**15. Antenatal steriods**

The Royal College of Obstetricians and Gynaecologists (RCOG) recommeded the use of antenatal corticosteriods in women with threating preterm labour as it is proven that their use has significant reduction in neonatal respiratory distress syndrome, intraventricular haemorrhage and neonatal death without increase in neonatal sepsis in women who has preterm labour and PPROM.

The use of antenatal steriods is recommeded with threatening preterm labour between 24 weeks and 34 weeks gestations may be considered up to 35 + 6 weeks with the optimal benefit within a window of one to seven days [1, 22].

The agent of choice is betamethasone as it has lesser risk of periventericular leucomalacia compared to the use of dexamethasone [22].

It is recommeded that betamethasone is adminstered intramuscularly in patients with preterm labour as the oral adminstration is associated with higher risk of neonatal sepsis and intraventricular haemorrhage. It is recommended to be used as two doses of 12 mg, 24 hours apart.

The use of mutiple courses of antenatal steriods is not recommeded as per RCOG guidance as it is associated with increassed risks of maternal osteoprosis, infection and imparied glucose tolerance. Multiple courses of steriods is associated with fetal risks including; intrauterine growth restriction, low birth weight, necrotizing enterocolitis, adrenal insufficiency and abnormal neurological development. Compared to a single course, mutiple courses have no benefit of improving neonatal respiratory distress syndrome, chronic lung disease and intraventericular haemorrhage [1, 22].
