European Journal of Cardiovascular Medicine

One of the most vulnerable groups in any community on Earth are newborns who have just entered the world. Premature birth is the term used by the World Health Organization (WHO) to describe the birth of a newborn child before 37 weeks of pregnancy.1

Preterm births are thought to be the cause of over 70% of neonatal deaths, 36% of infant deaths, and 25% to 50% of pediatric neurological disability cases. Additionally, children born before their due dates have a roughly 50% higher chance of developing cerebral palsy.2

The number of preterm births in India makes up 23.6% of all preterm births worldwide.3

Given the higher survival rate, perinatal and neonatal medicine faces a significant challenge in understanding and preventing the neurodevelopmental effects on preterm infants.4

India is the number one country contributing to the greatest number of preterm births all over the world accounting for 35,19,100 births annually. 5

Numerous mother and child healthcare initiatives have been implemented by the government. This issue may be caused by a lack of qualified services for prenatal and antenatal obstetric care, delayed referrals, and inadequate access to or utilization of health care services6.

It is a complicated condition, and it has not yet been established that the risk factors for preterm birth are surprisingly diverse.

This is due to the fact that there are several potential causes of premature delivery.

The identification of high-risk pregnancies and the reduction of maternal and neonatal mortality and morbidity rates resulting from problematic early parturition can be achieved by analyzing the related etiological variables.

In order to further lower the prevalence of preterm births, primary healthcare providers are crucial in identifying risk factors in women, increasing medical treatment before, during, and after pregnancies, improving access to contraception, and promoting female empowerment and education7

The purpose of this study is to analyse the contributing factors leading to preterm birth, analyze trends in preterm neonatal morbidity and mortality

Aims and objectives

To study the incidence of preterm labor in women attending Obstetrics and Gynaecology department, to analyze the risk factors associated with preterm labor

To analyze the neonatal outcomes in preterm deliveries

Type of study: A prospective cross sectional observational study

Place of study : Pregnant women attending antenatal opd and labor room at KIMS&RF,Amalapuram

Study period : one year from December 2023 - December 2024

Sample size : 110

Detailed history, general and obstetrical examinations were carried out.

Neonatal outcomes were noted.

Inclusion criteria:

• Women of age group 18-35 years
• Women with gestational age between 24 and 40 weeks of pregnancy who exhibit clinical or ultrasonographic signs of onset of labor
• Indicated preterm labor
• Spontaneous preterm labor
• Premature rupture of membranes

Exclusion criteria:

• Patients with threatened pre-term labor
• The fetus with congenital malformations
• Intrauterine fetal death
• Women who have not given consent

After obtaining verbal and written consent, participants were enrolled. Gestational age was calculated from the maternal last menstrual period

Clinical calculation of gestational age was performed in cases where the last menstrual date was unknown by reviewing the records of prior prenatal visits and early trimester scans.

All patients were interviewed, and their obstetric, neonatal, and surgical records were reviewed to obtain a thorough history

Parameters analyzed were demographic profile, psychosocial background, risk factors, probable causes of pre-term labor, and perinatal outcomes.

In patients who set into spontaneous established preterm labor, augmentation of labor was done irrespective of gestational age

In patients with fetal distress and malpresentation cesarean section was done

The babies were followed up in the neonatal period for NICU admissions, respiratory distress, evidence of sepsis, pyrexia

Statistical software SPSS was used for data analysis

Ethical consideration : Study was conducted after approval from the instituitional ethics committee

The incidence of preterm labor in the study was 27.5%

Highest incidence was noted in patients aged 18-25 years- 61.8%

The fact that it was more prevalent in the lower middle class suggests that low socioeconomic status is a risk factor for premature labor

The study found that most preterm deliveries fell into the late preterm range of 34 to 36 weeks-19.75%

Table 1: Incidence of preterm labor – 27.5%

Booked vs un booked

Referral Status

Table 2: Sociodemographic character of the study population

Education

Maternal pre pregnancy BMI

Table 3

Table 4 : Maternal risk factors

Table 5 : Complaints on admission

Spontaneous preterm vs indicated preterm

Mode of delivery

Indications for LSCS:

Neonatal outcomes:

Birth weight

One of the primary causes of infant death and morbidity worldwide is preterm labor. The disorder affects neurodevelopmental functioning throughout the rest of one's life and raises risk of developing chronic illnesses as an adult Since our institute is a tertiary care facility with a higher volume of referred cases requiring NICU care, the incidence of preterm labor was higher at our institute (27.5%), compared to studies conducted by Rao et al. and Trivedi et al(22.3%).

