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Background Antenatal corticosteroids (ACS) have long been regarded as a cornerstone intervention in mitigating the adverse effects of a preterm birth. However, the safety and efficacy of ACS in hospitals in low-resource countries has not been established in an efficacy trial despite their widespread use. Findings of a large cluster-randomized trial in six low- and middle-income countries showed that efforts to scale up ACS use in low-resource settings can lead to harm. There is equipoise regarding the benefits and harms of ACS use in hospitals in low-resource countries. This randomized controlled trial aims to determine whether ACS are safe and efficacious when given to women at risk of imminent birth in the early preterm period, in hospitals in low-resource countries. Methods/design The trial design is a parallel, two-arm, double-blind, individually randomized, placebo-controlled trial of ACS (dexamethasone) for women at risk of imminent preterm birth. The trial will recruit 6018 women in participating hospitals across five low-resource countries (Bangladesh, India, Kenya, Nigeria and Pakistan). The primary objectives are to compare the efficacy of dexamethasone with placebo on survival of the baby and maternal infectious morbidity. The primary outcomes are: 1) neonatal death (to 28 completed days of life); 2) any baby death (any stillbirth postrandomization or neonatal death); and 3) a composite outcome to assess possible maternal bacterial infections. The trial will recruit eligible, consenting pregnant women from 26 weeks 0 days to 33 weeks 6 days gestation with confirmed live fetuses, in whom birth is planned or expected within 48 h. The intervention comprises a regimen of intramuscular dexamethasone sodium phosphate. The comparison is an identical placebo regimen (normal saline). A total of 6018 women will be recruited to detect a reduction of 15% or more in neonatal deaths in a two-sided 5% significance test with 90% power (including 10% loss to follow-up). Discussion Findings of this trial will guide clinicians, programme managers and policymakers on the safety and efficacy of ACS in hospitals in low-resource countries. The trial findings will inform updating of the World Health Organization’s global recommendations on ACS use. Trial registration ACTRN12617000476336. Registered on 31 March 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3488-z) contains supplementary material, which is available to authorized users.

Blood and blood products are scarce in developing countries due to increasing demand and declining supply. Rational utilization of blood products is imperative and prompted this study, which identifies the risk factors for blood transfusion during C-sections in a tertiary hospital in Nigeria.This retrospective case-controlled study reviewed all C-sections in our hospital from January 1, 1998, to December 31, 2002. Clinical variables including demographic characteristics, surgical events, EBL, indication for transfusion, and the number of units transfused were recorded.A total of 1117 cesarean sections were performed within the study period. Sixty-three patients (5.6%) received blood transfusions. An unbooked patient was six times more likely to receive a blood transfusion during cesarean section than women who had had antenatal care (p0.001). Grand-multiparous women were associated with intraoperative transfusion during cesarean section (p=0.004). Placental previa was significantly associated with transfusion during cesarean section (p=0.0002). Previous cesarean section was an associated factor for intraoperative transfusion at cesarean section (p=0.02).The factors associated with transfusion at cesarean section were lack of prenatal care, grand multiparity, previous cesarean section, and pregnancies complicated by placenta previa. These factors should be considered in the care of parturients for cesarean section, especially in developing countries.