Risk Factors for premature birth in a hospital

Maternal Risk Factors Associated With Neonatal Outcome in Primiparous, Machala, Ecuador

Introduction The resulting neonatal, weight of the newborn (NB) is considered as a health indicator since the nutritional status of the neonate can have repercussions on the growth and development of the child until adulthood. Secondly, preterm delivery is associated with several maternal risk factors, such as the presence of anemia, adolescence, or advanced age. The aim of the study was to determine the maternal risk factors related to neonatal outcomes in primiparous. Methods A descriptive, observational, quantitative, longitudinal, and non-experimental study was conducted. Data were collected from women who gave birth from September 2021 to August 2022, in a Microsoft Excel database and the analysis was performed using SPSS software, version 26. Results The study population consisted of 224 pregnant women, aged 16 to 41 years, with a mean of 21 years (SD ± 4 years), the most predominant age range was under 20 years, with 53.33%, 81.7% were of middle socioeconomic status, 50.4% had basic education, 89.7% self-identified as mestizo race, 86.2% were of Ecuadorian nationality, and 96.0% resided in the urban area. A total of 97.8% were term NB, 69.9% were normal weight, and 96.4% had an Apgar score of 8 to 10 in the first minute after birth. Maternal factors related to Apgar 7 were adolescent and elderly women, with an odds ratio (OR) of 2.180; having maternal comorbidity OR: 2.0612; the factors related to preterm and post-term neonates were the degree of primary and basic education, OR: 2.0, without statistical significance (p>0.05). And in relation to low weight and high weight, we have an academic education OR: 3.0417, without statistical significance (p>0.05); and mothers with a history of previous abortions, OR: 8.6000, with high statistical significance (p<0.05). Conclusions Among the main maternal factors related to neonatal outcome in primiparous pregnant women were educational level, age, number of prenatal checkups, and history of previous abortions.

Efecto de la relación entre la anemia y la amenaza de parto pretérmino en gestantes de un hospital peruano

 Objetivo. Determinar la relación de la anemia y la amenaza de parto pretérmino en gestantes del Hospital Carlos Lanfranco La Hoz en el periodo 2020-2021. Materiales y Métodos. Se realizó un estudio observacional, retrospectivo analítico de caso y control en una población que estuvo constituida por todas las pacientes hospitalizadas en el servicio de ginecobstetricia con una población total de 240 de los cuales 120 gestantes con parto pretérmino fueron casos y 120 con partos normales fueron controles. Resultados. La variable independiente de la anemia represento un 36,7% del total de pacientes y los porcentajes de anemia con respecto a los grupos de casos fue de 48,3 % y en los controles 28,3 % respectivamente.El análisis multivariado muestra que la anemia (OR: 2,24; IC: 95% 1,26- 3,97; p:0,006) y controles prenatales insuficientes (OR: 2,33; IC: 95% 1,32- 4,1; p:0, 003) están asociadas significativamente  con la amenaza de parto pretérmino, ajustado a las variables de antecedentes de parto prematuro, controles prenatales insuficientes, edad, obesidad  y ser multigesta. Por lo contrario, no existió asociación significativa para las variables de obesidad, antecedente de parto prematuro, edad y ser multigesta. Conclusiones. Presentar anemia y controles prenatales insuficientes, demostró ser un factor de riesgo importante para desarrollar amenaza de parto pretérmino.

