BMJ  2005;331:662 (24 September), doi:10.1136/bmj.38547.416493.06 (published 22 August 2005)

Paper

Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomised trial

¹ Conwy and Denbighshire NHS Trust, Glan Clwyd Hospital, Rhyl, Denbighshire LL18 5UJ, ² Institute of Medical and Social Care Research, University of Wales Bangor LL572PX

Objective To test whether steroids reduce respiratory distress in babies born by elective caesarean section at term.

Design Multicentre pragmatic randomised trial.

Setting 10 maternity units.

Participants 998 consenting women randomised at decision to deliver by elective caesarean section; 503 randomised to treatment group.

Interventions The treatment group received two intramuscular doses of 12 mg betamethasone in the 48 hours before delivery. The control group received treatment as usual.

Outcome measures The primary outcome was admission to special care baby unit with respiratory distress. Secondary outcomes were severity of respiratory distress and level of care in response.

Results Sex, birth weight, and gestation were not different between the two groups. Of the 35 babies admitted to special baby units with respiratory distress, 24 were in the control group and 11 in the intervention group (P = 0.02). The incidence of admission with respiratory distress was 0.051 in the control group and 0.024 in the treatment group (relative risk 0.46, 95% confidence interval 0.23 to 0.93). The incidence of transient tachypnoea of the newborn was 0.040 in the control group and 0.021 in the treatment group (0.54, 0.26 to 1.12). The incidence of respiratory distress syndrome was 0.011 in the control group and 0.002 in the treatment group (0.21, 0.03 to 1.32).

Conclusions Antenatal betamethasone and delaying delivery until 39 weeks both reduce admissions to special care baby units with respiratory distress after elective caesarean section at term.

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Rapid Responses:

Read all Rapid Responses

A physiological approach to reducing neonatal morbidity in elective Caesarean Section

David J R Hutchon
bmj.com, 24 Aug 2005 [Full text]

Commentary on antenatal betemethasone at term

David J Garry
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confusing trials

nick brown
bmj.com, 23 Sep 2005 [Full text]

There is no longer any such thing as caesarean section without medical reasons.

Jonathan H West
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reducing SCBU addmissions for elective C Section

Chris J Griffin
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Caution is still needed.

Celestin O. Selo-Ojeme
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Why would antenatal steroids prevent transient tachypnoea of the newborn?

Humberto Fiori
bmj.com, 4 Oct 2005 [Full text]

No benefit for steroids

David J R Hutchon
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A clearer explanation of no benefit for steroids

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An answer please

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Elective Caesarean Section at Term -References Rapid Response 9th December

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Informed consent for cord clamping?

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