Impact of a Booster Course of Antenatal Steroids on Neonatal Outcome in Patients With Premature Rupture of the Membranes

A Randomized Double-blinded Trial Comparing the Impact of One Versus Two Courses of Antenatal Steroids on Neonatal Outcome in the Patient With Prelabor Premature Rupture of the Membranes

This trial hopes to prospectively evaluate the impact of one versus two courses of antenatal steroids on the incidence of major neonatal morbidity in pregnant women with pre-labor premature rupture of the membranes.

This is a multicenter randomized double blinded trial that hopes to prospectively evaluate the impact of one versus two courses of antenatal steroids on the incidence of major neonatal morbidity including respiratory distress syndrome in pregnant women with a singleton gestation between 24w0d - 32w6d gestation who have documented premature rupture of the membranes.

Inclusion Criteria:

• Participants age 18 years or older
• 24w0d to 32w6d weeks gestation
• Singleton pregnancy
• Received first course of ACS at or prior to 31w6d gestation
• Began first course of ACS at least 7 days ( =/> 168 hours) prior to randomization
• Expectant management planned
• Premature Ruptured membranes (PROM) before onset of labor

Exclusion Criteria:

• Known major fetal anomalies
• Multiple gestation
• Not a candidate for expectant management
• Clinical chorioamnionitis (two or more of the following: temperature > 38.0 degrees centigrade; uterine tenderness; foul smelling vaginal discharge or amniotic fluid; maternal tachycardia >100 bpm; fetal tachycardia >160 bpm; maternal White Blood Cell (WBC) count >20 X 109/L; C-Reactive Protein (CRP) > 5.9
• Already receiving corticosteroids for another condition
• Any contraindications to the maternal use of corticosteroids