Rates and Categories of Preterm Births in Maternity Care Facilities of Various Levels

Abstract

Objective: To analyze the rates and categories of preterm births (PTB) in maternity care facilities providing various levels of maternity care in the Sughd Province, Republic of Tajikistan (RT). Methods: A comprehensive review was conducted based on the annual reports spanning from 2019 to 2023 of the Sughd Regional Maternity Hospital (SRMH), the City Maternity Hospital (CMH), and the maternity department of the Central District Hospital (CDH) named after B. Ghafurov in the Sughd Province, RT. The review aims to evaluate the rates of PTB, including an analysis of the distribution of PTB by gestational age and clinical circumstances. The study compared the maternal care provided at Level II facilities, which offer specialty care, with those at Level III, which provide subspecialty care. This comparison also considered changes over the years as part of evaluating trends. The data analysis involved the use of both parametric and nonparametric statistical methods. Results: In the past 5 years, there has been a noticeable increase in the rates of PTB in various maternity care facilities across the Sughd Province, RT. However, there has been a positive trend of reduced late PTB rates alongside a rise in PTB rates before 35 weeks of pregnancy, specifically in a Level III facility. This trend indicates an overall improvement in the referral system's effectiveness within the Sughd Province, RT. Furthermore, it has been observed that the ratio of spontaneous PTB to medically induced PTB varies in relation to the level of the maternity care facility. Level II facilities tend to experience more spontaneous PTB cases, while level III facilities see a higher proportion of PTB due to the necessity for early delivery. Additionally, the prevalence of cesarean sections (CS) in cases of PTB ranges from 8.9% to 27.9% across facilities of different levels. Conclusion: Understanding the significance of addressing the lack of progress in reducing PTB, especially those occurring at gestational ages of less than 32 weeks, is crucial for improving maternal and infant health outcomes. These data have implications for preventing PTB, ensuring the availability of beds in neonatal intensive care units, and evaluating the maternity and newborn capability levels of the maternity care facilities. Keywords: Premature birth, facilities of different levels, gestational age, spontaneous premature birth, induced premature birth, cesarean section rate.