Antenatal care: antenatal corticosteroids: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Antenatal care: antenatal corticosteroids

Sample item

A woman at 30 weeks has threatened preterm labour. Which regimen of antenatal corticosteroids is standard?

ADexamethasone 24 mg single oral doseBPrednisolone 40 mg daily for 7 daysCHydrocortisone 100 mg IV every 6 hours for 3 daysDBetamethasone 12 mg IM, two doses 24 hours apart

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Betamethasone 12 mg IM, two doses 24 hours apart

Betamethasone 12 mg IM twice 24 hours apart (or dexamethasone 6 mg IM four doses 12 hours apart) is given to women at risk of delivery between 24 and 34 weeks to reduce respiratory distress, intraventricular haemorrhage and neonatal mortality. Hydrocortisone and prednisolone are largely inactivated by placental 11 beta-HSD2.

Option by option

A. Dexamethasone 24 mg single oral dose
A single oral dose of dexamethasone is not the standard regimen.
B. Prednisolone 40 mg daily for 7 days
Prednisolone does not cross the placenta in effective amounts.
C. Hydrocortisone 100 mg IV every 6 hours for 3 days
Hydrocortisone is metabolised by the placenta and does not reach the fetus adequately.
D. Betamethasone 12 mg IM, two doses 24 hours apart (correct)
Correct. This is the standard regimen for lung maturity.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Betamethasone 12 mg IM, two doses 24 hours apart. Betamethasone 12 mg IM twice 24 hours apart (or dexamethasone 6 mg IM four doses 12 hours apart) is given to women at risk of delivery between 24 and 34 weeks to reduce respiratory distress, intraventricular haemorrhage and neonatal mortality.

Why is "Dexamethasone 24 mg single oral dose" not the answer?

A single oral dose of dexamethasone is not the standard regimen.

Why is "Prednisolone 40 mg daily for 7 days" not the answer?

Prednisolone does not cross the placenta in effective amounts.

Why is "Hydrocortisone 100 mg IV every 6 hours for 3 days" not the answer?

Hydrocortisone is metabolised by the placenta and does not reach the fetus adequately.

What concept does this question test?

It tests Antenatal care: antenatal corticosteroids in OBG. Hydrocortisone and prednisolone are largely inactivated by placental 11 beta-HSD2.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Antenatal care: antenatal corticosteroids?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.