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 randomised controlled trials

Srinivasjois, Ravisha; Silva, Desiree

doi:10.1080/14767058.2016.1205031

Cited by 7 publications

(5 citation statements)

References 25 publications

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“…This conclusion is endorsed by Cochrane who concludes that antenatal corticosteroids at term in elective cesarean section reduce the risk of RDS (52%), TT (57%) and NICU admission (58%) due to respiratory complications [3]. On the E. V. Rubio et al Open Journal of Obstetrics and Gynecology other hand, the results of the present study allow us to support the safety of antenatal betamethasone for pathologies that require delivery during the early-term period.…”

Section: Discussionsupporting

confidence: 71%

“…Interestingly, elective cesarean sections are associated with a higher risk of respiratory morbidity even in term pregnancies. Thus, neonatal morbidity has been shown to be higher in newborns whose mothers were delivered by elective cesarean section at different gestational ages [3]- [10]. In this line, the ASTECS study concluded that the prophylactic administration of betamethasone in term pregnancies (38 or more weeks) 48 hours prior to an elective cesarean section reduced TT and RDS requiring admission to the NICU versus the control group (relative risk RR = 0.46, 95% confidence interval = 0.23 -0.93) [9].…”

Section: Introductionmentioning

confidence: 99%

“…Despite these results, the Cochrane Library suggested that more studies are needed to share valid conclusions [3]. Therefore, there is still controversy on whether the indication of corticosteroid has a beneficial effect on neonatal respiratory outcomes when indicated at 38 weeks in pregnant women who undergo an elective cesarean section [4]- [10].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Prophylactic Betamethasone Indication on the Neonatal Outcome in 38-Week Pregnancies Prior to Elective Cesarean Section

Rubio¹,

Socias²,

Urquieta³

et al. 2020

OJOG

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Objective: To assess whether the use of prenatal betamethasone in pregnancies with elective Caesarean section (C-section) at 38 weeks has a similar risk of adverse neonatal respiratory outcomes than elective C-section at 39 weeks. Methods: Retrospective cohort study of pregnant patients with singleton pregnancies and elective C-section at term in a one-year period. Cases were C-section at 38 weeks of gestation with a complete course of betamethasone started 48-hours before. As a control group, pregnancies with a C-section at 39 weeks without betamethasone were included. Results: During the study period, 186 patients were included. Of these, 91 were delivered at 38 weeks and 95 at 39 weeks. There were no significant differences in maternal age and parity. Moreover, there were no significant differences in respiratory complications (respiratory distress syndrome [RDS] = 0% vs 1.1%; p = 1.0, transitory tachypnea [TT] = 0% vs 0%) and admission to Neonatal Intensive Care Unit (NICU) (8.8% vs 6.3%; p = 0.7) between deliveries at 38 weeks and 39 weeks, respectively. Conclusion: Prophylactic use of betamethasone in early term pregnancies who undergo an elective C-section at 38 weeks is associated with similar adverse neonatal respiratory outcomes than patients with C-section at 39 weeks without corticosteroids.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Prophylactic Betamethasone Indication on the Neonatal Outcome in 38-Week Pregnancies Prior to Elective Cesarean Section

Rubio¹,

Socias²,

Urquieta³

et al. 2020

OJOG

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“…A large multinational cluster RCT of low- and middle-income countries reported higher, rather than lower, mortality among the preterm infants prenatally exposed to ACT [32]. Further, a meta-analysis examining ACT for elective cesarean section of term births concluded that although a small yet significant effect of ACT for prevention of neonatal morbidities was observed, the authors strongly cautioned against routine use of ACT because of other potential harms [33].…”

Section: Discussionmentioning

confidence: 99%

Antenatal corticosteroid therapy (ACT) and size at birth: A population-based analysis using the Finnish Medical Birth Register

