Dexamethasone in Prevention of Respiratory Morbidity in Elective Caesarean Section in Term Fetus Qena University Hospital Experience By Ahmed Abdel-Rady Ali (M.B, B.Ch.) Resident physician in obstetrics and gynecology Qena University Hospital South Valley University

1. Dexamethasone
in prevention of respiratory morbidity in
elective caesarean section
in term fetus
Qena University Hospital
Experience
Thesis
BY
Ahmed Abdel-Rady Ali
(M.B, B.Ch.)

2. Acknowledgments
Professor and the head of the department of obstetrics and gynecology
Faculty of Medicine , South Valley University
Prof/ Ahmed Hashem Abdellah
Dr / Ahmed Al-abd Ahmed
Dr / Abdel-Aziz Ezz-eldin Tammam
Lecturer of pediatrics
Faculty of Medicine , South Valley University
Lecturer of obstetrics and gynecology
Faculty of Medicine , South Valley University

3. 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)

4. 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)

5. 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)

6. 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.

7. Physiology
of the 1st
breath
Aeration
Surfactant
action
Gas
diffusion
Introduction

8. Physiology
of the 1st
breath
Aeration
Surfactant
action
Gas
diffusion
Introduction

9. Surfactant
Pneumocytes
type II
Phosphyatidylcholine +
Apo proteins +
calcium ions
Introduction

10. Effect of steroids on
fetal development
Introduction

11. Dexamethazone Betamethazone
Introduction

12. 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

13. 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

14. Aim of the work
Assess
prophylactic dose corticosteroid
elective caesarean section Term
neonatal respiratory morbidity
admission to neonatal intensive care unit

15. Patients and methods
prospective descriptive clinical study
Study design
Target
population
Inclusion
Criteria
Exclusion
Criteria
Methodology

16. Patients and methods
prospective descriptive clinical study
Study design
Target
population
Inclusion
Criteria
Exclusion
Criteria
Methodology

17. Patients and methods
prospective descriptive clinical study
Study design
Target
population
Inclusion
Criteria
Exclusion
Criteria
Methodology

18. Patients and methods
Methodology
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
History
Physical examinatio
Imaging studies
Routine laboratory work-
up:
•1. CBC
•2. RFTs.
•3. coagulation profile.
•4. LFTs.
•5. RBS.
Preoperative evaluation

19. Results
Table (1) : Demographic data of the studied women
Age (years)
Range
Mean ± SD
20 – 40
28.46±5.55
Parity
Range
Median
0 – 6
2
Gestational Age (weeks+days)
Range
Mean ± SD
37+0 – 38+6
(38w+5d) ± 4d

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

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

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

23. Results
Multiple Pie-charts describing the
distribution of neonatal respiratory
complication

24. Results
SVU = South valley university
ASU = Ain Shams Maternity Hospital
0
0.5
1
1.5
2
2.5
3
3.5
RDS TTN NICU admiddion Mech. Ventilation
SVU
ASU
Puplished in (Journal of American Science 2013;9(6) )And ( Med. J. Cairo Univ.,
Vol. 82, No. 1, March: 25-28, 2014)

25. Results
Comparison 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.
0
5
10
15
20
25
All RDS TTN NICU Adm.
QUH
Morrison et al.
Graziosi et al.

26. 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).

27. 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.

28. 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.

29. Discussion
Neonatal admission to NICU was (3%); in agreement with the present study;
Morrison et al.1995 which found that steroid given immediately before ECS
at 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
??

30. 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).

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

32. 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

33. Summary,
Conclusion
&
Recommendations