Patterns of Administration of Antenatal Corticosteroids at Kenyatta National Hospital

Abstract

Background: Routine administration of antenatal corticosteroids (ACS) to women at risk of preterm birth at gestation age between 24-34 weeks reduces incidence of prematurity related neonatal respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, newborn intensive care unit admission and neonatal mortality. However, respiratory distress has also been reported in about 6.4 to 7.8% for patients undergoing elective cesarean section at early term (≥37 to less than 39 weeks of) gestation in high resource countries and 15% to 29% of full term and late preterm respectively in low and middle resource countries. Recent evidence indicates that administration of a single course of ACS prior to delivery of late preterm and before elective cesarean section at early term (37 weeks to 38 weeks 6/7) reduces neonatal respiratory morbidity and need for oxygen support. Despites this, it is estimated that 10 to less than 50% women at risk of preterm birth receive ACS in low- and middle-income countries respectively. In 2013, Gwako et al found that 35 % of all eligible women received antenatal corticosteroids at Kenyatta National Hospital (KNH). With the expanded indications of ACS, this study aims to describe the current patterns of administration of ACS at KNH to identify gaps and make recommendations on how to improve uptake. Methodology: This was a retrospective descriptive cohort study in which files of patients who received ACS between January 2019 to December2019 were reviewed, and data abstracted then analyzed. The patters of administration including types, dosage frequency and completion rates of administration of ACS at the different gestation ages were described. We also evaluated the sociodemographic and obstetric characteristics associated with the completion of ACS using chi-square or Fisher’s exact test for categorical variables and student test for continuous variables. A two-sided P value of <0.05 was considered statistically significant. Results: Our study shows that ACS at KNH are used across all gestations from 24 weeks to 37 weeks and early term elective cesarean section. 61.3 % of the study participants completed the full dose of ACS vs 38.7 %. 2/3 of the study participants received the standard dose of 6mg 12 hourly vs 1/3 that received 12mg. Although the higher proportion of the study participants who completed ACS had PET 67.9 % followed by PPROM 22.2 %, there was no statistical difference among the factors associated with completion rate.