THE EFFECT OF CORTICOSTEROID ADMINISTRATION ON UTERINE ACTIVITY AND PRETERM LABOR IN HIGH-ORDER MULTIPLE GESTATIONS

Objective: To determine if corticosteroid administration causes increased contractions or labor in high-order multiple gestations. Methods: Medical records of all triplet and quadruplet pregnancies cared for by Phoenix Perinatal Associates from August 1988 to January 1992 were reviewed retrospectively. Twenty-one women were identified; 17 of them received at least one dose of corticosteroids for fetal lung maturation. Fifteen of the 17 had complete contraction data (2 hours per day before and after steroids) available for analysis. The mean number of contractions in the 48 hours before steroids was compared to the mean number of contractions in the 48 hours after the first steroid injection. Results: There was a significant increase in contractions during the first monitoring session (8-16 hours after injection, P = .002), and the second monitoring session, There was also a statistically increased chance of both labor with cervical change and the need for tocolytic intervention if the basal contraction rate was at least 3.5 contractions per hour than if it was less than 3.5 contractions per hour (P < .02). Conclusion: Betamethasone administration in triplet and quadruplet births is associated with increased uterine contractions, preterm labor with cervical change, and preterm labor requiring tocolysis. There should be fewer than 3.5 contractions per hour to minimize the steroid effect on uterine activity.