PEARLS FROM THE TORRES STRAIT AND NORTHERN PENINSULA AREA
Should we be giving our women steroids prior to elective caesarean section?
Posted On June 21, 2017
Delivery 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.
1. Tita AT, Landon MB, Spong CY, Lai Y, Leveno KJ,Varner MW, et al.; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network.Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med 2009;360:111–20.
2. Yee W,Amin H,Wood S. Elective cesarean delivery, neonatal intensive care unit admission, and neonatal respiratory distress. Obstet Gynecol 2008;111:823–8.
3. Hansen AK,Wisborg K, Uldbjerg N, Henriksen TB. Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study. BMJ 2008;336:85–7.
4. Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbid- ity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynecol 1995;102:101–6.
BSc, MBBS(Hons), FRACGP, FARGP.
Background in the Australian Defence Force RAAMC, Royal Flying Doctor Service and Emergency Medicine. Robin enjoys medical education, systems of primary health care delivery and op-shopping.