Do antenatal corticosteroids help in the setting of preterm rupture of membranes?

OBJECTIVE: It is now accepted that corticosteroid administration before preterm delivery reduces neonatal mortality and morbidity. However, corticosteroid use in the setting of rupture of membranes remains controversial. STUDY DESIGN: We reviewed data from the first and largest randomized trial in this area and included them in a new meta-analysis. RESULTS: Data from 318 women with rupture of membranes in the Auckland Trial showed that there was a trend toward reduction of the risk of respiratory distress syndrome with corticosteroids but that this trend did not reach statistical significance. There was little effect on the risks of neonatal death, intraventricular hemorrhage, and fetal, neonatal, or maternal infection. Combined data from 15 controlled trials involving >1400 women with rupture of membranes confirmed that corticosteroids reduce the risks of respiratory distress syndrome (relative risk, 0.56; 95% confidence interval, 0.46-0.70), intraventricular hemorrhage (relative risk, 0.47; 95% confidence interval, 0.31-0.70), and necrotizing enterocolitis (relative risk, 0.21;95% confidence interval, 0.05-0.82). They also may reduce the risk of neonatal death (relative risk, 0.68; 95% confidence interval, 0.43-1.07). They do not appear to increase the risk of infection in either mother (relative risk, 0.86; 95% confidence interval, 0.61-1.20) or baby (relative risk, 1.05; 95% confidence interval, 0.66-1.68). The duration of rupture of membranes does not alter these outcomes. CONCLUSION: The available data indicate that corticosteroid administration is beneficial in the setting of rupture of membranes. In our opinion further trials to address this question cannot be justified.