Audit of antenatal corticosteroids for fetal maturation in preterm labour

Abstract

Background: Preterm birth complications are the leading cause of neonatal morbidity and mortality as well as under-five (child) mortality. India has the highest number of Preterm births as well as neonatal deaths due to prematurity. One of the most important antenatal therapies available in Preterm labour is administration of corticosteroids for fetal maturation. Although data exists from western countries regarding its usage, efficacy and safety, the data from Indian centers is sparse and therefore, we did a prospective observational study in an attempt to identify the same in our country. Method: A prospective observational study with 182 pregnant women between 23 0 / 7 - 36 6 / 7 weeks in preterm labour were obtained from a teaching hospital in a metropolitan city. Results: Our study showed that 1) the antenatal steroid coverage in our hospital was 59.3% as compared to a coverage of 90% in well developed countries. 2) Out of the total patients, only 27.78% received the complete optimum course. 3) Although the Ministry of Health & Family Welfare of India recommend Injection Dexamethasone as the drug form to be used, 89.81% received Betamethasone as the drug form. 4) There was reduction in the risk of developing RDS, need for respiratory support, surfactant and inotrope which was statistically significant in age group 28 0/7 -31 6/7 weeks of gestation. Also, neonates less than 32 weeks receiving complete course showed significant reduction in neonatal death as compared to those who could not complete the course. 5) There was no evidence of any maternal or neonatal complications.Conclusion: Antenatal corticosteroids have a coverage rate of 59.3% with Betamethasone as the most commonly used drug form. Maximum efficacy was noted in gestational age group 28-32 weeks with no complications.