A retrospective analytical study of the epidemiology and causes of preterm birth

Shehla Jamal, Ruchi Srivastava


Background: Preterm birth is the leading cause of perinatal morbidity and mortality. The incidence of preterm birth in India is 7-9%, and the rates are constantly rising. The main cited reasons for this trend are increasing indicated preterm births and rising rates of artificially conceived pregnancies. Major causes for indicated preterm births are hypertensive disorders of pregnancy, foetal growth restriction, antepartum haemorrhage and PPROM. Risk factors for spontaneous preterm birth include obstetrical complications like multifetal gestation, malpresentations and infections, poor antenatal care, having history of previous preterm delivery, and history of bleeding in the index pregnancy.

Methods: This is a retrospective analytical study, done in the department of Obstetrics and Gynecology over a period of two years (January 2015-December 2016). All singleton preterm live births were included in the study. The records of all the included patients were studied from the medical records department of the hospital, after obtaining permission for the same. The results were analysed and obtained by percentage method.

Results: A total of 2564 pregnancies were analysed in present study. The number of preterm deliveries was 436 in two years. Out of 2564, the number of live births was 2365, making an incidence of 18.4%. Maximum preterm deliveries were observed in the teenage group (27%) and elderly gravidas (23.9%), both the groups falling into high risk categories for preterm birth. Multiparity was an independent risk factor observed in our study and was found to be associated with 47.5% cases. Level of antenatal care received was also directly related to the number of preterm deliveries. As high as 58.4% of the females landed into preterm birth, who never sought antenatal care, the commonest risk factor for preterm birth was PPROM (26.6%) followed by hypertensive disorders of pregnancy (18.6%). We observed a labor induction rate of 23.4% and Caesarean delivery was performed in 146 (33.5%) cases, thus indicating a high induction and caesarean rates in such pregnancies.

Conclusions: Preterm birth continues to challenge obstetricians despite much efforts being executed at all levels. Many of the risk factors are identifiable and can be addressed with a specialised antenatal care program. Screening of genitourinary infections and initiation of treatment can cut down the rates. Early referral and NICU equipped institutional delivery should be promoted to prevent neonatal morbidity and mortality.


Indicated preterm deliveries, Neonatal morbidity, Neonatal mortality, Preterm birth

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World Health Organisation. Preterm Birth. Available at on 15 august 2016

Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012 Jun 15;379(9832):2162-72.

Mathews TJ, Mc Dorman MF. Infant Mortality statistics from the 2005 period linked birth/infant death data set. Natl Vital Stat Rep. 2008 Jul 30;57(2):1-32.

Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008 Jan 11;371(9606):75-84.

Giraldo PC, Araújo ED, Junior JE, Amaral RL, Passos MR, Gonçalves AK. The prevalence of urogenital infections in pregnant women experiencing preterm and full-term labor. Infect Dis Obstet Gynecol. 2012 Jan 31;2012.

Meis PJ, Goldenberg RL, Mercer BM, Iams JD, Moawad AH, Miodovnik M, et al. The preterm prediction study: risk factors for indicated preterm births. Am J Obstet Gynecol. 1998;178(3):562-7.

Brown HK, Speechley KN, Macnab J, Natale R, Campbell MK. Maternal, fetal, and placental conditions associated with medically indicated late preterm and early term delivery: a retrospective study. BJOG. 2016 Apr 1;123(5):763-70.

Das A, Subrat P, Ahanthem SS, Sourabh GD, SG BP. Preterm Birth: Analysis of Risk Factors and Neonatal Outcome. Gynecology & Obstetrics Case report. 2015;1(1).

Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Bommarito K, Madden T, Olsen MA, et al. Maternal age and risk of labor and delivery complications. Maternal Child Health J. 2015;19(6):1202-11.

Beeckman K, Louckx F, Downe S, Putman K. The relationship between antenatal care and preterm birth: the importance of content of care. Eur J Public Health. 2012 Sep 13;23(3):366-71.

Sabiri N, Kabiri M, Razine R, Barkat A. Risk factors leading to preterm births in Morocco: a prospective study at the maternity souvissi in Rabat. Pan Afr Med J. 2015;22(1).

American College of Obstetricians and Gynecologists. ACOG committee opinion no. 560: Medically indicated late-preterm and early-term deliveries. Obstet Gynecol. 2013;121(4):908-10.

Singh U, Singh N, Seth S. A prospective analysis of etiology and outcome of preterm labor. J Obstet Gynecol India. 2007;57(1):48-52.