DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20200904

The neonatal outcomes of Dexamethasone administration before scheduled cesarean delivery at term: a randomized clinical trial

Shereen B. Elbohoty, Ayman S. Dawood, Ahmed M. Abbas, Adel E. Elgergawy

Abstract


Background: Caesarean delivery (CD) rates in developing countries are rising beyond the recommended rates of World health organization. Objective of this study was to evaluate whether Dexamethasone injections reduce neonatal incubation admissions when given before scheduled caesarean delivery (CD) at term or not.

Methods: A double blinded, two armed, randomized clinical trial was conducted at Tanta University hospitals in the period from October 2017 to March 2019. Four hundred pregnant women admitted for scheduled CD with gestational age ≥37 weeks were included. Patients were randomized into study group and control group. The study group was given 3 dexamethasone doses, 8 mg each while control group was given saline injections simultaneously as a placebo drug. The primary outcome was the neonatal incubatory admissions.

Results: Demographic data in both groups were comparable. Transient tachypnea of newborn (TTN) was 15.47% in study group versus 20.33% in control group with p=0.227. The respiratory distress (RDS) in study group was 6.63% versus 9.89% in control group with p=0.260. The incubation admissions were nasal oxygen 12.71% versus 15.38%, continuous positive airway pressure ventilation (CPAP) 5.52% versus 8.24% and mechanical ventilation was 3.87% versus 6.59% in the study and control groups respectively.

Conclusions: Although Dexamethasone administration before scheduled CD at term reduced both respiratory morbidity and incubation admissions, the differences between study and control groups were not significant.


Keywords


Cesarean delivery, Dexamethasone, Respiratory distress syndrome, Steroids, Transient tachypnea of newborn

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References


Betrán AP, Ye J, Moller A-B, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. Plos One. 2016;11(2):e0148343.

Dawood AS, Dawood AG, El-Shwaikh SL. A three-year retrospective study of caesarean section rate at Tanta University Hospitals. J Gynecol Obstet. 2017;5(2):25-30.

Gerten KA, Coonrod DV, Bay RC, Chambliss LR. Cesarean delivery and respiratory distress syndrome: does labor make a difference? Am J Obstet Gynecol. 2005;193:1061-4.

Berthelot-Ricou A, Lacroze V, Courbiere B, Guidicelli B, Gamerre M, Simeoni U. Respiratory distress syndrome after elective caesarean section in near term infants: a 5-year cohort study. J Matern Fetal Neonatal Med. 2013;26(2):176-82.

Freeman CI, Hezelgrave NL, Shennan AH. Antenatal steroids for fetal lung maturity: Time to target more frequent doses to fewer women? Obstet Med. 2015;8(4):172-6.

Sananès N, Koch A, Escande B. Pilot randomised controlled trial comparing the risk of neonatal respiratory distress in elective caesarean section at 38 weeks’ gestation following a course of corticosteroids versus caesarean at 39 weeks. Eur J Obstet Gynecol Reprod Biol. 2017;212:54-9.

Saccone G, Berghella V. Antenatal corticosteroids for maturity of term or near-term fetuses: systematic review and meta-analysis of randomized controlled trials. BMJ. 2016;355:i5044.

Salem MN, Abbas AM, Ashry M. Dexamethasone for the prevention of neonatal respiratory morbidity before elective cesarean section at term. Proceed Obstet Gynecol. 2016;6(3):1-0.

Ahmed MR, Sayed Ahmed WA, Mohammed TY. Antenatal steroids at 37 weeks, does it reduce neonatal respiratory morbidity? A randomized trial. The J Maternal Fetal Neonat Med. 2015;28(12):1486-90.

Dawood AS, Dawood AS. Meconium stained amniotic fluid and antenatal steroid administration at term. Austin J Obstet Gynecol. 2017;4(4):1086.

Sotiriadis A, Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis JP, McGoldrick E. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database Syst Rev. 2018:8.

Nabhan A, Al-Helaly A, Ramadan A. Prophylactic antenatal corticosteroid before elective cesarean delivery at or near term to improve perinatal outcome. Med J Cairo Univ. 2014;82(1).

WHO Reproductive Health Library. WHO recommendation on use of either dexamethasone or betamethasone as the antenatal corticosteroid of choice (November 2015). The WHO Reproductive Health Library; Geneva: World Health Organization. Last accessed at March, 2019

Tita AT, Landon MB, Spong CY, Lai Y, Leveno KJ, Varner MW, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. New Eng J Med. 2009;360(2):111-20.

Clinical Practice Guidelines for Perinatal Care. American College of Obstetrics and Gynaecology. 2014. Available at: URL:https://www.wellcare.com/wcassets/corporate/assets/ny_medicaid_pem_cpg-perinatalcare.pdf. Accessed on March 2019.

Royal College of Obstetricians and Gynaecologists Scientific Advisory Committee. RCOG guidelines No 7: antenatal corticosteroids to prevent respiratory distress syndrome. 2nd ed. London: RCOG Press; 2004.

Antenatal corticosteroids to reduce neonatal morbidity and mortality. London (UK): Royal College of Obstetricians and Gynaecologists (RCOG); 2010:3.

Kirshenbaum M, Mazaki-Tovi S, Amikam U, Mazkereth R, Sivan E, Schiff E, Yinon Y. Does antenatal steroids treatment prior to elective cesarean section at 34-37 weeks of gestation reduce neonatal morbidity? Evidence from a case control study. Arch Gynecol Obstet. 2018297(1):101-7.

Nada AM, Shafeek MM, El Maraghy MA, Nageeb AH, El Din AS, Awad MH. Antenatal corticosteroid administration before elective caesarean section at term to prevent neonatal respiratory morbidity: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2016;199:88-91.

Stutchfield P, Whitaker R, Russell I, on behalf of the Antenatal Steroids for Term Elective Caesarean Section (ASTECS) Research Team. Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomized trial. BMJ. 2005;331(7518):662.

Guinn D. Should we take another look at antenatal corticosteroids? The risks of administering ACS at late term and term remain unknown. Conte Obstet Gynecol. 2017;62(3):24-8.

Pettit KE, Tran SH, Lee E, Caughey AB. The association of antenatal corticosteroids with neonatal hypoglycemia and hyperbilirubinemia. J Maternal Fetal Neonat Med. 2014;27(7):683-6.

Dalziel SR, Lim VK, Lambert A, McCarthy D, Parag V, Rodgers A, et al. Antenatal exposure to betamethasone: psychological functioning and health related quality of life 31 years after inclusion in randomized controlled trial. BMJ. 2005;331(7518):665.

Chang YP. Evidence for adverse effect of perinatal glucocorticoid use on the developing brain. Korean J Pediatr. 2014:57(3):101-9.

Srinivasjois R, Silva D. Antenatal steroid administration in medically uncomplicated pregnancy beyond 37 weeks of gestation for the prevention of neonatal morbidities prior to elective caesarean section: a systematic review and meta-analysis of randomized controlled trials. J Maternal Fetal Neonat Med. 2017;30(10):1151-7.