Should we be giving our women steroids prior to elective caesarean section?

Image result for pregnancyDelivery by elective caesarean section at less than 39+0 weeks of gestation can lead to respiratory morbidity in neonates, requiring admission to the neonatal intensive care unit

A recent retrospective cohort study showed that, compared with elective caesarean section births at 39+0 weeks of gestation, births at 37+0 weeks of gestation and at 38+0 weeks of gestation were associated with an increased risk of a composite outcome of neonatal death and/or respiratory complications, treated hypoglycaemia, newborn sepsis and admission to the NICU (adjusted OR for births at 37 weeks of gestation 2.1, 95% CI 1.7–2.5; adjusted OR for births at 38 weeks of gestation 1.5; 95% CI 1.3–1.7; P for trend <0.001).

The rates of adverse respiratory outcomes, mechanical ventilation, newborn sepsis, hypoglycaemia, admission to the NICU and hospitalisation for 5 days or more were increased by a factor of 1.8–4.2 for births at 37 weeks of gestation and 1.3–2.1 for births at 38 weeks of gestation.A further study in Denmark23 showed the risk of respiratory morbidity for infants delivered by elective caesarean section decreased by gestation compared with vaginal birth (37 weeks of gestation OR 3.9, 95% CI 2.4–6.5; 38 weeks of gestation OR 3.0, 95% CI 2.1–4.3; and 39 weeks of gestation OR 1.9, 95% CI 1.2–3.0).

Treatment with antenatal corticosteroids prior to delivery by elective caesarean section has been shown to reduce the need for admission to the NICU up to 38+6 weeks of gestation compared with controls.

A. Corticosteroids should be given to reduce the risk of respiratory morbidity in all babies delivered by elective caesarean section prior to 38+6 weeks of gestation.

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