Tocolysis beyond 34 weeks gestation to complete steroid administration is not recommended.²

Treatment options include:

• Two doses of betamethasone 12 mg IM 24 hours apart

  OR

• Four doses of dexamethasone 6 mg IM 12 hours apart

The 2000 NIH Consensus panel did not find significant evidence to support using one drug preferentially over the other.

A second course of antenatal corticosteroids may be considered if clinically appropriate.³ Further repeat courses (more than two) are not currently recommended.

1. Society for Maternal-Fetal Medicine (SMFM). Reddy UM, Deshmukh U, Dude A, Harper L, Osmundson SS. Society for Maternal-Fetal Medicine Consult Series #58: Use of antenatal corticosteroids for individuals at risk for late preterm delivery. Am J Obstet Gynecol. 2021;225(5):B36-B42. doi:10.1016/j.ajog.2021.07.023
2. Gyamfi-Bannerman C, Thom EA, Blackwell SC, et al. Antenatal Betamethasone for Women at Risk for Late Preterm Delivery. N Engl J Med. 2016;374(14):1311-1320. doi:10.1056/NEJMoa1516783
3. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Practice Bulletin No. 171: Management of preterm labor. Obstet Gynecol. 2016;128(4):e155-e164. Reaffirmed 2022. doi:10.1097/AOG.0000000000001711