Study of iatrogenic preterm delivery in a tertiary center: a prospective observational study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20261260Keywords:
Neonatal complications, Caesarean section rate, Antepartum haemorrhage, PPROM, Iatrogenic preterm delivery, Obstetric high-risk factors, Maternal outcomes, Hypertensive disordersAbstract
Background: Iatrogenic preterm delivery, also known as provider-initiated preterm birth, involves planned delivery before 37 weeks of gestation.
Methods: A prospective observational study was conducted after getting clearance from the Institutional ethics committee the study was undertaken from December 2022 to June 2024. Data will be analysed using the SPSS 26.0 software (IBM, ARMONK, NY).
Results: In the study 68% patients were primigravida .72.45% patient were between 32-37 weeks of gestation. The risk of preterm births was higher among mothers with education lower than primary level in our studies. In our study 65% women belonged to lower socio-economic group. In this study, major risk factors included hypertensive disorders in pregnancy (37 cases), PPROM (37 cases), antepartum haemorrhage (16 cases). The most common indication for induction was PPROM and that for LSCS was failure of induction and PPROM with previous scarred uterus. The caesarean section rate in our study was around 81% which included cases of failed induction of labour (20%) and only 19% delivered vaginally following induction of labour. 37.7% delivered babies weighed between 1.5-–2 kg followed by 2-2.5 kg (23.6%) and 1-1.5 kg (21.7%). Most common maternal postnatal complication were anaemia (54.2%) followed by fever (16.7%) and breast engorgement (11.5%) whereas most common neonatal complications were hypoxia (15%), followed by neonatal hyperbilirubinemia (14%) and hypoglycaemia (8%).
Conclusions: For iatrogenic preterm birth, prevention may be targeted towards modifiable factors. Research into complications of pregnancy, such as pre-eclampsia and diabetes must focus on identifying pregnancies for which it is possible to delay birth while ensuring optimal maternal and neonatal outcomes.
References
Ada ML, Hacker MR, Golen TH, Haviland MJ, Shainker SA, Burris HH, et al. Trends in provider-initiated versus spontaneous pretermdeliveries, 2004–2013. J Perinatol. 2017;37(11):1187-91.
Ueki N, Takeda J. Hypertensive Disorders of Pregnancy. Cerebral Palsy. Springer, Singapore. 2022.
McIntire DD, Bloom SL, Casey BM, Leveno KJ. Birth weight in relation to morbidity andmortality among new-born infants. N Engl J Med. 1999;340(16):1234-8.
Nardozza L, Caetano A, Zamarian A, Mazzola J, Silva C, Marcal V. Fetal growth restriction:current knowledge. Arch Gynecol Obstet. 2017;295(5):1061-77.
Lindstorm L, Wikstrom AK, Bergman E, Lundgren M. Born small for gestational age and poor school performance, how small is too small?. Horm Res Paediatr. 2017;88(4):215-23.
Chen X, Zhang X, Li W, Li W, Wang Y, Zhang S, et al. Iatrogenic vs. Spontaneous Preterm Birth: A Retrospective Study of Neonatal Outcome Among Very Preterm Infants. Front Neurol. 2021;12:649749.
Gurung A, Wrammert J, Sunny AK, Gurung R, Rana N, Basaula YN, et al. Incidence, risk factors and consequences ofpreterm birth – findings from a multi-centric observational study for 14 months in Nepal. Arch Public Health. 2020;78:64.
Oftedal AM, Busterud K, Irgens LM, Haug K, Rasmussen S. Socio-economic risk factors forpreterm birth in Norway 1999-2009. Scand J Public Health. 2016;44(6):587-92.
Requejo J, Merialdi M, Althabe F, Keller M, Katz J, Menon R. Born Too Soon: Care duringpregnancy and childbirth to reduce preterm deliveries and improve health outcomes of thepreterm baby. Reprod Health. 2013;10(1):S4.
Huang L, Chen Z, Li J, Chen Y, Yin K, Chen Y, et al. Iatrogenic factors contributed to the high rate of preterm birth in a community hospital. Transl Pediatr. 2021;10(2):403-12.
Sheng-Ting Wu, Ching-Heng Lin, Yi-Hsuan Lin, Ya-Chi Hsu, Chung-Ting Hsu, Ming-Chih Lin. Maternal risk factors for preterm birth in Taiwan, a nationwide population-based cohortstudy, Pediatr Neonatol. 2024;65(1).
Chen KH, Chen IC, Yang YC, Chen KT. The trends and associated factors of preterm deliveries from 2001 to 2011 in Taiwan. Medicine. 2019;98:e15060.
Romero R, Espinoza J, Kusanovic JP, Gotsch F, Hassan S, Erez O, et al. The preterm parturition syndrome. BJOG. 2006;113(3):17-42.
Kietpeerakool C, Lumbiganon P, Laopaiboon M, Rattanachaiyanont M, Thinkhamrop J, Chawanpaiboon S, et al. Pregnancy outcomes of women withprevious caesarean sections: Secondary analysis of World Health Organization MulticountrySurvey on Maternal and Newborn Health. Sci Rep. 2019;9:9748.
Dehaene I, Scheire E, Steen J, De Coen K, Decruyenaere J, Smets K, et al. Obstetricalcharacteristics and neonatal outcome according to aetiology of preterm birth: a cohortstudy. Arch Gynecol Obstet. 2020;302(4):861-71.
Milani F, Sharami SH, Attari SM, RafieeSorouri Z, Farzadi S, et al. Factors Associated withCesarean Section in Preterm Births at a Tertiary Hospital in Rasht, Iran. J Kermanshah Univ Med Sci. 2024;28(2):e144362.
Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2017;3:CD004454.
Doyle LW, Crowther CA, Middleton P, Marret S. Magnesium sulphate for women at risk ofpreterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev. 2007;3:CD004661.
Petrova A, Mehta R. Magnesium sulfate tocolysis and intraventricular hemorrhage in verypreterm infants. Indian J Pediatr. 2012;79(1):43-7.
Stoll BJM, Hansen NIM, Adams-Chapman IM, Fanaroff AAM, Hintz SRM, Vohr BM, et al. National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA. 2004;292(19):2357-65.
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