RISK FACTORS AND OUTCOMES OF PRETERM LABOR IN HIGH-RISK PREGNANCIES
Main Article Content
Keywords
Preterm labor; High-risk pregnancy; Neonatal outcomes; Risk factors; Gestational age
Abstract
Preterm labor in high-risk pregnancies represents a significant obstetric challenge with substantial maternal and neonatal morbidity. This study aimed to assess risk factors and clinical outcomes of preterm labor in high-risk pregnancies and identify predictive factors for clinical management optimization.
Methods: A prospective observational cohort study was conducted at LNCT Medical College and Sewakunj Hospital, Indore, from June 2022 to December 2022. Consecutive sampling recruited 445 high-risk pregnant women presenting with preterm labor between 28-36 weeks gestation. Data collection included demographic characteristics, risk factors, clinical presentation, management interventions, and maternal-neonatal outcomes. Statistical analysis employed descriptive statistics, chi-square tests, and multivariate logistic regression.
Results: Participants were predominantly aged 18-30 years (67.0%) from rural areas (60.0%) with lower socioeconomic status (40.0%). Major risk factors included anemia (50.1%), urinary tract infections (42.5%), inadequate prenatal care (35.1%), previous preterm birth (30.1%), and pregnancy-induced hypertension (25.2%). Tocolytic therapy successfully delayed delivery ≥48 hours in 60.0% of cases. Cesarean section rate was 40.0%. Neonatal outcomes showed 50.1% NICU admission requirement, with respiratory distress syndrome affecting 30.1% of newborns. Gestational age at delivery significantly influenced outcomes, with neonatal mortality decreasing from 12.8% at 28-31 weeks to 0.7% at 35-36 weeks. Mean birth weights increased progressively with advancing gestational age (1245±285g to 2380±398g).
Conclusion: High prevalence of preventable risk factors, particularly anemia and infections, highlights opportunities for enhanced prenatal interventions. Strong gestational age-dependent outcome patterns emphasize the critical importance of pregnancy prolongation strategies in high-risk populations.
References
2. Blondel, B., Kogan, M. D., Alexander, G. R., Dattani, N., Kramer, M. S., Macfarlane, A., & Wen, S. W. (2002). The impact of the increasing number of multiple births on the rates of preterm birth and low birthweight: an international study. American Journal of Public Health, 92(8), 1323-1330. https://doi.org/10.2105/AJPH.92.8.1323
3. Chawanpaiboon, S., Vogel, J. P., Moller, A. B., Lumbiganon, P., Petzold, M., Hogan, D., ... & Gülmezoglu, A. M. (2019). Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. The Lancet Global Health, 7(1), e37-e46. https://doi.org/10.1016/S2214-109X(18)30451-0
4. Express Group. (2010). Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS). Acta Paediatrica, 99(7), 978-992. https://doi.org/10.1111/j.1651-2227.2010.01846.x
5. Goldenberg, R. L., Culhane, J. F., Iams, J. D., & Romero, R. (2008). Epidemiology and causes of preterm birth. The Lancet, 371(9606), 75-84. https://doi.org/10.1016/S0140-6736(08)60074-4
6. Haas, D. M., Caldwell, D. M., Kirkpatrick, P., McIntosh, J. J., & Welton, N. J. (2012). Tocolytic therapy for preterm delivery: systematic review and network meta-analysis. BMJ, 345, e6226. https://doi.org/10.1136/bmj.e6226
7. Honest, H., Bachmann, L. M., Gupta, J. K., Kleijnen, J., & Khan, K. S. (2012). Accuracy of cervicovaginal fetal fibronectin test in predicting risk of spontaneous preterm birth: systematic review. BMJ, 325(7359), 301. https://doi.org/10.1136/bmj.325.7359.301
