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

BMJ 2005; 331 doi: (Published 22 September 2005) Cite this as: BMJ 2005;331:662
  1. Peter Stutchfield, consultant paediatrician (DrPeter.Stutchfield{at},
  2. Rhiannon Whitaker, trial statistician2,
  3. Ian Russell on behalf of the Antenatal Steroids for Term Elective Caesarean Section (ASTECS) Research Team, director2
  1. 1Conwy and Denbighshire NHS Trust, Glan Clwyd Hospital, Rhyl, Denbighshire LL18 5UJ
  2. 2 Institute of Medical and Social Care Research, University of Wales Bangor LL572PX
  1. Correspondence to: P Stutchfield
  • Accepted 27 June 2005


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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  • Contributors Authors and other members of the ASTECS trial team contributed as follows. PS is consultant paediatrician and neonatologist at Glan Clwyd Hospital, which provides a neonatal intensive care service for North Wales. He developed the protocol, initiated and coordinated the trial, recruited other centres, supervised collection, validation and analysis of data, and drafted this paper. He guarantees its clinical content. Philip Banfield, consultant obstetrician at Glan Clwyd Hospital, recruited patients to the trial. Jeff Berry and James Satelle, information analysts at Glan Clwyd Hospital, developed and managed the trial database. Nigel Bickerton, consultant obstetrician at Glan Clwyd Hospital, contributed to the protocol and recruited patients to the trial. Duncan Cameron, consultant paediatrian and neonatologist at Glan Clwyd Hospital, contributed to the protocol, the newsletter for participating centres and data collection. Lesley Furneaux, personal secretary to PS, acted as research coordinator, randomising patients, collating and entering data, and checking their completeness. David Pilling, consultant radiologist at Alder Hey Children's Hospital, and Alan Sprigg, consultant radiologist at Sheffield Children's Hospital, independently assessed the chest radiographs submitted. IR contributed to analysing, interpreting, and writing this paper. He guarantees its statistical content. RW validated and analysed data, and contributed to interpreting and writing this paper. Matouk Zbaeda, previously senior paediatric registrar at Glan Clwyd Hospital, reviewed elective caesarean sections at term, thus stimulating the trial, and contributed to the protocol.

  • Funding Wales Office of Research and Development in health and social care (WORD) and Conwy and Denbighshire NHS Trust.

  • Competing interests None declared.

  • Ethical approval North West Multi-centre Research Ethics Committee and the 10 relevant local research ethics committees approved the trial protocol.

  • Accepted 27 June 2005
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