Antenatal Corticosteroid in Elective Cesarean Section
Condition: Cesarean Section Complications
Study type: Interventional
Phase: Phase 3

Summary: 
      Caesarean section is a risk factor for the development of neonatal respiratory complications,
      mostly respiratory distress syndrome (RDS) and transient tachypnoea of the new-born, both in
      term and preterm infants.
    

Detailed description: 
      Infants born at term by caesarean delivery are more likely to develop respiratory morbidity
      than infants born vaginally, and this risk increases furthermore for the subgroup of children
      born by elective caesarean section, i.e. before onset of labour, with potentially severe
      implications. The risk is decreasing with advancing gestational age, and infants born between
      37+0 and 37+6 weeks are at 1.7 times more risk for respiratory complications than those born
      between 38+0 and 38+6 weeks, which in turn are at 2.4 times more risk than the infants born
      between 39+0 and 39+6 weeks. If women were given two intramuscular injections of 12 mg of
      dexamethasone, two doses for 48 hrs,the rates of admissions were 5.2% at 37 weeks, 2.8% at 38
      weeks, and 0.6% at 39 weeks. Although none of the babies in the control group died, admission
      will increase parental anxiety, the cost to nursery unit and invasive procedures including
      artificial ventilation giving mothers dexamethasone, two doses before elective section halved
      neonatal morbidity. Five studies lasting between three and 20 years with more than 1500
      patients have shown no adverse effect of single course of antenatal corticosteroid, neither
      through infection of the fetus or mother nor in long term neurological or cognitive effect In
      view of this evidence, it is currently recommended that elective caesarean section should be
      deferred to 39 weeks. However approximately 10%-15% of woman planed for c/s may deliver
      before 38 weeks, and there may be concern on waiting in the presence of speci c indications
      or previous history. Respiratory morbidity in cases of term elective caesarean birth appears
      to have a different pathophysiology than in preterm birth, and retention in the lungs being
      the most likely cause.

      Interestingly, recent evidence indicates that apart from the traditional mechanical concept
      of vaginal squeeze, molecular mechanisms (predominantly lung epithelial sodium channels
      promote alveolar uid drainage, and these channels are under active in fetuses unexposed to
      the process of labor. Glucocorticoid appears to increase the number and the function of
      thyroid hormones, providing a rational for their exogenous administration in cases of
      elective caesarean delivery.
    

Intervention name(s): Dexamethasone; Placebo
Intervention type(s): Drug; Drug
Intervention description(s): Dexamethasone 6mg, IM, 48 hours before cesarean section; Placebo 6mg, IM, 48 hours before cesarean section
Other intervention name(s): Saline
Intervention MeSH terms: Dexamethasone
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Prevention