Difference between Preterm Birth in Adolescent and Adult Patients

Background: Preterm delivery represents an important public health problem due to its neonatal outcomes. There are numerous complications that occur due to prematurity, but the most significant one is represented by neonatal death. Even if the certain mechanism of prematurity is elusive, there are various risk factors known to be involved in the etiology of preterm birth, among which one is young age. Objectives: The present study aims to find whether preterm delivery has a higher rate in adolescent patients and if neonatal outcomes are different in adolescent and adult patients. Patients and methods:We performed an observational retrospective study about preterm infants from adolescent and adult patients. Thus, we analyzed 96 patients aged between 13 and 38 years who delivered in our unit between October 1st 2018 and December 31st 2021. Patients were divided into two groups: a study group (n=59), which included adolescents who delivered preterm, and a control group (n=37), which comprised adult patients who delivered preterm. We evaluated the rate of prematurity of all births and among patients enrolled in the present study and the neonatal outcome by newborn's weight, one-minute newborn's Apgar score and Neonatal Intensive Care Unit (NICU) admission. Results:In our study, the rate of prematurity was higher in adolescent patients, with a rate of 61.46%. The newborns' outcomes, analyzed by newborn's weight and one-minute Apgar score, were better in adolescent patients compared to adult ones. Therefore, newborns from adult patients needed neonatal intensive care more often, with a rate of 62.16%, while in the study group the percentage was 38.98%. The rate of antenatal care was higher in adult patients compared to adolescent ones (32.43% versus 27.12%). Conclusion:Adolescents have a higher risk of preterm delivery; however, their newborns have better outcomes than those of adult patients. The lack of antenatal care represents a risk factor for preterm delivery.

Prevalence of low birth weight and its associated factors: Hospital based cross sectional study in Nepal

Low birth weight is still an important public health problem worldwide. It is a major contributor to neonatal death in developing countries, including Nepal. The government of Nepal has developed and implemented different programs to improve maternal and neonatal health, including baby's birth weight. However, low birth weight is a major maternal and child health challenge. Maternal factors determining the birth weight of neonates have been poorly assessed in previous studies in Nepal. Thus, this study aims to assess the prevalence and risk factors associated with low birth weight in Nepal. An institution-based descriptive cross-sectional study was carried out in Paropakar Maternity Hospital and Tribhuvan University Teaching Hospital of Kathmandu district among 308 postnatal mothers. The data was collected through the face-to-face interview technique. The data was entered in EpiData 3.1 and exported to Statistical Package and Service Solutions version 21 for analysis. Multivariate logistic regression was used to obtain an adjusted odds ratio, while p-value < 0.05 with 95% Confidence Interval (CI) was considered significant. The findings showed that 15.3% of the children had low birth weight. The mean and standard deviation of childbirth weight was 2.96±0.59 kg. Mothers belonged to Dalit ethnic (AOR = 2.9, 95% CI = 1.2-7.1), Antenatal Care visited three or fewer (AOR = 2.6, 95%CI = 1.0-6.6) and did not comply with Iron and Folic Acid supplementation (AOR = 2.1, 95% CI = 1.0-4.4) were significantly associated with low birth weight. Nearly one in every six children had low birth weight. Maternal health services such as antenatal care and compliance with a recommended dose of maternal micronutrients significantly impact on birth weight. Maternal and neonatal health programs should consider these factors to reduce adverse birth outcomes in Nepal.

The association between protein levels in 24-hour urine samples and maternal and neonatal outcomes of pregnant women with preeclampsia

Objective

Hypertensive diseases of pregnancy are one of the leading causes of maternal and perinatal mortality worldwide. The aim of this study was to evaluate the association between protein levels in 24-hour urine samples and maternal and perinatal outcomes in preeclamptic patients.

Material and Methods

This retrospective cohort study was conducted with pregnant women who were diagnosed with preeclampsia (PE) and delivered in our clinic between 2010 and 2018. Patients were divided into those with a proteinuria value below 300 mg/24 h (non-proteinuria), proteinuria value between 300-2000 mg/24 h (mild proteinuria), proteinuria value between 2000-5000 mg/24 h (severe proteinuria) and proteinuria value >5000 mg/24 h (massive proteinuria) and were compared in terms of maternal and perinatal outcomes. Demographic characteristics (age, body mass index in kg/m2, gravidity), PE-related clinical symptoms (epigastric pain, neurological and respiratory symptoms), laboratory findings (24 h protein level, lactate dehydrogenase, aspartate aminotransferase, platelet count and creatine levels) were recorded in all patients.

