Question 46

When a planned caesarean birth is undertaken before 39+0 weeks, antenatal corticosteroids may be considered, but the decision should follow an informed discussion about the uncertain balance of benefit and harm. Evidence suggests that corticosteroids probably reduce neonatal unit admission specifically for respiratory morbidity, but there is uncertainty regarding their effect on respiratory distress syndrome, transient tachypnoea and overall neonatal unit admission. The absolute risk of respiratory morbidity at term is relatively low and is usually mild and transient. Potential harms also need consideration. Late-pregnancy corticosteroid exposure may increase neonatal hypoglycaemia, and limited evidence has raised concerns about possible longer-term developmental effects. Consequently, treatment should not be presented as mandatory or unequivocally beneficial. It is also incorrect to regard corticosteroids as absolutely contraindicated after 37 weeks. The appropriate management is shared decision-making in which the woman is informed of the possible short-term respiratory benefit, the uncertainty in the evidence, and potential neonatal and longer-term risks.

A) Corticosteroids are not recommended automatically for every planned caesarean before 39+0 weeks; an individualised discussion is required.

B) Corticosteroids are not absolutely contraindicated after 37+0 weeks and may be considered before planned caesarean birth.

D) Evidence does not establish a clear reduction in overall neonatal unit admissions.

C) Long-term developmental safety has not been definitively established, and limited evidence raises potential concerns.

Stock SJ, Thomson AJ, Papworth S, on behalf of the Royal College of Obstetricians and Gynaecologists. Antenatal corticosteroids to reduce neonatal morbidity and mortality. BJOG. 2022;129:e35–e60. RCOG Green-top Guideline No. 74. doi:10.1111/1471-0528.17027.