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Sir,

I note that Brocklehurst et al. (Vol 106, September 1999)1 found that all the units which responded used at least one course of antenatal corticosteroids (75% response rate). In 1995 I performed a postal survey of consultant obstetricians in the Republic of Ireland concerning their management of prelabour premature rupture of the membranes and also received a 75% response rate (n= 58). At that time 24% of consultants did not use corticosteroids under such circumstances. One quarter of these stated that they would refer such women to a tertiary referral unit and would not wish to anticipate any treatment that might be instituted in that unit. One third of the respondents had worries concerning the immunosuppressive effects of corticosteroids. I did not include a question on the use of multiple doses of corticosteroids. In 1996 using the same questionnaire I surveyed consultants in Yorkshire and found that they universally used corticosteroids in the same clinical setting. Both surveys following the publication of the meta-analysis of corticosteroids after preterm rupture of membranes2.

It is of interest that with the same evidence concerning the use of corticosteroids there was universal usage of at least one course of corticosteroids prior to preterm delivery1 in the UK in 1997. Perhaps a greater awareness of evidence based medicine is the factor which is responsible for this uniformity of practice.

References

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  2. References
  • 1
    Biocklehurst P, Gates S, McKenzie-McHarg K, Alfirevic Z, Chamberlain G. Are we prescribing multiple courses of antenatal corticosteroids? A survey of practice in the UK. Br J Obstet Gynaecol 1999; 106: 977979.
  • 2
    Crowley P. Corticosteroids after preterm rupture of membranes. In: The Cochrane Database of Systematic Reviews. Oxford : Update Software, 1994.