Steroids before elective CS at term (ASTECS trial)

Question 1

What was the aim of this study?

Answer 1

To see if antenatal corticosteroids reduce respiratory distress in babies born by elective CS at term.

Question 2

What type of study was this?

Answer 2

Multicentre PRAGMATIC RCT. Participants and health professionals were not blinded.

Question 3

What was the inclusion criteria for this trial?

Answer 3

Planned elective CS at or after 37 weeks.

Question 4

What was the exclusion criteria for this trial?

Answer 4

Exclusion criteria:

• Severe maternal HTN
• Severe fetal Rh sensitisation.
• Peptic ulcer disease history
• Intrauterine infection

Question 5

Describe the study groups and method:

Answer 5

Treatment group 503: received two doses of IM betamethasone 12mg 48 hours before elective CS.
Control group 495: received usual care without steroids. (NO placebo = UNBLINDED)
Algorithm used to ensure participants were accurately dated.
Intention to treat analysis.

Question 6

What were the primary outcomes measured?

Answer 6

Primary outcome:

- Admission to SCBU with respiratory distress.

Question 7

What were the secondary outcomes measured?

Answer 7

Secondary outcomes:

• Level of care required.
• Severity of respiratory distress.

Question 8

What were the main results and conclusions of the study?

Answer 8

Results:

• Significant reduction in admission to SCBU for respiratory distress for steroid group RR 0.46.
• Rates of admission to SCBU fell with increasing gestational age.
• Lower incidence of RDS (RR 0.21) and TTN (RR 0.54) i the steroid group.

Conclusions:
- Antenatal betamethasone and delaying delivery until 39 weeks both reduce admissions to SCBU with respiratory distress after elective CS at term by >50%.

Question 9

What were the strengths and weaknesses of this trial?

Answer 9

Strengths:
- Similar characteristics between tx and control grp.
Weaknesses:
- Lacked power to detect effect of race