Current use in High-Resource Settings
Corticosteroids are not currently labeled for use in preterm labor in the US; however, coricosteroids are commonly used for preterm delivery. Given the relatively low cost and ease of administration, increased penetration is limited by the ability to quickly diagnose an at-risk fetus. Cost savings associated with the avoidance of surfactant and respiratory support are substantial.
Application in Low-Resource Settings
Where surfactant and ventilation are less likely to be available, corticosteroid use has the potential to save lives. In facility settings and among skilled attendants, intramuscular injection is feasible. There are ongoing efforts to pre-load betamethasone into the Uniject device in order to further reduce the skill required for administration. This could expand the base of end users, but is not yet commercially available. Corticosteroid therapy is not advised for women who have systemic infections such as tuberculosis. Caregivers in regions with high prevalence of infectious disease must be more cautious before administration of this drug.