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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