Role of Prophylactic Dexamethasone Administration before Elective Cesarean Section at Term in Reducing the Incidence of Neonatal Respiratory Distress Syndrome (A Randomized Controlled Trial

Abstract

T erm neonates born between (37-39 wks) by elective cesarean section are more likely to develop respiratory distress syndrome than term neonates born by vaginal delivery. Prophylactic antenatal administration of corticosteroid enhance fetal lung maturity and reduce the probability of respiratory morbidity in preterm births (Amiya et al., 2016). The risk is decreasing with advanced gestational age and neonates born in 37 weeks are at 1.7 times more than those born at 38 weeks, which in turn are at 2.4 times more than those born at 39 weeks (Roth-Kleiner et al., 2003). According to Cochrane Database of Systematic Reviews 2018, prophylactic administration of antenatal corticosteroids appeared to reduce the rate of RDS by approximately 52%. It also reduced the need for NICU admission, both due to respiratory morbidity (by approximately 58%) and for any indication. The reduction of NICU admissions due to respiratory reasons is consistent with the reduction of respiratory morbidity after corticosteroid administration (Sotiriadis et al., 2018). The American College of Obstetricians and Gynecologists recommends that in the absence of other indications for early delivery, cesarean delivery on maternal request should not be performed before a gestational age of 39 weeks (ACOG, 2019). The objective of this study is to assess the effect of prophylactic dexamethasone 48hs before elective cesarean section at term (less than 39 weeks) on decreasing the neonatal respiratory distress syndrome and NICU admission. Design: A randomized controlled clinical trial. Sample Size: 920 pregnant females underwent elective CS at term {37-39wks} will be randomly distributed into 2 groups: Group A will received one dose of dexamethasone 6 mg (3/4 ampoule of Dexamethasone 8 mg) intramascular and repeated after 12 hours for two days by which the last dose was 48 hours before the elective cesarean section time (RCOG, 2010) and group B who received no treatment. Data was collected, cases were followed up for outcomes.