Antenatal corticosteroid therapy for foetal maturation in women with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania

Mooij, R.; Mwampagatwa, I. H.; Dillen, J. van; Stekelenburg, J.

dc.creator	Mooij, R.
dc.creator	Mwampagatwa, I. H.
dc.creator	Dillen, J. van
dc.creator	Stekelenburg, J.
dc.date	2021-05-10T09:32:59Z
dc.date	2021-05-10T09:32:59Z
dc.date	2016
dc.date.accessioned	2022-10-20T14:01:43Z
dc.date.available	2022-10-20T14:01:43Z
dc.identifier	Mooij, R. et al. (2016). Antenatal corticosteroid therapy for foetal maturation in women with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania. BMC Pregnancy Childbirth 16, 235. https://doi.org/10.1186/s12884-016-1023-8
dc.identifier	DOI: 10.1186/s12884-016-1023-8
dc.identifier	http://hdl.handle.net/20.500.12661/3002
dc.identifier.uri	http://hdl.handle.net/20.500.12661/3002
dc.description	Full text article. Also available at https://doi.org/10.1186/s12884-016-1023-8
dc.description	Preterm birth is a major cause of neonatal mortality, especially in low and middle income countries. Antenatal corticosteroid therapy for foetal maturation could have a significant impact and therefore is often referred to as an important strategy to reduce neonatal mortality. A recently conducted large multinational trial showed that antenatal corticosteroids can have adverse effects in low income countries, but this is likely to depend on the specific setting. In our hospital preterm birth is only recognized in patients with severe maternal disease, due to physician-initiated delivery. Spontaneous preterm births are rarely seen in the hospital and often take place in the community or while on the road to a health facility. To investigate the effects of antenatal corticosteroid therapy in a rural hospital in Tanzania. A secondary analysis of a retrospective medical records study of women with severe pre-eclampsia and eclampsia performed in Ndala Hospital between July 2011 and December 2012. We used data on gestational age, birth weight, Apgar score, time between admission and birth, use of corticosteroids and maternal and foetal survival. Ethical clearance was obtained from the directorate of research and publications of the University of Dodoma. Thirty-six women with forty live foetuses were analysed. Twelve women (13 neonates) were given corticosteroids and could be compared to 24 women (27 neonates) who did not get corticosteroids. The incidence of fresh stillbirths (antenatal death) was 20 %. The 13 neonates who received corticosteroids had significantly smaller birth weight, longer interval between admission and delivery and poorer outcomes (stillbirth and neonatal death). An analysis of 24 neonates with a birth weight between 1.5 and 2.5 kg showed a trend toward better outcome in neonates who did not receive antenatal corticosteroid therapy. Small retrospective studies as these have a low level of evidence, but this study helped to gain more knowledge of local conditions affecting the effectiveness of antenatal corticosteroid therapy in our setting of a small rural hospital. Reliability of estimating gestational age, epidemiology of preterm birth, exposure to infections, foetal monitoring and quality of neonatal care are likely to influence the effect of antenatal corticosteroid therapy. Further larger prospective studies should be conducted to determine the exact preconditions of antenatal corticosteroid therapy in low-income countries. Until that time, the WHO precautions seem reasonable and audits and small observational studies like ours can help in assessing whether a specific hospital is suited for antenatal corticosteroid therapy.
dc.language	en
dc.publisher	BioMed Central Ltd.
dc.subject	Low-income countries
dc.subject	Preterm birth
dc.subject	Glucocorticoids
dc.subject	Antenatal corticosteroid therapy
dc.subject	Tanzania
dc.subject	Antenatal corticosteroids
dc.subject	Rural hospital
dc.title	Antenatal corticosteroid therapy for foetal maturation in women with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania
dc.type	Article