Prepared for: Bangladesh EmONC Facilities
Source references: WHO, RCOG, ACOG, OGSB protocols
1) Bangladesh — National / OGSB Practical Summary
Indication:
- Women at risk of imminent preterm birth when gestational age can be accurately assessed.
- Delivery expected before 34+0 weeks (<34 weeks in many national protocols).
- No clinical evidence of maternal infection.
Drugs & regimen (choose either):
- Betamethasone 12 mg IM × 2 doses, 24 hours apart (total 24 mg)
- Dexamethasone 6 mg IM × 4 doses, 12 hours apart (total 24 mg)
- Alternative: Dexamethasone 12 mg IM × 2 doses, 12 hours apart (total 24 mg)
Timing / Target Window:
- Best if birth occurs within 7 days of administration.
- Give when preterm birth is imminent and GA is accurately assessed.
Repeat Dosing:
- Consider a repeat (rescue) course if >7 days since initial course and ongoing high risk of delivery within the next 7 days.
- Follow local neonatal capacity and guidelines.
Mechanism & Benefits:
- Accelerates fetal lung maturity.
- Stimulates type II pneumocytes → ↑ surfactant synthesis.
- Reduces risk of RDS, IVH, NEC.
- Improves cardiovascular stability.
- Enhances antioxidant enzyme activity.
- Promotes structural lung changes.
Contraindications / Cautions:
- Do not give in clinical chorioamnionitis or overt maternal infection.
- Ensure maternal/facility capacity for neonatal care.
Other notes:
- Recommended for preterm labour, antepartum haemorrhage with anticipated <34 wk delivery.
- Transfer to appropriate neonatal facility planned if needed.
- Local guidance references WHO & international guidelines.
2) International Guideline Positions
WHO (2022):
- ACS recommended for women at risk of preterm birth, accurate GA assessment, imminent birth, adequate facility care.
- Standard regimens: Betamethasone 12 mg IM ×2, Dexamethasone 6 mg IM ×4.
RCOG (Green-top 74, 2025):
- Strong evidence ACS reduce neonatal respiratory morbidity & mortality.
- Recommended for 24+0 – 34+6 weeks; guidance for borderline gestations, repeat dosing, multiple pregnancies.
ACOG (Committee Opinion 713, 2017, reaffirmed 2024):
- Single course recommended for 24+0 – 33+6 weeks, at risk of delivery within 7 days.
- May consider 23+0 weeks depending on parental wishes.
- Late preterm (34–36+6 wk) use considered in selected cases.
- Betamethasone preferred; dexamethasone alternative.
Supporting Evidence:
- Low-resource settings trials (e.g., NEJM ACT trial) support cautious use under proper facility conditions.
3) Practical Checklist for Bedside Use
- Confirm accurate GA (early US or reliable LMP).
- Confirm imminent preterm birth: cervical change, regular contractions, APH with likely delivery, preterm PROM.
- Ensure no maternal infection (chorioamnionitis).
- Confirm facility/newborn capacity to care for preterm infant or plan urgent transfer.
- Choose regimen:
- Betamethasone 12 mg IM × 2 doses, 24h apart OR
- Dexamethasone 6 mg IM × 4 doses, 12h apart
- If birth delayed >7 days and high risk persists, consider rescue dose after reassessment.
4) Special Situations
- Multiple pregnancy: Same ACS protocol as singleton if preterm birth imminent.
- PPROM/PROM <34 wk: ACS indicated if no chorioamnionitis; follow local guidance.
- Late preterm (34+0–36+6 wk): Consider ACS in selected cases (planned early delivery, high risk RDS).
5) Key References
- RCOG Green-top Guideline No. 74: Antenatal Corticosteroids to Reduce Neonatal Morbidity & Mortality (2022)
- ACOG Committee Opinion No. 713: Antenatal Corticosteroid Therapy for Fetal Maturation (Reaffirmed 2024)
- WHO Recommendations on Antenatal Corticosteroids for Improving Preterm Birth Outcomes (2022 update)
- NICE Guideline [NG25]: Preterm labour and birth (2023 update)
- Roberts D, Brown J, Medley N, Dalziel SR. Cochrane Database Syst Rev. 2017;3:CD004454
Compiled By
Dr. Sumaiya Binte Asif
Contributors
1. Prof Fawzia Hossain
2. Prof Anowara Begum
3. Dr Maniza Khan
4. Dr Taslima Tithi
5. Dr Tasrina Hamid
6. Dr Amena Fardous
7. Dr Reshma Sharmin
8. Dr Polly Ahmed
9. Dr Ayesha Siddika
10. Dr Sayema Tabassum
11. Dr Raafa Islam