Dexamethasone in prevention of respiratory morbidity in

elective caesarean sectionin term fetus

Qena University Hospital Experience

ThesisBY

 

Ahmed Abdel-Rady Ali(M.B, B.Ch.)

Acknowledgments

Professor and the head of the department of obstetrics and gynecologyFaculty of Medicine , South Valley University

Prof/ Ahmed Hashem Abdellah

Dr / Ahmed Al-abd Ahmed

Dr / Abdel-Aziz Ezz-eldin Tammam

Lecturer of pediatricsFaculty of Medicine , South Valley University

Lecturer of obstetrics and gynecologyFaculty of Medicine , South Valley University

Introduction

Maternal steroid treatment before preterm delivery is one of the best documented and most cost effective life saving treatments in prenatal medicine.

(Mareiniak et al., 2011)

Introduction

Elective caesarean section intended vaginal delivery

leads to a 2-fold to 4-fold increased risk of over-all

‘’neonatal respiratory morbidity’’

in term newborns(Sotiridis et al., 2009)

Introduction

Antenatal steroids for term caesarean section randomized trials

are sought to evaluate whether giving the recommended dose

of steroids before delivery may lead to a reduction in morbidity

in babies delivered by section at term?

((McCarthy , 1994)

Introduction

Betamethasone given before elective caesarean section at term

reduces respiratory distress and admission to a special care

baby unit

(Sotiriadis et al., 2009)

The benefit falls with increasing gestation, supporting

the recommendation to delay elective caesarean section

until the 39th weeks.

Physiology of the 1st

breath

Aeration

Surfactant action

Gas diffusion

Introduction

Physiology of the 1st

breath

Aeration

Surfactant action

Gas diffusion

Introduction

Surfactant

Pneumocytestype II

Phosphyatidylcholine + Apo proteins +calcium ions

Introduction

Effect of steroids on

fetal development Lung maturation

Brain development

Behavioral

changes

Introduction

Dexamethazone Betamethazone

Introduction

Respiratory morbidity in neonates

• insufficiency of surfactant and immaturity of lungs• Preterm labour or genetic• tachypnea, tachycardia, chest wall retraction, expiratory

grunting, nasal flaring and cyanosis• → Apnea• lasts about 2 to 3 days• Oxygen → continuous positive airway pressure ("CPAP")• Surfactant Replacement• Extracorporeal membrane oxygenation (ECMO)

Infant Respiratory Distress Syndrome

Introduction

Respiratory morbidity in neonates

• Commonest causes of respiratory distress in term neonates

• common in 35+ weak gestation babies

• a period of rapid breathing (↑ 40-60 times / minute)

• this condition is self limited and resolves over 24-48 hours

Transient tachypnea of the newborn

Introduction

Aim of the work

Assessprophylactic dose corticosteroid

elective caesarean section Termneonatal respiratory morbidityadmission to neonatal intensive care unit

Patients and methods

prospective descriptive clinical study

Study design Target population

Inclusion Criteria

Exclusion Criteria Methodology

Patients and methods

prospective descriptive clinical study

Study design Target population

Inclusion Criteria

Exclusion Criteria Methodology

Patients and methods

prospective descriptive clinical study

Study design Target population

Inclusion Criteria

Exclusion Criteria Methodology

Patients and methodsMethodology

1. incidence of admission to neonatal intensive care unit (NICU)2. the incidence of respiratory distress syndrome (RDS)3. incidence of transient tachypnea of newborn (TTN)4. The need for mechanical ventilation within 24 h after birth.

The outcome measures

two IM doses of 12 mg dexamethasone 12 hours apart in the 48 hours before ECS

Technique

HistoryPhysical examinatioImaging studiesRoutine laboratory work-up:•1. CBC•2. RFTs.•3. coagulation profile.•4. LFTs.•5. RBS.

Preoperative evaluation

Results

Table (1) : Demographic data of the studied women Age (years)

RangeMean ± SD

20 – 40

28.46±5.55Parity

RangeMedian

0 – 6

2Gestational Age (weeks+days)

RangeMean ± SD

37+0 – 38+6

(38w+5d) ± 4d

Results

Pie-chart showing distribution of indication of elective CS in recruited women

Results

  

Fig (5) : Pie-chart showing distribution of neonatal gender

Results

  

Bar-chart showing distribution of Apgar score at 1 Min and at 5 Min

Results 

 

Multiple Pie-charts describing the distribution of neonatal respiratory

complication

Results 

 

SVU = South valley university ASU = Ain Shams Maternity Hospital

RDS TTN NICU admiddion Mech. Ventilation 0

0.5

1

1.5

2

2.5

3

3.5

SVUASU

Puplished in (Journal of American Science 2013;9(6) )And ( Med. J. Cairo Univ., Vol. 82, No. 1, March: 25-28, 2014)

ResultsComparison of neonatal respiratory complications without the use of prophylactic steroids

* Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective casearean section. Br J Obstet Gynecol 1995; 102:101-6. ** Graziosi GeM, Bakker CM, Brouwers HA, Bruinse HW. Elective caesarean section is preferred after the completion of a minimum of 38 weeks of pregnancy. Ned Tijdschr Geneeskd 1998;142:2300-3.

All RDS TTN NICU Adm.0

5

10

15

20

25

QUHMorrison et al.Graziosi et al.

Discussion

Many researches starting between 1977 and 2001 including;

Mailes et al.,1917 ; Reece et al., 1987 and Gregory et al.,1999

showed that caesarean section carried out before the onset of labor

is considered to increase the risk of RDS.

(Eiliot et al. , 2001).

Discussion

All cases performed ECS 24-48 hours after completed antenatal

steroid course.

Neonatal outcomes were examined for any respiratory morbidity

Results were analyzed by SPSS programme.

Discussion

Residence : (65%) rural areas and (35%) urban areas

Indication for C.S :(77%) due to previous C.S.

Anesthesia : (8%) general and (92 %) spinal.

Discussion

Neonatal admission to NICU was (3%); in agreement with the present study; Morrison et al.1995 which found that steroid given immediately before ECSat full term reduce respiratory distress and admission to a special care baby unit, and the benefits of antenatal steroids persist until 39 weeks

(Morrison et al., 1995).

The present study doesn't agree with (Hutchon,2005) who found that there was no role for corticosteroid in elective section at term

??

Discussion

(TTN) was 2%: This agree with Stutchfield et al. who published an article showing a reduction in the incidence of transient tachypnea (TTN) in infants of mothers submitted to elective caesarean section receiving antenatal betamethasone

(Stutchfield et al., 2005).

Discussion

(RDS) was 1% This agree with Stutchfield et al. 2005 (Stutchfield et al., 2005).

Discussion

Neonatal respiratory complications e.g. pneumonia and air leak syndrome and maternal complications e.g. postpartum pyrexia was not followed to avoid the bias

Summary,Conclusion

&Recommendations