PP.04 Antenatal Corticosteroids, for Women with Diabetes, Undergoing Elective Lower Uterine Segment Caesarean Section Between 38 + 0–38 + 6, are they worth it?

Le résumé fourni par la source

Background The Royal College of Obstetricians and Gynaecologists (RCOG) recently recommended antenatal corticosteroids for all women undergoing elective lower uterine segment caesarean section (El-LSCS) prior to 38+6 weeks. National Institute for Health and Clinical Excellence recommend delivery for women with diabetes at 38+0 weeks. Corticosteroids can destabilise maternal glycaemic control. The purpose of this study was to assess the outcomes in women with diabetes undergoing El-LSCS between 37+6 and 38+6 weeks who did not receive antenatal corticosteroids prior to the RCOG guideline. Methods We performed a retrospective audit of 27,869 consecutive live births in a tertiary referral hospital. We calculated admission rates to Special Care Baby Unit (SCBU) in those undergoing El-LSCS without corticosteroids, identifying presence of diabetes, type of diabetes and gestation at delivery. Results 32% (n = 985/3016) of El-LSCS were performed prior to 38+6 weeks in the general population. In the diabetic population 70% (n = 51/72)of El-LSCS were performed prior to 38+6 weeks. 41.6% (n = 30/72)of which were performed between 38+0–38+6 weeks. The admission rate to SCBU in the diabetic population undergoing El-LSCS was 1.38%, lower than both the 4.7% rate in the general population undergoing El-LSCS and the 2.7% overall rate in the diabetic population. No women with diabetes undergoing El.LSCS after 37+6 weeks had a baby admitted to SCBU despite not receiving corticosteroids. Conclusion The admission rates to SCBU observed in babies born to mums with diabetes delivering between 38+0–38+6 by El-LSCS without corticosteroid cover, does not support their routine administration in this population, especially given the destabilising effect they have on glycaemic control.

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