Risk Factors Associated with Preterm Delivery in Singleton Pregnancy in a Tertiary Care Hospital in South India: A Case Control Study

Abstract

Background Preterm delivery is a major obstetric complication and a leading cause of neonatal mortality and morbidity. It is also associated with significant costs in terms of psychological and financial hardship, to the families. Objective The primary objective of this study was to determine the risk factors associated with all preterm deliveries in singleton pregnancy in a tertiary care hospital and the secondary objective was to determine the fetal outcomes among women with preterm delivery. Materials and Methods A case control study was conducted between January 2019 and June 2019 in the Department of Obstetrics and Gynecology of a tertiary care center in Central Kerala, India. Women who delivered before 37 completed weeks of gestation were taken as cases and those who delivered at or after 37 weeks were considered as controls in a 1:1 ratio, approximately. Data regarding 191 cases and 200 controls were taken from delivery room records of the years 2016 to 2018 with the help of a predesigned checklist. Univariate and multivariate analysis were done to determine the magnitude of association between the exposure factors and preterm delivery. Results The mean age of study participants among the cases was 29.3 ± 5.1 years and controls was 28.1 ± 4.4. Pregnancy induced hypertension (aOR = 14.60; 95% CI 4.8, 44.1; p<0.001), abnormal amniotic fluid volume (aOR = 10.68; 95% CI 3.46, 32.98; p<0.001), premature rupture of membranes (PROM) (aOR = 10.27; 95% CI 4.82, 21.86; p<0.001), previous history of preterm delivery (aOR = 4.12; 95% CI 1.22, 13.85; p<0.002), history of urinary tract infection (UTI) during pregnancy (aOR = 3.67; 95% CI 1.39, 9.68; p<0.002), systemic diseases (aOR = 2.78; 95% CI 1.28, 6.39; p<0.001), anaemia (aOR = 2.54; 95% CI 1.28, 5.03; p<0.004) were found to be the independent risk factors for preterm delivery. On analyzing the fetal outcomes, the average birth weight of preterm babies was 2 ± 0.6 kg compared to 3.1kg among term babies. Conclusion Early detection and adequate treatment of various conditions like anaemia, pregnancy induced hypertension, UTI and systemic illness can help in reduction of the prevalence of preterm delivery.

Demographic Profile, Etiology, and Perinatal Outcome Associated With Preterm Birth in a Tertiary Hospital of Eastern India: A Retrospective Study

“…Factors associated with increased risk of preterm birth at India sites included severe antepartum haemorrhage, maternal hypertensive disorders, fetal malpresentation, and moderate/severe anaemia recorded anytime during pregnancy [ 10 ]. PROM was evident in 29.96% of our study participants; this finding accords with another Indian study from Kerela [ 23 ]. Anaemia, IUGR, and preeclampsia/eclampsia were the most common adverse pregnancy conditions prevalent in the present study after PROM.…”

“…The average birth weight of preterm babies tends to be significantly lower as compared to the term babies. The mean birth weight of preterm neonates in our study was 2205.76 ± 701.33 grams, which is similar to another Indian study in which the average preterm birth weight was 2.1 ± 0.6 kg [ 23 ]. The effect of preeclampsia, IUGR, and associated anaemia on the birth weight of premature babies has to be taken into consideration.…”

“…About 76.9% of our preterm neonates required NICU admissions with neonatal sepsis (19.6%), jaundice (25.6%), birth asphyxia (17.5%), and respiratory distress syndrome (10.8%) being the most common complications. More than half (51.8%) of the preterm babies in Kerela required NICU admission [ 23 ]. From the literature review, it was found that all neonatal adverse outcomes including lower APGAR scores were significantly more frequent in preterm birth groups than in term groups [ 7 , 8 , 21 ].…”

Preterm Premature Ruptures of Membrane and Factors Associated among Pregnant Women Admitted in Wolkite Comprehensive Specialized Hospital, Gurage Zone, Southern Ethiopia

“…This study finding was in line with the study conducted in Kambala International University Teaching Hospital in Uganda 7.5% [12], Brazil 3.1% [3], Egypt 5.3% [6], and Nigeria 3.3% [7]. This finding was also higher than the study conducted in India 2.01% [13] and south Kerala India 0.8% 3 Infectious Diseases in Obstetrics and Gynecology [4]. The discrepancy might be due to differences in accessibility and service quality in the study area.…”

Effects of Interaction Between Gestational Hypertension and History of Preterm Birth on the Risk of Preterm Birth: An Analysis Based on the National Vital Statistics System Database

“…Women with GH have a significantly increased risk of preterm birth compared with healthy pregnant women [ 11 ]. In addition, special attention and intervention for women with HPB are also beneficial [ 12 , 13 ]. Studies have found that GH and HPB have been identified to be risk factors for preterm birth [ 14 , 15 ].…”