RCOG World Congress 2023

Help or harm? Debating steroid use for early term Caesarean section
Shobini Sukumaran1, Priyatha Babychan1, PapaYaw Opokuansah1Chidimma Kanu1
1Lister Hospital, East and North Hertfordshire NHS Trust

OBJECTIVE

To standardise the local policy & advice given to women offered antenatal corticosteroids (ACS) prior to Caesarean section at early term (37-39 weeks) as per RCOG recommendations

BACKGROUND

RCOG guidelines recommend an informed discussion regarding the risks and benefits of corticosteroids at early term1.

ACS use at this gestation varies across UK maternity units, including our own unit at Lister Hospital, Stevenage, UK.

This variance would bias antenatal counselling. To address this, we reviewed the evidence and engaged our department in a lively debate of whether steroids help or harm overall.

DESIGN

We analysed RCOG guidelines1. high - quality studies and systematic reviews

METHODS

Departmental debate between four O&G trainees one team ‘for’ and another team ‘against’ steroid use, following a literature review of relevant studies from 2017-2022.

RESULTS

•ACS for early term CS is a tool that can be used to support the ATAIN programme (Avoidable Term Admissions Into NICU). 3

•ACS may reduce educational attainment at school age (increase in the proportion of children ranked by teachers as being in lower quartile of academic ability from 9 to 18%)

•

•ACS exposure in term infants is associated with a higher risk of mental or behavioural disorders (AHR- 1.47 (95% CI 1.36-1.60) as well as proven or suspected neurocognitive disorders (AHR 1.16 (95% CI 1.10 to 1.21) 2.

•There is uncertainty if there is any reduction in respiratory distress syndrome, transient tachypnoea of the newborn or neonatal unit admission overall in early term infants.

•Causation has not been clearly established. Data is limited and incomplete trial follow up in a key study. Most findings are from observational studies not RCTs.

DISCUSSION

Recommendations for ACS use in early term CS are inconsistent in the literature.

An RCOG approved infographic has been adopted in our unit to standardise counselling for ACS use1.

Neurodevelopmental delay is multifactorial in aetiology therefore cannot be attributed to ACS use alone. However, ACS may have a role in programming the fetal hypothalamic–pituitary axis (HPA) leading to alterations in neurological and endocrine function in later life.

Antenatal steroids may prevent unnecessary term NICU admissions and the negative experience of parents.

Counselling bias must be avoided. Patients should be encouraged to make an informed choice.

RCOG World Congress 2023

Help or harm? Debating steroid use for early term C-Section

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