DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20184924

A prospective analysis of the risk factors and the perinatal outcome of preterm labour

Sunitha Mary Mathew, Ajay Kumar

Abstract


Background: Preterm labour is a challenging complication encountered by obstetricians. The dictum prevention is better than cure well applies for preterm labour also, hence the importance of knowing the risk factors. Infection is one treatable, thus preventable risk factor.

Methods: Prospective cohort study involving 75 antenatals at gestational age from 28 to 36+6 weeks.  After getting clearance from institutional ethical committee detailed history including history of UTI, excessive vaginal discharge, previous abortions and previous preterm labour and medical complications were collected. Two doses of injection Betamethasone 12 mg 24 hours apart were given for all patients. High vaginal swab was taken from all subjects and results analysed. Neonates are then followed up till discharge.

Results: The incidences were higher in primigravidas compared to multiparas. Late preterms (34-36+6 weeks) were the majority in the group. PPROM was the major cause for late preterm births, this was followed by UTI and vaginal infections. Among the high vaginal swab 30.7% were culture positive. E Coli was the most common organism isolated followed by Staphylococcus Aureus, Klebsiella, and MRSA. Hyperbilirubinemia was the most common neonatal complication. Out of 7 neonatal deaths 6 were due to RDS and one was extremely preterm newborn. Women who delivered at least 24 hours after initiation of steroid were considered steroid covered group. Steroid covered group had lesser incidence of RDS with P value of 0.001which was statistically significant.

Conclusions: UTI and vaginal infections were major risk factors for preterm labour and should be tackled antenatally. High vaginal swab should be taken for threatened preterm labour especially early preterm. Betamethasone administration causes a definite reduction in the incidence of RDS. Induce PPROM after 36 weeks to reduce late preterm complications provided there is no chorioamnionitis.


Keywords


Antenatal steroids, Early preterm, High vaginal swab, Late preterm, Steroid covered

Full Text:

PDF

References


McPheeters ML, Miller WC, Hartmann KE, Savitz DA, Kaufman JS, Garrett JM, et al. The epidemiology of threatened preterm labor: a prospective cohort study. Am J Obstet Gynecol. 2005;192(4):1325-9.

Goldenberge RL, Culhane JF, Iams JD, Romero R. Preterm birth 1-epidemiology and causes of preterm birth. Lancet. 2008;371.

Ananth CV, Joseph KS, Oyelese Y, Demissie K, Vintzileos AM. Trends in preterm birth and perinatal mortality among singletons: United States, 1989 through 2000. Obstet Gynecol. 2005;105(5):1084-91.

McCormick MC. The contribution of low birth weight to infant mortality and childhood morbidity. New Engl J Med.1985;312:82-90.

Engle WA. A recommendation for the definition of late preterm (near-term) and the birth weight-gestational age classification system. In Seminars in Perinatology. WB Saunders. 2006;(1):2-7.

Raju TN, Higgins RD, Stark AR, Leveno KJ. Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics. 2006;118(3):1207-14.

March of Dimes Perinatal Data Center Late preterm birth: every week matters. 2005, National Center for Health Statistics, final natality data, January 2008. Available at: www.marchofdimes.com/perstats/.8.

Ghazi A, Jabbar S, Siddiq NM. Emrgency obstetric hysterectomy: a lifesaving procedure in obstetrics. Pak J Surg. 2006;22(4):222-6.

Uma S, Nisha S, Shikha S. A prospective analysis of etiology and outcome of preterm labor. J Obstet Gynecol India. 2007;57(1):48-52.

Hoffman HJ, Bakketeig LS. Risk factors associated with the occurrence of preterm birth. Clin Obstet Gynecol. 1984;27(3):539-52.

Chan A, Scott J, Nguyen AM, Sage L, Unit PO, Branch E. Pregnancy outcome in South Australia. Government of South Australia, editor. Pregnancy Outcome (Statistics) Unit SH. Adelaide: Pregnancy Outcome Unit Epidemiology Branch, Department of Human Services. 2007.

McParland PC, Bell SC. The fetal membranes and mechanisms underlying their labour associated and pre-labour rupture during pregnancy. Fetal Maternal Med Review. 2004;15:73-108.

Goldenberg RL. The management of preterm labour. Obstet Gymecol. 2002;100(5):1020-37.

Parry S, Strauss JF. Premature rupture of the fetal membranes. N Eng J Med. 1998;338:663-70.

Thomson C. Urinary tract infection. In Warrell DA, Cox TM, Firth J,Benz EJ, eds. Oxford Textbook of Medicine. 4th ed. Oxford University Press; 2003:420-433.

Cassell G, Hauth J, Andrews W, Cutter G, Goldenberg R. Chorioamnion colonization: correlation with gestational age in women delivered following spontaneous labor versus indicated delivery. Am J Obstet Gynecol. 1993;168(425):A464.

Hillier SL, Martius J, Krohn M, Kiviat N, Holmes KK, Eschenbach DA. A case-control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. New Eng J Med. 1988;319(15):972-8.

Shim SS, Romero R, Hong JS, Park CW, Jun JK, Kim BI, et al. Clinical significance of intra-amniotic inflammation in patients with preterm premature rupture of membranes. Am J Obstet Gynecol. 2004;191(4):1339-45.

Geopfert AR, Goldenberg RL. Prediction of prematurity. Curr Opin Obstet Gynecol. 1996;8:417-27.

McDonald HM, O’Loughlin JA, Jolly P, Vigneswaran R, Mc Donald PJ. Vaginal infection and preterm labour. BJOG. 1991;98(5):427-35.

Stoll BJ, Hansen NI, Higgins RD. Very low birth weight preterm infants with early onset neonatal sepsis:the predominance of gram negative infections continues in the National Institute of Child Health and Human Devolopment Neonatal Research Network, 2002-2003. Pediatr Infect Dis J. 2005;2(7):635-9.

Bratu S, Eramo A, Kopec R. Community associated methicillin resisant Staphylococcus aureus in hospital nursery and maternity units. Emerg Infect Dis. 2005;11(6):808-13.

Crowther CA, Doyle LW, Haslam RR, Hiller JE, Harding JE, Robinson JS. Outcome at 2 years of age after repeated doses of antenatal corticosteroids. N Eng J Med. 2007;357(12):1179-89.

Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics. 1972;50(4):515-25.

Elimian A, Garry D, Figueroa R, Spitzer A, Wiencek V, Quirk JG. Antenatal betamethasone compared with dexamethasone (betacode trial): a randomized controlled trial. Obstet Gynecol. 2007;110(1):26-30.

Kenyon SL, Taylor DJ, Tarnow-Mordi WF. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. Lancet. 2001;357(9261):979-88.

Kenyon S, Pike K, Jones DR, Brocklehurst P, Marlow N, Salt A, et al. Childhood outcomes after prescription of antibiotics to pregnant women with preterm rupture of the membranes: 7-year follow-up of the ORACLE I trial. Lancet. 2008;372(9646):1310-8.