According to the study, the lower middle class accounted for 73% of preterm labor cases, indicating that low socioeconomic status may contribute to undernutrition, poor sanitation, and infections, all of which may be significant risk factors for the onset of preterm labor. Similar findings were observed in the Trivediet al (74.6%)8

The incidence of preterm labor is more in women who were underweight(34.54%) when compared with women who were overweight (9.08%) in this study

The current study found that the incidence of premature labor was greater in second gravida (40%)

 The study found that 71.8% of preterm deliveries occur between 34 and 36 weeks, which is comparable to the findings of studies by Jamalet al(68%)

Majority of the patients in the study presented with pain abdomen, symptoms of UTI followed by leaking per vaginum

Similar findings were noted in study conducted by Verma et al in which urogenital infection was 2.1 times more in women with preterm labor compared to term labor9

 Total 25.4% patients delivered vaginally in the current study, 74.5% delivered by cesarean section in the current study 61.81% of women progressed to spontaneous preterm labor whereas indicated preterm deliveries were of 38.18%

Indicated preterm delivery is mainly done for IUGR with severe oligohydramnios(42.68%), Hypertensive disorders of pregnancy(21.81%) and Antepartum hemorrhage(4.54%)

Preterm delivery more commonly observed in unbooked cases(76.36%) when compared to booked cases(23.63%)

 Risk factors for preterm labor found in the study were Anemia (34.54%), Hypertensive disorders of pregnancy (21.81%), PPROM (15.45%), UTI (8.18%), multiple gestation (7.27%) 60% of preterm babies in the study had birth weight in the range of 1.5 kg to 2.0 kg whereas it is 74% in the study conducted by Jiang et al where the average birthweight was 2.3kg±604gms10

In the study made by Sehgal et al which reported that neonatal hyperbilirubinemia (78%) and RDS (65%)were the common causes for morbidity in extremely low birth weight babies

The most common cause of death was RDS which accounted for 12.7% of NICU admissions

The NICU hospitalizations were either for observation or for treatment of prematurity and associated problems such as perinatal hypoxia, respiratory distress syndrome, sepsis

Thus, recognizing women at risk of preterm labor and providing them with appropriate therapy and care may help to improve outcomes

Incidence of neonatal mortality in present study is 2.72%, all of which was seen in extremely low birth weight babies proving the importance of early and effective management in early and late preterm babies

The primary factor contributing to neonatal mortality and morbidity is preterm birth

The negative effects of prematurity can be reduced with early detection and timely care

Preterm births can be decreased by routine prenatal care, early detection and timely management of risk factors,appropriate management of preeclampsia, GDM and prompt management of APH and offering health education.

The higher prevalence in our study can be attributed to the large volume of referred complicated cases like eclampsia, APH, and referral due to NICU availability.

Since aggressive management has been demonstrated to reduce neonatal problems in preterm neonates, a proper plan for in utero transfer to units with NICU care needs to be implemented

Poor neonatal outcomes like LBW, low APGAR scores, IUGR are significantly associated with the babies delivered pre-mature.

1. National Health Portal, India. "Preterm Birth." National Health Portal of India, www.nhp.gov.in/disease/reproductive-system/female-gynaecological-diseases/pretermbirth. Last accessed on 22 June 2022.
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4. Hedderich, D. M., et al. "Increased Brain Age Gap Estimate (BrainAGE) in Young Adults After Premature Birth." Frontiers in Aging Neuroscience, vol. 13, 2021, article 653365. [CrossRef] [PubMed].
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10. Jiang, M., et al. "A Case-Control Study of Risk Factors and Neonatal Outcomes of Preterm Birth." Taiwan Journal of Obstetrics and Gynecology, vol. 57, no. 6, 2018, pp. 814-818.