et al. 2019

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Background Antenatal corticosteroid therapy (ACT) is used clinically to prepare the fetal lung for impending preterm birth, but animal and human studies link corticosteroids to smaller birth size. Whether ACT is associated with birth size is debated; therefore, we assessed differences in birth size in treated versus untreated pregnancies. Methods and findings This observational register-based study used data from the Finnish Medical Birth Register (FMBR) covering all births in Finland (January 1, 2006–December 31, 2010). We used unadjusted and adjusted regression analyses as well as propensity score matching (PSM) to analyze whether birth size differed by ACT exposure. PSM provides a stringent comparison, as subsamples were created matched on baseline and medical characteristics between treated and untreated women. All analyses were stratified by timing of birth. The primary study outcome was birth size: birth weight (BWT), birth length (BL), ponderal index (PI), and head circumference (HC) measured immediately after birth and recorded in the FMBR. Additional analyses explored indicators of neonatal health in relation to ACT exposure and birth size. A total of 278,508 live-born singleton births with ≥24 gestational completed weeks were registered in the FMBR during the 5-year study period. Over 4% of infants were born preterm, and 4,887 women were treated with ACT (1.75%). More than 44% of the exposed infants ( n = 2,173) were born at term. First, results of unadjusted regression analyses using the entire sample showed the greatest reductions in BWT as compared to the other analytic methods: very preterm −61.26 g (±SE 24.12, P < 0.01), preterm −232.90 g (±SE 17.24, P < .001), near term −171.50 g (±SE 17.52, P < .001), and at term −101.95 g (±SE 10.89, P < .001). Second, using the entire sample, regression analyses adjusted for baseline and medical conditions showed significant differences in BWT between exposed and unexposed infants: very preterm −61.54 g (±SE 28.62, P < .03), preterm −222.78 g (±SE 19.64, P < .001), near term −159.25 g (±SE 19.14, P < .001), and at term −91.62 g (±SE 11.86, P < .03). Third, using the stringent PSM analyses based on matched subsamples, infants exposed to ACT weighed less at birth: −220.18 g (±SE 21.43, P < .001), −140.68 g (±SE 23.09, P < .001), and −89.38 g (±SE 14.16, P < .001), born preterm, near term, and at term, respectively. Similarly, significant reductions in BL and HC were also observed using the three analytic methods. There were no differences among postterm infants regardless of analytic method. Likewise, we observed no differences with respect to PI. Additional analyses showed that exposed and unexpo...

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“…They concluded that although steroid administration before scheduled CD reduces the neonatal morbidities; however, routine administration of steroids prior scheduled CD should be cautiously because of long-term risks related to steroids. 20…”

Section: Discussionmentioning

confidence: 99%

Effect of Dexamethasone for Prevention of Neonatal Respiratory Distress Syndrome in mothers undergoing Elective Caesarean Section

Mushtaq¹,

Nawaz²,

Waheed³

et al. 2021

PJMHS

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Background: Neonatal respiratory distress syndrome (RDS) remains one of the major causes of neonatal mortality and morbidity despite advance in perninatal care. In RDS, ventilation may be affected by homogeneity of the airways with atelectasis and over distension, as hyaline membranes block small airways. Aim: To compare the frequency of neonatal respiratory distress syndrome with dexamethasone versus control (without dexamethasone) in mothers admitted for elective cesarean section. Design of the Study: Randomized controlled trial Place and Duration of Study: Obstetrics and Gynecology Department, Unit- II, Aziz Bhatti Shaheed Hospital, Gujrat from 01-05-2019 to 31-10-2019. Methodology: A total of 140 patients were included in the study. In group A, females were given 4 doses of 6mg intramuscular dexamethasone, 12 hours apart pre-operatively. In group B, females were not given any corticosteroids. Results: Patients ranged between 18-40 years of age with mean age 31.1±4.7 and 31.3±4.2 years in Group A & B, respectively. The mean gestational age in Group-A was 38.0±0.6 and in Group-B 38.1±0.7 weeks. In Group-A mean BMI was observed 29.1±3.9 and Group-B 29.0±4.3 Kg/m2. In both groups there was a majority of primigravidae. Neonatal RDS in Group-A was found in 6 (8.6%) while in Group-B RDS was found in 18 (25.7%). There was a statisticallysignificant difference (p=0.007) between two groups. Stratification with respect to age, gestational age, parity and BMI was also noted. Conclusion: In conclusion, preoperatively Dexamethasone administration was associated with a significant lowering (p=0.007) of the incidence of neonatal respiratory distress syndrome in mothers of undergoing elective cesarean section. Keywords: Cesarean section; Neonatal respiratory distress syndrome, Dexamethasone

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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 randomised controlled trials

Abstract: Although antenatal steroid administration prior to elective caesarean section demonstrated significant benefit in the prevention of neonatal morbidities; however, one need to be cautious before it can be routinely administered because of the paucity of long-term safety data.

Cited by 7 publications

References 25 publications

Impact of Prophylactic Betamethasone Indication on the Neonatal Outcome in 38-Week Pregnancies Prior to Elective Cesarean Section

Impact of Prophylactic Betamethasone Indication on the Neonatal Outcome in 38-Week Pregnancies Prior to Elective Cesarean Section

Antenatal corticosteroid therapy (ACT) and size at birth: A population-based analysis using the Finnish Medical Birth Register

Effect of Dexamethasone for Prevention of Neonatal Respiratory Distress Syndrome in mothers undergoing Elective Caesarean Section

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