571 Contributing factors to overutilization of antenatal late preterm steroids

Abstract

Antenatal Late Prenatal Steroids (ALPS) for the reduction of neonatal respiratory disorders have clear criteria for use. Our objective was to evaluate utilization of ALPS in a large teaching hospital, and identify factors associated with overutilization. A retrospective chart review of records identified patients who received ALPS and all late preterm deliveries (LPTD) at 34 0/7-34 6/7 weeks from 2017 to 2019. Clinical and demographic information was obtained. “Overutilization” was defined as administration of ALPS to a patient who met exclusion criteria in the NICHD clinical trial (PMID:26842679). Cohorts of Appropriate Utilization vs. Overutilization were compared using Student t test and Fisher’s exact test. A p-value <0.05 was considered statistically significant. Of 401 patients identified: 272 received ALPS, and 129 delivered at 34 0/7-36 6/7 weeks without receiving ALPS. Of the 129 women with LPTD without ALPS, only four (3.1%) were appropriate candidates, as they had not previously received steroids. There were no differences based on age, payer status, or OB history (Table 1). Of 272 patients receiving ALPS, 146 (53.7%) were at risk of indicated preterm birth, and 126 (46.3%) at risk of spontaneous preterm birth. ALPS were overutilized in 52 patients (19.1%) who did not meet criteria: 36 (69%) due to insufficient cervical dilation (3cm) or effacement (75%); 7 (13.5%) with multifetal pregnancy; 6 (11.5%) who received steroids at <34 weeks; and 3 (5.8%) with pre-gestational diabetes. Overutilization was associated with lower rate of preterm birth, later gestational age at birth, and fewer deliveries within one-week of ALPS. Nearly one-fifth of patients who received ALPS did not meet criteria. This most commonly occurred in those with signs of preterm labor without sufficient cervical dilation or effacement. As overutilization was associated with high rates of delivery at term and low probability of delivery within one week, these criteria appear to be effective in identifying appropriate candidates.