title: Antenatal corticosteroid therapy for foetal maturation in women with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania.
abstract: Preterm birth is a major cause of neonatal mortality, especially in low and middle income countries. Antenatal corticosteroid therapy for foetal maturation could have a significant impact and therefore is often referred to as an important strategy to reduce neonatal mortality. A recently conducted large multinational trial showed that antenatal corticosteroids can have adverse effects in low income countries, but this is likely to depend on the specific setting. In our hospital preterm birth is only recognized in patients with severe maternal disease, due to physician-initiated delivery. Spontaneous preterm births are rarely seen in the hospital and often take place in the community or while on the road to a health facility.
  
  
  
  To investigate the effects of antenatal corticosteroid therapy in a rural hospital in Tanzania.
  
  
  
  A secondary analysis of a retrospective medical records study of women with severe pre-eclampsia and eclampsia performed in Ndala Hospital between July 2011 and December 2012. We used data on gestational age, birth weight, Apgar score, time between admission and birth, use of corticosteroids and maternal and foetal survival. Ethical clearance was obtained from the directorate of research and publications of the University of Dodoma (ref. UDOM/DRP/346).
  
  
  
  Thirty-six women with forty live foetuses were analysed. Twelve women (13 neonates) were given corticosteroids and could be compared to 24 women (27 neonates) who did not get corticosteroids. The incidence of fresh stillbirths (antenatal death) was 20 %. The 13 neonates who received corticosteroids had significantly smaller birth weight, longer interval between admission and delivery and poorer outcomes (stillbirth and neonatal death). An analysis of 24 neonates with a birth weight between 1.5 and 2.5 kg showed a trend toward better outcome in neonates who did not receive antenatal corticosteroid therapy.
  
  
  
  Small retrospective studies as these have a low level of evidence, but this study helped to gain more knowledge of local conditions affecting the effectiveness of antenatal corticosteroid therapy in our setting of a small rural hospital. Reliability of estimating gestational age, epidemiology of preterm birth, exposure to infections, foetal monitoring and quality of neonatal care are likely to influence the effect of antenatal corticosteroid therapy. Further larger prospective studies should be conducted to determine the exact preconditions of antenatal corticosteroid therapy in low-income countries. Until that time, the WHO precautions seem reasonable and audits and small observational studies like ours can help in assessing whether a specific hospital is suited for antenatal corticosteroid therapy.
authors.affiliation: Ndala Hospital, 15 Ndala, Tabora, Tanzania. r.mooij1983@gmail.com.|Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. r.mooij1983@gmail.com.
authors.forename: R
authors.identifier: 0000-0002-3637-8318
authors.initials: R
authors.lastname: Mooij
authors.affiliation: College of Health Sciences, University of Dodoma, 395, Dodoma, Tanzania.
authors.forename: I H
authors.initials: IH
authors.lastname: Mwampagatwa
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van Dillen
authors.affiliation: Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands.|Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Stekelenburg
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D004461:Eclampsia / Q000188:drug therapy*; D005260:Female; D047109:Fetal Development / Q000187:drug effects*; D006780:Hospitals, Rural; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D066087:Perinatal Death / Q000209:etiology; D011225:Pre-Eclampsia / Q000188:drug therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology*; D013636:Tanzania; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Antenatal corticosteroid therapy; Glucocorticoids; Low-income countries; Preterm birth; Tanzania