Results

A total of 1,379 patients meeting the study criteria were included. There were 315 (23%) patients in the non-proteinuria group, 704 (51%) in the mild proteinuria group, 234 (17%) patients in the severe group and 126 (9%) patients in the massive proteinuria group. The massive proteinuria group was found to have the highest rates of maternal and prenatal complications. The Apgar score, umbilical cord pH value, birth weight, gestational week at delivery, intrauterine growth restriction and intrauterine fetal death were significantly higher in the massive proteinuria group.

Conclusion

Our data showed that the degree of proteinuria appears to be associated with maternal, fetal and neonatal outcomes among women diagnosed with PE. Women with proteinuria of >5000 mg/24 hours had notably poorer natal outcomes.

Pituitary apoplexy of a giant prolactinoma during pregnancy

AIMS AND METHODS

Prolactinomas are a common cause of sexual dysfunction and infertility. We aimed, through this case report, to illustrate the difficulties of management of women with giant prolactinoma, especially in cases of desire of pregnancy.

RESULTS

A 30-year-old woman was referred to our department for secondary amenorrhea. Investigations showed a prolactin level of 5168 ng/mL and giant pituitary adenoma of 4 cm in diameter. Cytoreductive surgery was performed after failure to normalize prolactin levels during three years with medical treatment by cabergoline. After seven months, menstrual cycles have resumed, and after 13 months, the patient became pregnant. At 22nd week of gestation, she was admitted in our hospital for pituitary apoplexy. Medical treatment with bromocriptine was chosen. The vaginal premature delivery at 28 weeks gave birth to twins weighing 1 Kg each who died on the 7th day of life.

CONCLUSION

This is a relevant clinical case that illustrates the efficacy of cytoreductive surgery in case of insufficient response to dopamine agonists to restore gonadal function. The possibility of a pregnancy should be considered in these patients since it can be associated with high maternal and fetal risks.

Trophoblasts Modulate the Ca2+ Oscillation and Contraction of Myometrial Smooth Muscle Cells by Small Extracellular Vesicle- (sEV-) Mediated Exporting of miR-25-3p during Premature Labor

The placenta could transmit information to the maternal circulation via the secretion of small extracellular vesicles (sEVs), but little is known about whether and how these sEVs participate in premature labor (PTL). We speculate that miRNA plays an important role in sEV-mediated fetal-maternal information transmission. The present study was aimed at investigating whether the placenta can regulate the contraction of the maternal myometrium via sEV-mediated transmit of miR-25-3p during PTL. The expression of miR-25-3p and its targets Cav3.2 and SERCA2a in clinical samples, cells, and animal specimens was detected. The role of miR-25-3p was observed in the LPS-induced preterm labor mouse model. The sEVs from HTR-8/SVneo cells were characterized by transmission electron microscopy and nanoparticle tracking analysis. The Ca²⁺ oscillation in HMSMs was analyzed by an intracellular Ca²⁺ change tracking assay on a confocal microscope. The contraction of HMSMs was detected by a collagen matrix contraction assay. We found that miR-25-3p can directly bind to the 3′UTR of Cav3.2 and SERCA2a. The miR-25-3p level was decreased, and the expression of its targets Cav3.2 and SERCA2a was increased in the placenta and myometrium tissues of PTL patients. Forced upregulation of miR-25-3p reduced the oxidative stress and inflammation responses and the incidence of PTL in LPS-treated mice. The expression of miR-25-3p was not changed in LPS-stimulated human myometrial smooth muscle cells (HMSMs) but was strongly reduced in the trophoblast cell and its sEVs. Additionally, the trophoblast cell line HTR-8/SVneo could transmit miR-25-3p into HMSMs via sEVs. The sEVs derived from LPS-stimulated trophoblasts upregulated the expression of Cav3.2 and SERCA2a and triggered Ca²⁺ oscillation as well as the contraction of HMSMs; these effects were partially reversed by the overexpression of miR-25-3p in the trophoblasts. Further, the upregulation of miR-25-3p induced changes of Ca²⁺ oscillation and contraction of HMSMs mediated by sEVs which were also abrogated by the knockdown of miR-25-3p in HMSMs. The results demonstrated that miR-25-3p plays a crucial role in PTL via Cav3.2- and SERCA2a-mediated Ca²⁺ oscillation and contraction of HMSMs. PTL seems to be related to the decreased exosomal miR-25-3p content transmitted by the trophoblasts under inflammatory conditions.

