Effect of antenatal corticosteroids on neonatal outcome in term elective caesarean section: a randomised controlled trial

Megha Panwar, Shailja Agrawal, Deepti Pachauri, H. P. Anand, Bhushan Dattatray Kamble, Ruchi Gurbani


Background: Infants born at term by elective caesarean section are more likely to develop respiratory morbidity than infants born vaginally. Prophylactic corticosteroids in singleton preterm pregnancies accelerate lung maturation and reduce the incidence of respiratory complications. Thus, the aim of this randomized controlled trial was to assess the effect of antenatal corticosteroids on neonatal outcome among term pregnant women undergoing elective caesarean section.

Methods: It was an open labelled randomized controlled trial conducted among women with term pregnancy of 37-38+6 weeks and planned for caesarean section at term and who were willing to participate in the study. We randomized 50 pregnant women into intervention group which received antenatal corticosteroids in the form of injection dexamethasone 12 mg IM, 4 doses at 12 hourly intervals before term elective caesarean section and 50 pregnant women into control group which did not receive antenatal corticosteroid. Fetal outcomes were compared in both groups after caesarean section. Data were analysed using SPSS vs.20.

Results: Nearly half (54%) of pregnant women belonged age group of 21-25 years and majority (58%) of pregnant women belonged to 38-39 weeks of gestation. Out of 50 pregnant women in intervention group, only two percent neonates developed RDS, four percent neonates developed transient tachypnea of neonate (TTN) and six percent neonates required NICU admission which was lower than control group. However, difference between fetal outcomes in intervention and control group was not statistically significant (p>0.05).

Conclusions: Administration of prophylactic antenatal corticosteroids before 48 hours of elective term caesarean section does not have impact on fetal outcome in our study.


Term pregnancy, Caesarean section, Antenatal corticosteroids, Fetal outcome, Randomized trial

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Crowther CA, Browfoot FC, Gagliardi DI, Bain E. Different corticosteroids and regimen for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Sys Rev. 2013;(8):CD006764.

Lawn J, Davidge R, Paul V, Jhonson J, Costello A. Born too soon: care for the preterm baby. Reproductive Health. 2013;10:55-65.

Haram K, Mortensen JHS, Wollen AL. Preterm delivery. Acta Obstetricaet Gynecologica Scandinavica. 2003;82:687-704.

Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet. 2008;371(9608):261-9.

Doyle LW, Faber B, Callanan C, Freezer N, Ford GW, Davis NM. Bronchopulmonary dysplasia in very low birth weight subjects and lung function in late adolescence. Paediatrics. 2006;118(1):08-13.

Anderson PJ, Doyle LW. Neurobehavioral outcomes of school age children born extremely low birth weight or very preterm. JAMA. 2003;289(24):3264-72.

Doyle LW. Outcome at 5 years of age of children 23-27 weeks gestation: refining the prognosis. Pediatrics. 2001;108:134-41.

Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR. Neurologic and developmental disability after extremely preterm birth. New Eng J Med. 2000;343:378-84.

Singer L, Salvator A, Guo S, Colin M, Lilien L, Baley J. Maternal psychological distress and parenting stress after the birth of a very low birth weight infant. JAMA.1999;9(281):799-805.

Hovi P, Andersson S, Eriksson JG, Jarvenpaa A, Karlsson S, Makitie O et al. Glucose regulation in young adults with very low birth weight. New Eng J Med. 2007;356(20):2053-63.

Doyle LW, Rogerson S, Chaung SL, James M, Bowman ED, Davis PG. Why do preterm infants die in 1990s? Aus J Med. 1999;170:528-32.

Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database of Systemic Rev. 2006;(3):CD004454.

Rojas MX, Morley CJ, Soll R. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane database sys rev. 2012;(3):CD000510.

Saigal S, Burrows E, Stoskopf B, Rosenbaum P, Streiner D. Impact of extreme prematurity on families of adolescent children. J Paediatr. 2000;5(137):701-6.

World Health Organization. WHO Recommendations on Interventions to improve Preterm Birth Outcomes. Geneva, Switzerland: World Health Organization. 2015. Available at: 26447264/. Accessed on 3 March 2022.

Liggins GC, Howie RN. Antenatal corticosteroids therapy for fetal lung maturation. J Obstet Gynecol. 1972;25:45-52.

McClure EM, Goldenberg RL, Bann CM. Maternal mortality, stillbirth and measures of obstetric care in developing and developed countries. J Obstet Gynecol. 2007;96:139-46.

Hook B, Kiwi R, Amini SB, Fanaroff A, Hack M. Neonatal morbidity after elective caesarean section and trial of labour. Paediatrics. 1997;100(3):348-53.

Maisels MJ, Rees R, Marks K, Friedman Z. Elective delivery of the term fetus: An obstetrical hazard. JAMA. 1977;238:2036-9.

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 Gynecol. 1995;102(2):101-6.

Bowers SK, MacDonald HM, Shapiro ED. Prevention of iatrogenic neonatal respiratory distress syndrome: elective repeat caesarean section and spontaneous labor. Am J Obstet Gynecol. 1982;143:186-9.

Al Kiaat A, Hutchinson M, Jacques A, Sharp MJ, Dickinson JE. Evaluation of the frequency and obstetric risk factors associated with term neonatal admissions to special care units. Aus and New Zea J Obstet Gynecol. 2013;53(3):277-82.

National Collaborating Centre for Women’s Health (UK). Cesarean Section. NICE Clinical Guideline 132. London: RCOG Press. 2011.

