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Background Respiratory distress (RD) is higher among newborns born by caesarean section (CS) compared to vaginal delivery. Royal College of Obstetricians and Gynaecologists recommend steroid administration for CS prior to 39 weeks. Effectiveness of steroids for neonatal RD at term is inconclusive. The racial differences are yet to be studied. Methods A single center retrospective cohort study was conducted in Colombo, Sri Lanka from December 2016 to February 2019. All mothers delivered by CS between 37+0 and 38+6 weeks were included. Mothers with severe maternal hypertension, fetal rhesus sensitization, intrauterine infection, multiple pregnancies and who received steroids at a prior gestation were excluded. Cohort was subdivided according to administration of intramuscular dexamethasone prior to CS. Primary outcomes measured were RD, admissions to neonatal intensive care unit (NICU) and special care baby unit (SCBU). Neonatal infections and maternal duration of hospital stay were recorded as secondary outcome measures. Results 560 patients were included. 23.2% of patients received antenatal corticosteroids. Incidence of RD, NICU admissions and SCBU admissions in the study cohort was 10%, 0.9%, and 2.7% respectively. Relative risk for developing RD in the steroid group compared to non-steroid group was 2.67 (95CI 1.64-4.35). 4.6% of the steroid group and 3.3% of the non-steroid group needed to be admitted to the NICU/SCBU (p=0.464). A significantly higher number of babies in the steroid group needed IV antibiotics. The average number of days the mothers were admitted to the hospital was 2.45 days (SD+/- 1.424) for steroid group and 1.4 days (SD+/- 0.856) for the non-steroid group (p < 0.001). Conclusions There is a significant increase in the respiratory morbidity in the dexamethasone administered south Asian mothers at term prior to CS. However, this effect has no clinical significance since the admissions to NICU and SCBU were not significantly different.

Background: Dengue virus (DENV) and coronavirus disease 2019 (COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) are two viral illnesses that require very distinct management protocols. Missed diagnosis and under reporting of DENV is predicted due to COVID-19 pandemic. Pregnancy is associated with increased fetal and maternal morbidity and mortality due to both illnesses. Co-infection need to be reported and studied to optimize the outcomes. Methods: This is a retrospective study on pregnant patients with COVID-19 and DENV co-infection conducted from the medical records from 1 st of April 2021 to 1 st of September 2021. Results: In this series four patients are described. Patient 1 is a diagnosed patient with immune thrombocytopenic purpura who was in remission. She developed DENV infection during recovery of SARS-CoV-2. She received intensive care unit (ICU) care during the leaking phase. Patient 2 had an uncomplicated miscarriage during the co-infection. Patient 3 was a patient with advanced maternal age with multiple co-morbidities. She did not progress into the leaking phase. Diagnosis of DENV was missed in patient 4 and she had a fetal death. Conclusions: SARS-CoV-2 and DENV co-infection in pregnancy can be life threatening to the mother and can lead to adverse fatal outcomes. Timely diagnosis and multidisciplinary management are essential for better outcomes. Continuous data collection and reporting is advisable till the guidance is formed.