Determination of risk factors and cumulative effects of the maternal and neonatal risk factors in relation to preterm labor

Background

Preterm labor is the leading cause of neonatal morbidity and mortality this study aimed to determine single and combined effects of all risk factors in relation to preterm labor.

Methods

This was a case-control study that included patients from a teaching hospital affiliated to Tehran University of Medical Sciences. Women who came to this hospital for delivery were divided into two groups: 200 in preterm delivery (before 37 weeks) and 195 in term delivery (after 37 weeks).

Results

In all 409 pregnant women were delivered. 217 were preterm (group A) and 192 were term (group B). The mean age of mothers in group A was 30.04 ± 5.74 and the mean age of mothers in group B was 27.28 ± 5.90 (P < 0.001). The risk of preterm labor was 4.22 higher in mother with any risk factor before or during pregnancy (P < 0.001), it was 3.67 higher in mother with complication of pregnancy (P < 0.001) and it was 3.40 higher in neonate with any complication (P = 0.002) compared to mother without any risk factors. For each mother, we calculated risk score for preterm labor by counting the number of risk factors. The risk of preterm labor was significantly higher in mother with risk factors compared to those without any risk factors (P for trend = 0. 002). Mother with two risk factors had a 5.60 (P = 0.01) and mother with three or more risk factors had a 23.48 (P = 0. 001) times higher risk for preterm labor than those who did not have any risk factors.

Conclusion

The screening and identification of mothers with risk factors for preterm delivery can increasing mother's attention and participation to better manage of these condition to have more safe pregnancy period.

Adrenomedullin regulated by miRNA-574-3p protects premature infants with bronchopulmonary dysplasia

Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease (CLD) in premature infants. The present study was designed to elucidate the regulation of miRNA-547-3p on adrenomedullin (ADM) during the pathogenesis of BPD. We used Agilent Human 4x44K Gene Expression Microarrays v2 and miRCURY LNA™ microRNA Array to identify the differently expressed miRNA and its potential target genes, and certified them again by luciferase reporter gene analysis. We only retained target genes that met the following two conditions: first, coexisting in two databases, and second, expressing differences, and then identifying target genes by luciferase reporter gene analysis. Thus, we selected miRNA-574-3p and its target gene ADM for further research. We used real-time q-PCR to determine the expression of miRNA-574-3p and its target gene ADM in premature infants with BPD. We used microarray expression to analyze BPD samples and non-BPD samples and found that there were 516 differently expressed probes between them. The 516 differently expressed probes included 408 up-regulated probes and 108 down-regulated probes. The blood samples of BPD infants were detected by real-time q-PCR and found that the expression of miRNA-574-3p was decreased, while the expression of ADM was significantly increased. Luciferase reporter gene analysis showed that hsa-miR-574-3p can regulate the expression of luciferase with ADM 3′UTR, and decrease it by 61.84%. It has been reported in the literature that ADM can protect the premature infants with BPD. The target gene ADM of miRNA-574-3p may contribute to the prevention and treatment of BPD.

