Efficacy of Antenatal Prostaglandin E1versus Placebo In Prevention of Neonatal Respiratory Morbidity In Pregnant Women at Early Term Elective Caesarian Section: A Randomized Clinical Trial

Abstract

Neonatal respiratory morbidities, especially transient tachypnea of newborn are evident postnatal disorders that may lead to serious sequelae. They are responsible for 30% of neonatal mortalities. The incidence of these disorders increases among infants born at lower gestational ages and those delivered by elective caesarian section. Transient tachypnea of newborn is a parenchymal lung disease, in which deficiency and/or malfunction of the pulmonary surfactant is considered the cornerstone pathology, with subsequent fluid infiltration in the alveoli, hindering oxygen and carbon dioxide transport between blood and alveolar gases, and leading to hypoxemia that necessitates oxygen and/or ventilatory support. A proposed method for reducing their incidence is by using antenatal Misoprostol. It is thought to achieve its effects through its anti-inflammatory properties. This way, it can avoid the accumulation of protein-rich pulmonary fluid, thereby protecting pulmonary surfactant from deactivation. Another proposed mechanism is by activating the catecholamine surge and stimulating beta adrenergic receptors in the lungs, leading to surfactant production.