Poster Session 1
Category: Prematurity
Poster Session 1
Teresa Cobo, MD, PhD (she/her/hers)
Senior Researcher
Hospital Clínic de Barcelona
Hospital Clinic (Barcelona), Catalonia, Spain
David Boada, MD
Pre-Doctoral Researcher
Hospital Clínic Barcelona
BARCELONA, Catalonia, Spain
Ignacio herraiz
Hospital 12 Octubre
Hospital 12 Octubre (Madrid), Madrid, Spain
Cecilia Villalain
Hospital 12 Octubre
Hospital 12 Octubre (Madrid), Madrid, Spain
Sílvia Ferrero, MD, PhD
Senior Obstetrician
BCNatal – Barcelona Center for Maternal Fetal and Neonatal Medicine Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona
BARCELONA, Catalonia, Spain
María Goya
Hospital Vall d'Hebrón
Hospital Vall d'Hebrón (Barcelona), Catalonia, Spain
Laia Martí-Malgosa
Hospital Consorci Corporació Sanitària Parc Taulí
Hospital Consorci Corporació Sanitària Parc Taulí (Sabadell), Catalonia, Spain
Mª Àngels Vives
Consorci Sanitari Terrassa
Consorci Sanitari Terrassa (Terrassa), Catalonia, Spain
mª Paz Carrillo, MD, PhD
Hospital Universitario Virgen de las Nieves
Hospital Universitario Virgen de las Nieves (Granada), Andalucia, Spain
Fernando Bugatto
Hospital Puerta del Mar
Hospital Puerta del Mar (Cádiz), Andalucia, Spain
Carmen Garrido, PhD
Hospital de la Santa Creu i Sant Pau
Hospital de la Santa Creu i Sant Pau (Barcelona), Catalonia, Spain
Carmen Medina
Hospital de la Santa Creu i Sant Pau
Hospital de la Santa Creu i Sant Pau (Barcelona), Catalonia, Spain
Alicia Martínez
Hospital La Fe
Hospital La Fe (Valencia), Comunidad Valenciana, Spain
Vicente Diago
Hospital La Fe
Hospital La Fe (Valencia), Comunidad Valenciana, Spain
Laia Pratcorona, MD
Hospital Germans trias i Pujol
Hospital Germans trias i Pujol (Badalona), Catalonia, Spain
Cristina Paulés
Hospital Clinico Universitario Lozano Blesa
Hospital Clinico Universitario Lozano Blesa (Zaragoza), Aragon, Spain
Francisco López
Hospital La Paz
Hospital La Paz (Madrid), Madrid, Spain
Marta Jané
Hospital Joan 23
Hospital Joan 23 (Tarragona), Catalonia, Spain
Mªdel Mar Gil, MD, PhD, MSc
Consultant in Fetal Medicine and Obstetrics
Hospital Universitario de Torrejón
Hospital Universitario de Torrejón (Torrejón de Ardoz), Madrid, Spain
Victoria Aldecoa, MD, PhD
Hospital Clínic Barcelona
Hospital Clinic (Barcelona), Catalonia, Spain
Francesc Figueras, MD, PhD (he/him/his)
Head of Department
BCNatal – Barcelona Center for Maternal Fetal and Neonatal Medicine Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona
Barcelona, Catalonia, Spain
Montse Palacio *, MD, PhD (she/her/hers)
Senior Consultant
Hospital Clínic Barcelona
BARCELONA, Catalonia, Spain
Eduard Gratacós, MD, PhD
Hospital Clínic Barcelona
BARCELONA, Catalonia, Spain
Most of patients with preterm labor (PTL) don’t deliver preterm. However, they are routinely managed with corticosteroids, trading off the benefit of fetal maturation for deleterious neurodevelopmental, cardiovascular and metabolic effects in fetuses finally delivered near term. We aimed to evaluate whether amniocentesis-based management reduces the antenatal course of corticosteroids and maternal hospital stay without jeopardizing neonatal or maternal outcomes.
Study Design:
Pragmatic randomized multicenter clinical trial in singleton pregnancies with PTL between 23+0-34+6 weeks, not in arrested labor, without clinical chorioamnionitis.
The standard-management arm was managed according to institutional protocols, including a course of steroids, tocolysis, and magnesium sulfate.
The amniocentesis-based management arm consisted of the use of predictor models: if low-risk, the course of steroids was not completed, discontinuing the rest of the medication and promoting hospital discharge within 24 h. If high-risk, antibiotics were added to the standard management.
The primary outcome was courses of corticosteroids and maternal hospital stay.
Results:
From 2021-2024, 261 were randomized (134 in the standard and 127 in the amniocentesis-based management arm). Maternal characteristics didn’t differ between groups.
In the standard-management arm, 96.3% of patients were treated with a course of steroids, compared to 44.9% in the amniocentesis-based management arm. The difference (95% confidence interval (CI)) was 51.4% (40.3-61.3). Maternal stay length was significantly reduced in the amniocentesis-based management arm (median (p25; p75)) (4 (3; 6) days vs. 2 (2; 4) days).
We did not find differences at gestational age at delivery (38.1 (34.9; 39.6) vs. 37.3 (34.6; 39.0) weeks), latency-to-delivery (7.4 (3.4; 10.4) vs. 6.3 (3.3; 10) weeks), spontaneous delivery within 7 days (13.4% vs. 11.2%) and neonatal or maternal morbidity between groups.
Conclusion:
An amniocentesis-based management allows optimizing antenatal steroids administration and maternal stay without worsening perinatal outcome.