MATERNAL AND PERINATAL OUTCOMES WITH ANTENATAL CORTICOSTEROID ADMINISTRATION IN PRETERM DELIVERIES AT GOVERNMENT DISTRICT HOSPITAL, NANDYAL- AN OBSERVATIONAL STUDY

Abstract

BACKGROUND: Preterm birth remains a major health issue worldwide. Preterm delivery affects over 7–12% of births in India and is responsible for up to 75% of neonatal deaths. Despite advances in medical technology, the prevalence of preterm birth is increasing. Discovery of antenatal corticosteroid for fetal maturation and its adoption into clinical practice highlights several fascinating and universal truths about science and medicine. The challenge in human studies is to demonstrate antenatal corticosteroid administration in pregnancy contributes to developmental programming and how this is manifested in later life. The World Health Organization recommends the use of one course of antenatal steroids for all pregnant women between 26 and 35 weeks of gestation who are at risk of preterm delivery within 7 days. Both, the American College of Obstetricians and Gynaecologists and the Royal College of Obstetricians and Gynaecologists recommend their use between 24 and 34 weeks of gestation (1). The use of antenatal steroids after 34 or 35 weeks of gestation is not recommended unless there is evidence of fetal pulmonary immaturity. Despite this, antenatal steroids are widely used globally across all gestational periods. In a diverse country like India, diversity in clinical practice is a reality. Hence, the present research study intends to study the maternal and perinatal outcomes with antenatal corticosteroid administration in preterm deliveries at Government district hospital, Nandyal in South India. AIMS AND OBJECTIVES Ÿ To determine the incidence of RDS at District hospital, Nandyal among neonates delivered between 28-37 weeks due to PTL, PPROM or severe PET whose mothers received ACS and in those whose mothers did not receive ACS. Ÿ To determine the severity of RDS at District hospital, Nandyal among neonates delivered between 28-37 weeks due to PTL, PPROM or severe PET whose mothers received ACS and in those whose mothers did not receive ACS. Ÿ To compare the neonatal mortality among neonates delivered between 28-37 weeks due to PTL, PPROM or severe PET whose mothers received ACS with those whose mothers did not receive ACS. Ÿ To determine the effectiveness of antenatal corticosteroid administration in preventing early neonatal respiratory distress syndrome in early preterm labour versus late preterm labour. Ÿ To determine the effectiveness of ACS administration in preventing neonatal complications with respect to the mode of delivery. METHODOLOGY: Study was conducted at Government District Hospital, Nandyal from 01/01/2019 to 30/10/2019. A structured questionnaire was prepared under guidance of thesis guide. All pregnant women with gestational age between 28 completed weeks to 37 completed weeks, presenting in OPD either in labour or getting admitted due to any other maternal medical complication, are initially assessed thoroughly to estimate the gestational age by history, LMP, early USG, and clinical examination. They are given a course of ACS if they were not expecting delivery within next 1 hour, after explaining the benets and risks of ACS as per recommendations of Federation of International st Gynecology and Obstetrics. Those who did not receive ACS or those who delivered within 24hrs of administration of 1 dose of ACS were considered as subjects in NACS group. Those who received ACS were considered as subjects in ACS group. After delivery, the neonate is followed up in NICU until discharged or until 7 days whichever is shorter. Mother is followed up for any clinical signs of infection, until she is discharged. Data is analyzed scientically. RESULTS: In Antenatal corticosteroids group (ACS), there were 36 subjects within 20 years, 43 subjects between 20-25 years, 29 subjects between 25-30 years, 25 subjects between 30-35 years. In No Antenatal corticosteroids group (NACS), there were 32 subjects within 20 years, 49 subjects between 20-25 years, 25 subjects between 25-30 years, 10 subjects between 30-35 years. Study observed that Antenatal corticosteroids group had lower incidence of Respiratory distress syndrome compared to No Antenatal corticosteroids group (12.07% versus 23.28%). Antenatal corticosteroids group had lower incidence of severe Respiratory distress syndrome compared to No Antenatal corticosteroids group (21.3 % versus 33.33%) among those who had Respiratory Distress Syndrome. Antenatal corticosteroids group had fewer admissions to NICU than No Antenatal corticosteroids group (20.69% versus 33.62%). Antenatal corticosteroids group had lower mortality than No Antenatal corticosteroids group (12.07 % versus 22.41%). Antenatal corticosteroids group had 35 % less chances of Respiratory distress syndrome compared to No Antenatal corticosteroids group. In No Antenatal corticosteroids group, subjects who underwent vaginal delivery had 10% less risk compared to those who underwent LSCS for their neonates to have Respiratory distress syndrome. In Antenatal corticosteroids group, subjects who underwent vaginal delivery had 14.29 % less risk compared to those who underwent LSCS for their neonates to have Respiratory distress syndrome. Antenatal corticosteroids group had maternal infection rate comparable to No Antenatal Corticosteroids group. CONCLUSION: Use of antenatal corticosteroids was found to be benecial in pregnant women with Gestational age of 28 completed weeks to less than 37 completed weeks at Government District hospital, Nandyal. Antenatal corticosteroids did not have statistically signicant adverse effects (i.e. increased rate of infection) in mothers.