Use of corticosteroids for lung maturation in multiple pregnant at risk of preterm delivery; Perinatal outcomes

Objective: Although antenatal corticosteroid (ACS) treatment is widely used for prevention of respiratory distress syndrome (RDS) in preterm infants the results of this treatment is still controversial in multiple pregnancies. The aim of this study is to evaluate the effect of antenatal corticosteroid on the mother and the neonate in multiple pregnancies at risk of preterm birth. Methods: Medical records of 68 women with twin or triplet pregnancies at risk of preterm birth who delivered at a University Hospital in two years period were analyzed. Sixty-seven of the women recruited had twin pregnancy while the remaining one had triplets. The demographic characteristics, obstetric history, gestational age, presence of maternal co-morbidities, mode of delivery, maternal and fetal outcome were recorded. Findings: The average age of the patients was 31.9±5.7. The average week of pregnancy at admission to the hospital was 33.1±2.5 weeks. 48.5% of the patients had spontaneous pregnancy while 26.5% got pregnant after controlled ovarian hyperstimulation and intrauterine insemination and 25% had in vitro fertilization and embryo transfer. Out of 68 patients 45 (66.2%) received single dose, 23 had (33.8%) multi doses of corticosteroids. The average time between corticosteroid administration and delivery was 81±276 hours. One patient had facial paralysis and another one had surgical site infection during the postpartum period. Out of 137 babies delivered, 70 (51.1%) were not admitted to the Neonatal Intensive Care Unit (NICU) while the indications for admission in the remaining 48.9% were RDS, icterus and transient tachypnea of the neonate. Three neonates did not survive (650, 750 and 875 gr). Conclusion: Preterm birth that is encountered in 50% of the multiple pregnancies is a major risk factor for neonatal morbidity and mortality. In order to prevent RDS and decrease the need for admission to NICU it is important to administer ACS. In multiple pregnancies complicated with preterm delivery, development of RDS has the highest impact on survival. ACS use is important for prevention of RDS