8. Iams, J. D., Romero, R., Culhane, J. F., & Goldenberg, R. L. (2008). Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth. The Lancet, 371(9607), 164-175. https://doi.org/10.1016/S0140-6736(08)60108-7
9. Jahan, S., Went, S., Baron, I., & Johnstone, M. J. (2014). A systematic review of the quality of antenatal care in countries with high neonatal mortality rates. BMC Pregnancy and Childbirth, 14(1), 1-12. https://doi.org/10.1186/1471-2393-14-145
10. Kramer, M. S., Seguin, L., Lydon, J., & Goulet, L. (2000). Socio‐economic disparities in pregnancy outcome: why do the poor fare so poorly? Paediatric and Perinatal Epidemiology, 14(3), 194-210. https://doi.org/10.1046/j.1365-3016.2000.00266.x
11. Lawn, J. E., Davidge, R., Paul, V. K., Von Xylander, S., De Graft Johnson, J., Costello, A., ... & Salehi, F. (2013). Born too soon: care for the preterm baby. Reproductive Health, 10(1), 1-19. https://doi.org/10.1186/1742-4755-10-S1-S5
12. McManemy, J., Cooke, E., Amon, E., & Leet, T. (2007). Recurrence risk for preterm delivery. American Journal of Obstetrics and Gynecology, 196(6), 576-e1. https://doi.org/10.1016/j.ajog.2007.01.039
13. Meis, P. J., Klebanoff, M., Thom, E., Dombrowski, M. P., Sibai, B., Moawad, A. H., ... & National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. (2003). Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. New England Journal of Medicine, 348(24), 2379-2385. https://doi.org/10.1056/NEJMoa035140
14. Osungbade, K. O., & Ige, O. K. (2011). Public health perspectives of preeclampsia in developing countries: implication for health system strengthening. Journal of Pregnancy, 2011, 481095. https://doi.org/10.1155/2011/481095
15. Petrou, S., Mehta, Z., Hockley, C., Cook‐Mozaffari, P., Henderson, J., & Goldacre, M. (2003). The impact of preterm birth on hospital inpatient admissions and costs during the first 5 years of life. Pediatrics, 112(6), 1290-1297. https://doi.org/10.1542/peds.112.6.1290
16. Plunkett, J., & Muglia, L. J. (2008). Genetic contributions to preterm birth: implications from epidemiological and genetic association studies. Annals of Medicine, 40(3), 167-195. https://doi.org/10.1080/07853890701806181
17. Rashed, M., Jahan, M., Howlader, S., & Sultana, F. (2018). Maternal and perinatal outcome of pregnancy with severe anemia. Mymensingh Medical Journal, 27(1), 14-19. PMID: 29459630
18. Romero, R., Dey, S. K., & Fisher, S. J. (2014). Preterm labor: one syndrome, many causes. Science, 345(6198), 760-765. https://doi.org/10.1126/science.1251816
19. Sharma, D., Shastri, S., & Sharma, P. (2016). Intrauterine growth restriction: antenatal and postnatal aspects. Clinical Medicine Insights: Pediatrics, 10, 67-83. https://doi.org/10.4137/CMPed.S40070
20. Simhan, H. N., & Caritis, S. N. (2007). Prevention of preterm delivery. New England Journal of Medicine, 357(5), 477-487. https://doi.org/10.1056/NEJMra050435
21. Stoll, B. J., Hansen, N. I., Bell, E. F., Walsh, M. C., Carlo, W. A., Shankaran, S., ... & Eunice Kennedy Shriver National Institute of Child Health & Human Development Neonatal Research Network. (2015). Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA, 314(10), 1039-1051. https://doi.org/10.1001/jama.2015.10244
22. Vogel, J. P., Chawanpaiboon, S., Moller, A. B., Watananirun, K., Bonet, M., & Lumbiganon, P. (2018). The global epidemiology of preterm birth. Best Practice & Research Clinical Obstetrics & Gynaecology, 52, 3-12. https://doi.org/10.1016/j.bpobgyn.2018.04.003
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Mili Poonia
Associate Professor, LNCT Medical College and Sewakunj Hospital, Indore, Madhya Pradesh,