PDF herunterladen
CC BY 4.0 · Rev Bras Ginecol Obstet 2021; 43(04): 283-290
DOI: 10.1055/s-0041-1726055
Original Article
Obstetrics

Is there a Role for Antenatal Corticosteroids in Term Infants before Elective Cesarean Section?

Augusta Arruda 
1   Pediatrics Department, Hospital Divino Espírito Santo, Ponta Delgada, Portugal
,
Mariana Ormonde 
2   Obstetrics & Gynecology Department, Hospital Divino Espírito Santo, Ponta Delgada, Portugal
,
Sarah Stokreef 
1   Pediatrics Department, Hospital Divino Espírito Santo, Ponta Delgada, Portugal
,
Beatriz Fraga 
1   Pediatrics Department, Hospital Divino Espírito Santo, Ponta Delgada, Portugal
,
Catarina Franco 
1   Pediatrics Department, Hospital Divino Espírito Santo, Ponta Delgada, Portugal
,
Catarina Dâmaso 
1   Pediatrics Department, Hospital Divino Espírito Santo, Ponta Delgada, Portugal
,
Ana Lima 
2   Obstetrics & Gynecology Department, Hospital Divino Espírito Santo, Ponta Delgada, Portugal
› Institutsangaben
› Weitere Informationen
   Lizenzen und Reprints

Abstract

Objective Cesarean section (CS) delivery, especially without previous labor, is associated with worse neonatal respiratory outcomes. Some studies comparing neonatal outcomes between term infants exposed and not exposed to antenatal corticosteroids (ACS) before elective CS revealed that ACS appears to decrease the risk of respiratory distress syndrome (RDS), transient tachypnea of the neonate (TTN), admission to the neonatal intensive care unit (NICU), and the length of stay in the NICU.

Methods The present retrospective cohort study aimed to compare neonatal outcomes in infants born trough term elective CS exposed and not exposed to ACS. Outcomes included neonatal morbidity at birth, neonatal respiratory morbidity, and general neonatal morbidity. Maternal demographic characteristics and obstetric data were analyzed as possible confounders.

Results A total of 334 newborns met the inclusion criteria. One third of the population study (n = 129; 38.6%) received ACS. The present study found that the likelihood for RDS (odds ratio [OR] = 1.250; 95% confidence interval [CI]: 0.454–3.442), transient TTN (OR = 1.,623; 95%CI: 0.556–4.739), and NIUC admission (OR = 2.155; 95%CI: 0.474–9.788) was higher in the ACS exposed group, although with no statistical significance. When adjusting for gestational age and arterial hypertension, the likelihood for RDS (OR = 0,732; 95%CI: 0.240–2.232), TTN (OR = 0.959; 95%CI: 0.297–3.091), and NIUC admission (OR = 0,852; 95%CI: 0.161–4.520) become lower in the ACS exposed group.

Conclusion Our findings highlight the known association between CS-related respiratory morbidity and gestational age, supporting recent guidelines that advocate postponing elective CSs until 39 weeks of gestational age.

Keywords

elective cesarean section delivery - neonatal outcomes - antenatal corticosteroids

Contributors

All of the authors contributed with the project and data interpretation, the writing of the article, the critical review of the intellectual content, and with the final approval of the version to be published.




