PREVALENCE OF COMPLETE COURSE OF DEXAMETHASONE IN PREGNANT WOMEN WITH LATE PRETERM DELIVERY IN SIRIRAJ HOSPITAL

Problem statement: To evaluate the prevalence of a complete course of dexamethasone in pregnant women who delivered late preterm and the association with neonatal outcomes.

Methods: Medical records of 1,500 pregnancies delivered at late preterm were reviewed retrospectively. Baseline and obstetric characteristics, dexamethasone administration and pregnancy outcomes were extracted. Neonatal outcomes were analyzed separately for singleton and twins, then compared among three groups as complete, incomplete and no dexamethasone group.

Results: The overall prevalence of complete dexamethasone was 31.7% among the study population, with rates of 29.2% and 48.4% in singleton and twins, respectively. In singleton pregnancies, after adjusting for covariates, the analysis revealed that the complete course group was significantly less likely to have an APGAR score less than 7 at 5 minutes compared to the incomplete and no dexamethasone group (adjusted RR 0.22, 95% CI 0.05-0.94 and 0.11, 95% CI 0.02-0.64, respectively). Furthermore, the complete course group was also significantly less likely to have apnea compared to the incomplete group (adjusted RR 0.32, 95% CI 0.13-0.78). In twin pregnancies, neonatal sepsis in the complete course group had a lower incidence compared to the incomplete and no dexamethasone group (adjusted RR 0.02, 95% CI 0.001-0.65, and 0.005, 95% CI 0.001-0.3, respectively).

Conclusion: Completed course of dexamethasone were administered only one- third of late preterm pregnancies. Although incidence of APGAR score at 5 minutes less than 7 and apnea in singleton, as well as neonatal sepsis in twins, were lower than the incomplete course.

Keywords: late preterm delivery, dexamethasone, complete course, neonatal complications