Use of antenatal corticosteroids prior to preterm delivery: the practice at muhimbili national hospital, Dar es Salaam.

Abstract

Background Foetal lung maturity has been a challenge to obstetricians and pediatricians in managing neonates born prematurely. In preterm babies RDS is the main cause of neonatal death and therefore the solution to the immaturity of foetal lungs is a primary concern. Several studies have shown the efficacy of antenatal corticosteroids prophylaxis in reducing RDS and intraventricular haemorrhage in preterm infants hence reducing neonatal death. This life saving therapy is now widely used throughout the world however the coverage of its use and practice in Tanzania which is one of the developing countries is not adequately documented. The present study evaluated the use of antenatal corticosteroids prior to preterm delivery as practiced at MNH. Methodology Data was collected by using a questionnaire which was supplemented by maternal and neonatal data from the case notes. The questionnaire contained fifty items grouped into four sections for survey of the mother and neonate. The maternal survey included questions concerning sociodemographic characteristics, obstetric history, antenatal care and items related to the administration of antenatal corticosteroids and to events surrounding the delivery and the health of the newborn. Eligible women were identified from the delivery book which contains the summary of ANC data, delivery data, maternal and neonatal outcome and destination of the mother after delivery and her premature neonate. Data was cleaned and analyzed by SPSS version 17 for windows. Chi-square test was used to find out the significant differences between variables. vii Results The prevalence of antenatal corticosteroids use in preterm deliveries at MNH was 31%. For neonates born between 28 and 34 weeks of gestation 34% of theirs mothers were given dexamethasone of whom 76% received a complete course. About 51% of those with PPROM received dexamethasone of whom 57% received a complete course. Our study found that the use of dexamethasone was associated with a number of factors such as long time of stay in hospital, caesarian section delivery and seniority of the first doctor to attend the patient. Among the socio-demographic factors women with high level of education and those employed were more likely to be administered dexamethasone. Conclusion The use of antenatal corticosteroids among the pregnant mothers who had preterm delivery at MNH was low compared to other studies. However the prevalence was high for mothers directly admitted to MNH as compared to those referred from other hospitals for care of anticipated premature neonate. This observation necessitates education to the health workers on use of antenatal corticosteroids in anticipated preterm delivery especially in the peripheral hospitals.