Davidoff MJ, Dias T, Damus K, Russell R, Bettegowda VR, Dolan S et al. Changes in the gestational age distribution among U.S. singleton births; impact on rate of late preterm birth. Semin Perinatol. 2002;30(1):8-15.

Roberts D, Brown J, Medley N, Daizel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm births. Cochrane Database Syst Rev. 2017;3:CD004454.

Whitelaw A, Thoresen M. Antenatal steroids and the developing brain. Arch Dis Child Fetal Neonatal. 2000;83:154-7.

Yinon Y, Haas J, Mazakitovi S, Lapidot N, Mazkereth R, Hourvitza A. Should patients with documented fetal lung immaturity after 34 weeks of gestation be treated with steroids? Am J Obstet Gynecol. 2012;207:222-6.

Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Risk of respiratory morbidity in term infants delivered by elective ceserian section. BMJ. 2008;336:185-9.

Murray SF. Relation between private health insurance and high rates of caesarean section in Chile: qualitative and quantitative study. BMJ. 2000;321:1501-5.

Mufti R, McCarthy A, Fisk NM. Survey of obstetrician’s personal preference and discretionary practice. Eur J Obstet Gynecol Reprod Biol. 1997;73:1-4.

Bergholt T, Ostberg B, Legarth J, Weber T. Danish obstetrician’s personal preference and general attitude to elective cesarean section on maternal request:a nationwide postal survey. Acta Obstet Gynecol Scand. 2004;83:262-6.

Scott JR. Caesarean delivery on request where do we go from here? Obstet Gynecol. 2006;107:1222-3.

Hnnah ME. Planned elective caesarean section; a reasonable choice for some women? CMAJ. 2004;170:813-4.

Jackson NV, Irvine LM. The influence of maternal request on the elective caesarean section rate. J Obstet Gynecol.1998;18:115-9.

Kolas T, Hofoss D, Daltveit AK, Nilsen ST, Hager R, Henriksen et al. Indication of caesarean delivery in Norway. Am J Obstet Gynecol. 2003;188:864-70.

Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Elective cesarean section and respiratory morbidity in the term andnear term neonate. Acta Obstet Gyenecol Scand. 2007;86:389-94.

Watlers DV, Oliver RE. The role of catecholamines in lung fluid absorption at birth. Pediatr Res. 1978;12:239-42.

Lawson EE, Brown ER, Torday JS, Madansky DL, Taeusch HW. The effect of epinephrine on tracheal fluid flow and surfactant efflux in fetal sheep. Am Rev Respir Dis. 1978;118:1023-6.

Wennergren M, Krantz M, Hjalmarson O, Karlsson K. Interval from rupture of the membranes to delivery and neonatal respiratory adaptation. Br J Obstet Gynaecol. 1986;93:799-803.

Brown MJ, Olver RE, Ramsden CA, Strang LB, Walters DV. Effects of adrenaline and spontaneous labour on the secretion and absorption of lung liquid in the fetal lamb. J Physiol. 1983;344:137-52.

Irestedt L, Lagercrantz H, Hjemdahl P, Hagnevik K, Belfrage P. Fetal and maternal plasma catecholamine levels at elective cesarean section under general or epidural anesthesia versus vaginal delivery. Am J Obstet Gynecol. 1982;142:1004-10.

Faxelius G, Hagnevik K, Lagercrantz H, Lundell B, Irestedt L. Catecholamine surge and lung function after delivery. Arch Dis Child. 1983;58:262-6.

Wang ML, Dorer DJ, Fleming MP, Cathin E. Clinical outcomes of near-term infants. Paediatrics. 2004;114(2):372-6.

American College of Gynecologists. ACOG committee opinion no.561: Nonmedically indicated early term deliveries. Obstet Gynecol. 2013;121:911-5.

Royal College of Obstetricians and Gynecologists Scientific Advisory Committee. RCOG guidelines NO.7. Antenatal Corticosteroids to prevent respiratory distress syndrome. 2nd ed. London: RCOG Press. 2004;19.

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

Peter G, Yee W, Amin H, Wood S. Elective caesarean delivery, neonatal intensive care unit admission, and neonatal respiratory distress. J Obstet Gynecol. 2008;111:823-6.

Alexandros S, George M, Stefania P, John PA. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database Syst Rev. 2018(8):CD006614.

Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anest Anal. 1953;32(4):260-7.

Downes JJ, Vidyasagar D, Boggs TR Jr, Morrow GM. Respiratory distress syndrome of newborn infants. I. New clinical scoring system (RDS score) with acid--base and blood-gas correlations. Clin Pediatr (Phila). 1970;9(6):325-31.

Sotiriadis A, Makrydimas G, Papatheodorou S, Loannidis JPA. Corticosteroids for preventing neonatal respiratory morbidity after elective cesarean section at term. Cochrane Database of Sys Rev. 2018;2018(8):CD006614.

Stutchfield PR, Whitaker R, Russell I. Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomized trial. BMJ. 2005;331(7518):645-6.

Saccone G, Berghella V. Antenatal corticosteroids for maturity of term near term fetuses: Systemic review and meta-analysis of randomized controlled trials. BMJ. 2016;355:215-7.

Madar J, Richmond S, Hey E. Surfactant deficient respiratory distress after elective delivery at term. Acta Paediatrics. 1999;88:1244-8.

Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Pettker CM et al. Indications contributing to the increasing caesarean delivery rate. J Obstet Gynecol. 2011;118(1):29-38.

Jain L, Dudell GG. Respiratory transition in infants delivered by cesarean section. Semin Perinatol. 2006;30:296-304.

Vaisbuch E, Levy R, Hagay Z. Effect of betamethasone administration to pregnant women on maternal serum indicators of infection. J Pernat Med. 2002;30:287-91.