What Are Rescue Steroids in Preterm Labor Patients?
Rescue steroids refer to a repeat course of antenatal corticosteroids administered to pregnant women less than 34 weeks gestation who received an initial course more than 14 days prior and now face imminent preterm delivery within 7 days. 1, 2
Definition and Clinical Context
Rescue corticosteroids are distinguished from the initial "single course" of antenatal steroids by their timing and indication:
- A rescue course is administered when the initial course was given more than 14 days previously and the patient now has an imminent risk of preterm delivery within the next 7 days 1, 3
- Rescue courses can be provided as early as 7 days from the prior dose if indicated by the clinical scenario 1, 2, 4
- This applies specifically to pregnancies less than 34 0/7 weeks gestation 1, 3, 4
The concept was introduced by a 2009 randomized controlled trial by Garite et al, which established the framework for rescue course administration before 34 weeks of gestation 5
Key Distinction from Standard Dosing
The standard single course consists of betamethasone 12 mg intramuscularly as two doses given 24 hours apart 5, 6. The rescue course uses the same dosing regimen but is administered in a different clinical scenario—when the initial course's benefit has waned and delivery risk has re-emerged 1, 3.
Important Limitations
Routine repeat or "rescue" courses are NOT advised for late preterm gestations (34-36 weeks) 6. The evidence and recommendations for rescue steroids apply specifically to the earlier gestational age range (before 34 weeks) where the initial course was given but delivery did not occur within the expected timeframe 1, 3, 4.
Clinical Rationale
The rationale for rescue steroids stems from the time-limited benefit of the initial course:
- Maximum benefit occurs when delivery happens 24 hours to 7 days after administration 6
- When delivery is delayed beyond this window but subsequently becomes imminent again, a rescue course may restore the protective benefits against respiratory distress syndrome, intraventricular hemorrhage, and other complications 7, 1
Common Pitfalls to Avoid
- Do not confuse rescue steroids with late preterm steroids—these are distinct clinical scenarios with different evidence bases and recommendations 5, 6
- Do not administer rescue courses routinely or prophylactically—they should only be given when there is genuine imminent risk of delivery 1, 3
- Do not give rescue courses at or beyond 34 weeks gestation—the evidence supports single course only in this population 6, 1