Publikationsverlauf

Eingereicht: 14. Februar 2020

Angenommen: 06. Januar 2021

Artikel online veröffentlicht:
12. Mai 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 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 (3 Pt 2): 1061-1064
    CrossrefPubMedSuche in Google Scholar
  • 2 Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Elective caesarean section and respiratory morbidity in the term and near-term neonate. Acta Obstet Gynecol Scand 2007; 86 (04) 389-394
    CrossrefPubMedSuche in Google Scholar
  • 3 Kamath BD, Todd JK, Glazner JE, Lezotte D, Lynch AM. Neonatal outcomes after elective cesarean delivery. Obstet Gynecol 2009; 113 (06) 1231-1238
    CrossrefPubMedSuche in Google Scholar
  • 4 Levine EM, Ghai V, Barton JJ, Strom CM. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol 2001; 97 (03) 439-442
    CrossrefPubMedSuche in Google Scholar
  • 5 Zanardo V, Simbi AK, Franzoi M, Soldà G, Salvadori A, Trevisanuto D. Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery. Acta Paediatr 2004; 93 (05) 643-647
    CrossrefPubMedSuche in Google Scholar
  • 6 Visco AG, Viswanathan M, Lohr KN, Wechter ME, Gartlehner G, Wu JM. et al. Cesarean delivery on maternal request: maternal and neonatal outcomes. Obstet Gynecol 2006; 108 (06) 1517-1529
    CrossrefPubMedSuche in Google Scholar
  • 7 Wax JR, Herson V, Carignan E, Mather J, Ingardia CJ. Contribution of elective delivery to severe respiratory distress at term. Am J Perinatol 2002; 19 (02) 81-86
    Thieme ConnectPubMedSuche in Google Scholar
  • 8 World Health Organization (WHO). Physical status: the use and interpretation of anthropometry. Geneva: WHO; 1995. . (WHO Technical Report Series; No. 854).
    Suche in Google Scholar
  • 9 Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J. et al; WHO Multi-Country Survey on Maternal and Newborn Health Research Network. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health 2015; 3 (05) e260-e270
    CrossrefPubMedSuche in Google Scholar
  • 10 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 (7635): 85-87
    CrossrefPubMedSuche in Google Scholar
  • 11 Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynaecol 1995; 102 (02) 101-106
    CrossrefPubMedSuche in Google Scholar
  • 12 Antenatal Corticosteroid Clinical Practice Guidelines Panel. Antenatal corticosteroids given to women prior to birth to improve fetal, infant, child and adult health: Clinical Practice Guidelines. Auckland: The University of Auckland/Liggins Institute; 2015
    Suche in Google Scholar
  • 13 Royal College of Obstetricians and Gynaecologists. Antenatal corticosteroids to reduce neonatal morbidity and mortality. London: RCOG; 2010. . (Green-top Guideline; No. 7).
    Suche in Google Scholar
  • 14 National Institute for Health and Care Excellence (NICE). Caesarean section: clinical guideline [CG132] (Internet). 2019 [cited 2019 Dec 20]. Available from: https://www.nice.org.uk/guidance/cg132
    PubMedSuche in Google Scholar
  • 15 Venkatesh VC, Katzberg HD. Glucocorticoid regulation of epithelial sodium channel genes in human fetal lung. Am J Physiol 1997; 273 (1 Pt 1): L227-L233
    CrossrefPubMedSuche in Google Scholar
  • 16 Jain L. Alveolar fluid clearance in developing lungs and its role in neonatal transition. Clin Perinatol 1999; 26 (03) 585-599
    CrossrefPubMedSuche in Google Scholar
  • 17 Brown MJ, Olver RE, Ramsden CA, Strang LB, Walters DV. Effects of adrenaline and of spontaneous labour on the secretion and absorption of lung liquid in the fetal lamb. J Physiol 1983; 344: 137-152
    CrossrefPubMedSuche in Google Scholar
  • 18 Irestedt L, Lagercrantz H, Belfrage P. Causes and consequences of maternal and fetal sympathoadrenal activation during parturition. Acta Obstet Gynecol Scand Suppl 1984; 118: 111-115
    CrossrefPubMedSuche in Google Scholar
  • 19 Ahmed MR, Sayed Ahmed WA, Mohammed TY. Antenatal steroids at 37 weeks, does it reduce neonatal respiratory morbidity? A randomized trial. J Matern Fetal Neonatal Med 2015; 28 (12) 1486-1490
    CrossrefPubMedSuche in Google Scholar
  • 20 Nada AM, Shafeek MM, El Maraghy MA, Nageeb AH, Salah 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
    CrossrefPubMedSuche in Google Scholar
  • 21 Nooh AM, Abdeldayem HM, Arafa E, Shazly SA, Elsayed H, Mokhtar WA. Does implementing a regime of dexamethasone before planned cesarean section at term reduce admission with respiratory morbidity to neonatal intensive care unit? A randomized controlled trial. J Matern Fetal Neonatal Med 2018; 31 (05) 614-620
    CrossrefPubMedSuche in Google Scholar
  • 22 Stutchfield P, Whitaker R, Russell I. Antenatal Steroids for Term Elective Cesarean Section (ASTECS) research team. Antenatal betamethasone and incidence of neonatal respiratory distress after elective cesarean section: pragmatic randomised trial. BMJ 2005; 331 (7518): 662
    CrossrefPubMedSuche in Google Scholar
  • 23 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 (08) CD006614
    CrossrefPubMedSuche in Google Scholar
  • 24 Stutchfield PR, Whitaker R, Gliddon AE, Hobson L, Kotecha S, Doull IJ. Behavioural, educational and respiratory outcomes of antenatal betamethasone for term caesarean section (ASTECS trial). Arch Dis Child Fetal Neonatal Ed 2013; 98 (03) F195-F200
    CrossrefPubMedSuche in Google Scholar
  • 25 Adams TM, Kinzler WL, Chavez MR, Vintzileos AM. The timing of administration of antenatal corticosteroids in women with indicated preterm birth. Am J Obstet Gynecol 2015; 212 (05) 645.e1-645.e4
    CrossrefPubMedSuche in Google Scholar