Prophylactic Dexamethasone for improving perinatal outcome before elective caesarean section at term pregnancy

Parzheen Ibrahim  Hamadamin; Ariana Khalis  Jawad

doi:10.56056/amj.2019.81

Authors

Parzheen Ibrahim Hamadamin M.B.Ch.B, Hawler Medical University, College of Medicine, Erbil Training Center of Obstetrics 57 and Gynecology
Ariana Khalis Jawad M.B.Ch.B. CABOG, FIBOG, Asst. Prof, Program director of KHCMS in Obstetrics and Gynecology

DOI:

https://doi.org/10.56056/amj.2019.81

Keywords:

Dexamethasone, Elective caesarean section, Neonatal respiratory morbidities

Abstract

Background and objectives: With the increase in the incidence of elective caesarean section, and the absence of onset of labour, the increase in the rate of neonatal respiratory morbidities and admissions to neonatal intensive care unit have also been observed. The objective of the study is to evaluate the role of prophylactic dexamethasone in reducing the occurrence of neonatal respiratory morbidities in term pregnancies before elective caesarean section.

Methods: The study was a prospective cohort study conducted at Maternity Teaching Hospital at Erbil – Iraq from first Septem- ber 2017 till first of September 2018, 400 term pregnant ladies scheduled for elective caesarean section divided to 200 women who received prophylactic 4 doses of 6 mg dexamethasone, and 200 women who received nothing. We compare the incidence of admissions to neonatal intensive care unit, respiratory distress syndrome, transient tachypnea of newborn and early neonatal death between the two groups.

Results: Dexamethasone group showed lower incidences of admissions to neonatal intensive care unit 3.5 % and transient tachypnea of newborn 2.5% than control group 10.5% and 7 % respectively with statistically significant differences between them, using Chi-square test. Respiratory distress syndrome and an early neonatal death have lower incidences in dexamethasone group 2.5% and 0% than control group 3.5% and 1% respectively, but statistically were not significant.

Conclusions: The use of prophylactic antenatal corticosteroid was found significantly to reduce neonatal respiratory morbidities and admissions to neonatal intensive care unit, especially in our center with low neonatal intensive care unit facilities.

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References

McClure E, Goldenberg R, Bann C. Maternal mortality, stillbirth and measures of obstetric care in developing and developed countries. Int J Gynaecol Obstet 2007; 96(2):139-46.

Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis J. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database of Syst Rev. 2009. doi: 10.1002/14651858.CD006614.pub2.

Gerten K, Coonrod D, Bay R, Chambliss L. Cesarean delivery and respiratory distress syndrome: Does labor make a difference? Am J Obstet Gynecol 2005; 193(3):1061-64.

Levine E, Ghai V, Barton J, Strom C. Mode of Delivery and Risk of Respiratory Diseases in Newborns. Obstet. Gynecol 2001; 97(3):439-42.

Brown J, Olver E, Ramsden A, Strang B, Walters V. Effects of adrenaline and of spontaneous labour on the secretion and absorption of lung liquid in the fetal lamb. J Physiol 1983; 344:137-52.

Morrison J, Rennie J, Milton P. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean sec- tion. BJOG: An International Journal of Obstetrics and Gynecology 1995; 102(2):101-6.

Hansen K, Wisborg K, Uldbjerg N, Henriksen B. Elective caesarean section and respiratory morbidity in the term and near-term neonate. Acta Obstet Gynecol Scand 2007; 86(4):389-94.

Zanardo V, Simbi A, Franzoi M, Soldá G, Salvadori A, Trevisanuto D. Neonatal respiratory morbidity risk and mode of delivery at term: in- fluence of timing of elective caesarean delivery. Acta Paediatr 2004; 93(5):643-7.

Bloomfield T. Caesarean section, NICE Guidelines and management of labour. J Obstet Gynecol 2004; 24(5):485-90.

Nabhan A. Long-term outcomes of two different surgical tech-niques for cesarean. Int J Gynaecol Obstet 2008; 100(1):69-75.

Van den Berg A, van Elburg R, van Geijn H, Fetter W. Neonatal respiratory morbidity following elective caesarean section in term infants. Eur J Obstet Gynecol Reprod Biol 2001; 98(1):9-13.

Mwansa-Kambafwile J, Cousens S, Hansen T, Lawn E. Antenatal steroids in preterm labour for the prevention of neonatal deaths due to complications of preterm birth. Int J Epidemiol 2010;39. Suppl 1:i122-33.

Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database. Syst Rev 2006: 19;(3): CD004454. Available from: https://www. ncbi.nlm.nih.gov/pubmed/16856047.

Royal college of obstetricians and gynaecologists: Antenatal Corticosteriods to Reduce Neonatal Morbidity and Mortality. Green Top Guideline No.7 2010. Available from: https://www.rcog.org.uk/en/guidelines-research services/guidelines/gtg7.

Ammar A, Rabei N, Gad H. Dexamethasone in prevention of respiratory morbidity in elective caesarean section in term fetus. A randomized control trial Am J Sci 2013;9(6): 286-9.

Salem M, Abbas A, Ashry M. Dexamethasone for the prevention of neonatal respiratory morbidity before elective cesarean section at term. Proceedings in Obstetrics and Gynecology 2016; 6(3):1-10.

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):25-8.

Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Book Series. Wiley; 2011.

Nada M, Shafeek M, El Maraghy M, Nageeb A, Salah El Din A, Awad M. 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. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26905469.

Ismail K, Taha U, Mahgoub A et al. Effect of Prophylactic Corticosteroid Therapy on Respiratory Morbidity in Infants Borne at Term by Elective Cesarean Section at Omdurman Maternity Hospital. Fam Med Med Sci Res 2017; 6:2. DOI: 10.4172/2327-4972.1000215.