Iris Publishers_World Journal of Gynecology & Womens Health

Steroids Administration at Term in Egypt: Does it become a Routine Practice?

Abstract

Background: Antenatal steroids become a routine daily practice before elective Cesarean deliveries in Egypt. These drugs were recommended only from 24 weeks to 34 weeks of gestation to minimize respiratory morbidities in newborn. Steroids are not without side effects or complications for both the baby and the mother.
Objective: To evaluate the evidence regarding the use of antenatal steroids at term prior to scheduled cesarean delivery. Materials and Methods: Reviewing published data in recent ten years since January 2009 till 31, December 2017.
Results: Antenatal steroids were recommended only from 24 weeks to 34 weeks with extension up to 37 weeks of gestation not later to minimize respiratory morbidities in newborn.
Conclusion: Steroids are not without side effects or complications for both the baby and the mother. These drugs should be limited to high risk patients with imminent preterm birth and discouraged before term deliveries till evidence approve its long-term safety.
Keywords: Antenatal steroids; Scheduled; Cesarean delivery; Neonatal; Maternal outcomes

Introduction

Antenatal steroids were mainly given in high risk situations with eminent preterm birth as multiple gestations, cervical incompetence, polyhydramions and patients with history of previous preterm birth. Corticosteroids are of great benefit for normal development and enhancement of lung maturity. Evidence supports the use of steroids in those patients with strong limitation to single course and discouraging multiple weekly courses. Many authors advocate the use of steroids at term before scheduled cesarean delivery, but other institutions disagree with the results and conclusions of these studies [1,2].

Discussion

Nowadays, many studies emerged with evidence supporting the use of such drugs before term cesarean delivery ≤ 39 weeks. This practice became a routine daily practice even in gestations beyond 39 weeks. Many researchers advised the use of steroids before term elective cesarean section to reduce respiratory and composite morbidities [3-5].
On the other hand, many studies found that exposure of the fetus at term to corticosteroids either by betamethasone or dexamethasone can profoundly affect the development of the neuroendocrine system at term than at any other time in pregnancy duration. These drugs had life-long effects on endocrine system, emotions, affection and cognitive functions. These side effects of corticosteroids are still under continuous investigation and evidence till now didn’t reach to a final conclusion regarding this issue [6,7].
Do exogenous synthetic steroids affect endogenous corticosteroids surge near term? Do they affect the mechanism and initiation of parturition mechanism? Do they affect brain and other organs if they were given prior to delivery? Evidence still had no clear answers to these questions. Debates are still present whether to revise the use of steroids before term cesarean or not [6,7]. Nabhan A et al [8], in their study found that prophylactic antenatal corticosteroid for elective cesarean delivery between 34 and 37 weeks is not effective in improving neonatal outcomes [8]. De Vivo et al, found that wound complications were more in patients who received antenatal steroids before Cesarean section [9].

For More Open Access Journals in Iris Publishers Please click on:
https://irispublishers.com/
 
For More Articles in World Journal of Gynecology & Womens Health
https://irispublishers.com/wjgwh/

For More Information: https://irispublishers.com/wjgwh/fulltext/steroids-administration-at-term-in-egypt-does-it-become-a-routine-practice.ID.000537.php