Do we use too much antenatal XXXX ?

@entity1 @entity5935 @entity600
OBJECTIVE: To review and rationalize the liberal use of antenatal @entity5935 in the setting of threatened @entity600 . STUDY DESIGN: A retrospective review was performed using the charts of all @entity1 at Ste-Justine Hospital, Montreal QC, who received antenatal @entity5935 between 01 April 1997 and 31 March 1998. Initial treatment consisted of 2 doses of 12 mg IM given 24 hours apart. Repeat doses of 12 mg weekly were administered at the discretion of the treating physician. Optimal antenatal @entity5935 therapy was defined as delivery within 1 week of initial treatment, prior to 34 weeks. Aside from number and timing of doses, other factors analyzed included: gestational age at admission and delivery, diagnosis associated with threatened @entity600 ( @entity600 ), number of hospital admissions, and delay between re-admission and delivery. RESULTS: Of the 334 @entity1 identified, 82 (25%) received optimal treatment. Of the remaining 252 @entity1 , 204 (81%) received repeat doses. In the repeat dose group, 112 (55%) @entity1 delivered after 34 weeks, while 70 of the 92 remaining @entity1 were hospitalized until delivery. The other 22 @entity1 who received serial doses were discharged at least once prior to delivery; of these @entity1 , 8 were re-admitted more than 24 hours pre-delivery (i.e., adequate time for re-treatment), while 14 were not, but only 6 of these were delivered urgently. Thus, a maximum of 60 @entity1 (25% of repeat doses) could potentially have benefited from this approach. Of the 48 @entity1 not receiving repeat doses, 37 (77%) delivered after 34 weeks. Five remained hospitalized, and 6 were discharged prior to delivery and re-admitted (2 @entity1 > 24 hr and 4 @entity1 < 24 hr from delivery). This represented a potential underutilization of @entity5935 by 3% (11/334) of the @entity1 , but only 1.8% (6/334) were of less than 32 weeks' gestation. CONCLUSION: This study demonstrated the difficulty in predicting which of the @entity1 presenting with threatened @entity600 would actually go on to deliver during the window of benefit of antenatal @entity5935 therapy. Our desire to permit all premature fetuses to profit from the positive effects of this therapy must be balanced by a reserve in exposing too many to too much. Use of antenatal @entity5935 in our unit has significantly decreased since this review.
