Neonatal Outcome of cesarean section in pregnancy complicated with foetal distress: A Comparision Between hydrocortisone pre-treatment and placebo

Background of the study: Foetal distress is a serious complication of pregnancy which can lead to early neonatal morbidity and mortality. In the past, general anaesthesia was the choice of anaesthesia in the face of foetal distress but presently, spinal anaesthesia has been found to be a better choice. There is a major lack of a prospective study evaluating the effects of hydrocortisone pretreatment on neonatal outcomes in emergency cesarean section for feotal distress. Therefore, we evaluated the effects of hydrocortisone pretreatment on neonatal outcome in mothers with foetal distress scheduled for cesarean deliveries under spinal anaesthesia. Aim and objective: The study was conducted to compare neonatal outcomes in pregnant women complicated with foetal distress undergoing caesarean section under subarachnoid block with or without hydrocortisone pre-treatment. Methods: Sixty pregnant women with foetal distress scheduled for cesarean section under spinal anaesthesia were randomized into two groups and received either hydrocortisone or placebo pre-treatment using a non-probability purposive sampling technique. Thirty parturients in HP group had spinal anaesthesia and intravenous administration of 10 ml of 100 mg hydrocortisone solution, while 30 parturients in PP group had spinal anaesthesia and intravenous administration of 10 ml of normal saline. Maternal and neonatal outcomes were recorded. Results: The result of the study revealed that incidence of intraoperative hypotension in the mothers (16 vs 8) was significantly higher in the parturients in placebo group than in parturients in hydrocortisone group (P=0.020). The number of neonates with less than 7 Apgar Score in one minute was insignificantly higher in parturients who had placebo pretreatment (16 vs 13) than in parturients who had hydrocortisone pretreatment (P=0.772). However, the recovery 5 minute Apgar scores in neonates in parturients with hydrocortisone pretreatment (2 neonates with Apgar score ˂ 7) was significantly better than that of the neonates in parturients with placebo pretreatment (9 neonates with Apgar score ˂ 7)), (P=0.013). Conclusion: The study concluded that a single bolus hydrocortisone before induction of spinal anaesthesia is effective in reducing incidence of poor neonatal outcome during cesarean section in pregnant women complicated with foetal distress.