“Obstetrician-gynecologists should be engaged in the process of developing guidelines and presenting data to help foster stakeholder buy-in and create consensus, thus improving adherence to guidelines and protocols.”

“Even without new research, it may be possible to improve performance by simply encouraging clinicians to thoughtfully evaluate the actual risk of birth within 7 days before giving corticosteroids to patients whose risk may be fairly low, such as those with an asymptomatic short cervix, or those with contractions but a long, closed cervix and negative fetal fibronectin test result.”

“The failure to accurately predict impending preterm delivery was apparent from the Liggins and Howie study, in which approximately 1 in 3 women delivered >7 days after ACS administration. We have known for >50 years that timing is everything in regard to ACS efficacy, but the precision in our administration timing has not improved.
By 2019, only 15% to 40% of women treated with ACS were treated within the optimal window of 7 days before delivery, leading to an approximate 50% reduction in expected benefit, irrespective of confounders. It has been estimated that for every 3 to 4 cases of premature births in which ACS were administered >7 days before delivery, the associated increase in neonatal mortality (when compared with those cases in which ACS administration was optimally timed) is roughly equivalent to the neonatal mortality associated with 1 case of failure to administer ACS.”