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CME Credit Offered
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Poster Session 3

(943) Betamethasone for Preterm Premature Rupture of Membranes at Late Prematurity

Friday, January 31, 2025
10:30 AM – 12:30 PM  

    Submitting Author and Presenting Author(s)

  • Yossi Bart, MD

    MFM fellow
    McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

    • Coauthor(s)

  • Michal Fishel Bartal, MD (she/her/hers)

    Maternal Fetal Medicine Faculty
    UTH Houston & Sheba Medical Center Israel
    Houston, TX, United States

  • Farah H. Amro, MD

    Assistant Professor
    McGovern Medical School at UTHealth Houston
    Bellaire , TX, United States

  • Sean C. Blackwell, MD

    Professor and Chair
    McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

  • Baha M. Sibai, MD

    Professor
    McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

Objective: As of 2020, the American College of Obstetricians and Gynecologists extended the upper limit of expectant management of preterm premature rupture of membranes (PPROM) to 36 weeks. Treatment with betamethasone (BMZ) in the subset of patients with PPROM in the late preterm period has not been well studied. Therefore, we sought to investigate this.

Study Design:

A secondary analysis of the Antenatal Late Preterm Steroids (ALPS) trial. All individuals enrolled in the parent trial were included. The primary outcome was a composite of respiratory support at 72 h, including continuous positive airway pressure or high flow nasal cannula ≥ 2 h, oxygen with an inspired fraction of ≥ 30% for ≥ 4 h, or mechanical ventilation, together with extracorporeal membrane oxygenation, or stillbirth or neonatal death within 72 h after delivery. Poisson regression was implemented to adjust for confounders.

Results:

Overall, 22% (620/2,831) had PPROM upon enrollment. Among individuals with PPROM, compared to those without, the median latency period was 15.6 hours (IQR 8.3-24.1) versus 45.0 hours (IQR 20.0-158.0; P< 0.001) (Figure). Among the patients who received BMZ, two doses were given to 26% (83/316) of those with PPROM vs. 70% (775/1,110; P< 0.001) of those without. Latency ≥ 48 hours, compared to < 48 hours, was associated with a lower primary outcome rate: 9% (94/1,078) vs. 16% (273/1,749); P< 0.001.

Among patients with PPROM, 49% (304) received BMZ and 51% (316) received placebo. The BMZ and placebo groups had similar baseline characteristics. In this subgroup, there was no difference in the primary respiratory outcome rate (adjusted RR 0.91, 95% CI 0.60-1.38) between BMZ and placebo (Table). Secondary neonatal and maternal outcomes did not differ as well.

Conclusion:

Compared to those without, individuals with PPROM in the late preterm period had shorter latency; three out of four delivered within 24 hours from randomization. Among individuals with PPROM, there were no differences in neonatal morbidity following treatment with BMZ compared to placebo. However, our study was underpowered to detect such differences.