PERINATAL FACTORS ASSOCIATED WITH PREMATURITY IN NEONATAL INTENSIVE CARE UNIT

ABSTRACT Objective: to identify the perinatal factors associated with prematurity in neonatal intensive care units from prenatal care. Method: a case-control study carried out in the southern region of the country with 186 puerperal women, from July to November 2018. A hierarchical approach strategy and conditional logistic regression were used in data analysis. Results: among the preterm births, 5.9% (n=11) were classified as extremely premature (<31 weeks), 12.9% (n=24) as moderate prematurity (32 to 34 weeks and 6 days) and 31.2% (n=58) as late premature (35 to 36 weeks and 6 days). The factors associated with the occurrence of prematurity were maternal age (30 years old), schooling (<8 years) and income (4 wages). Among the perinatal factors in the final adjustment model, insufficient number of consultations (OR 2.69/95% CI 1.10 - 6.55) and late onset of prenatal care (OR 4.34/95% CI 1.49 - 12.58) were associated with the occurrence of the outcome. On the other hand, absence of complications, premature membrane rupture and infections in the current pregnancy, as well as adequate clinical management and specific referral were protective factors against the occurrence of births before 37 weeks of pregnancy. Conclusion: it is necessary that health professionals are accessible to the most varied social changes, considering their role as educators and health promoters. Qualified and appropriate Nursing assistance in prenatal care for pregnant women reduces the chance of the newborns being admitted to neonatal intensive care units.

Risk factors associated with preterm birth: a retrospective study in Mukalla Maternity and Childhood Hospital, Hadhramout Coast/Yemen

Preterm birth (PTB) is a major determinant of neonatal mortality, morbidity and childhood disability. It has long-term adverse consequences for health. The causes of preterm delivery (PTD) are multifactorial. This study was conducted to determine the most common risk factors for PTB at Mukalla Maternity and Childhood (MCH) Hospital, Yemen. A retrospective case-control study was conducted. It involved the records of 100 women with live PTD as cases and 400 women with live term delivery as controls at Mukalla MCH Hospital in 2018. All the data were analysed using the Statistical Package for the Social Sciences (version 24). The statistical relationship between independent variables and PTB was studied by the Chi-square test in bivariate analysis and logistic regression in multivariate analysis. The strength of association was confirmed by using odds ratios (ORs) with a 95% confidence interval (CI). Risk factors with statistically significant association with premature birth were a family history of PTD (adjusted OR [AOR] 2.353; CI 1.3-4.258, p-value 0.005), pre-eclampsia (AOR 4.120; CI 1.818-9.340, p-value 0.001), parity (AOR 2.139; CI 1.249-3.662, p-value 0.006), premature rupture of membranes (AOR 4.161; CI 2.323-7.456, p-value 0.000) and abnormal amniotic fluid volume (AOR 4.534; CI 1.364-15.071, p-value 0.014). An early recognition of preterm risk factors will help medical staff and healthcare workers to identify women with a high-risk pregnancy.

Magnitude of Preterm Birth and Its Associated Factors: A Cross-Sectional Study at Butajira Hospital, Southern Nations, Nationalities, and People's Region, Ethiopia

BACKGROUND

Preterm birth infants are at a greater risk of mortality and a variety of health and developmental problems; reliable data support that this rate is increasing in almost all countries. The purpose is to find the magnitude of preterm birth and its associated factors among newborns delivered at Butajira Hospital, Southern Nations, Nationalities, and People's Region, Ethiopia.

METHODS

This hospital-based cross-sectional study was carried out on 304 maternity cards using the systematic sampling method during May 1_21 in 2019. The data collection was performed using a structured case record form. The data were entered into EpiData software (version 3.1) and analyzed using SPSS software (version 21). Binary and multivariable logistic regression analyses were computed to identify the associated factors at 95% CI.

RESULTS

Overall magnitude of preterm birth was observed to be 15.5%. The factors significantly associated with the preterm birth were preeclampsia (AOR = 4.0; 95% CI: 1.6-10.0), and premature rupture of fetal membranes (AOR = 4.2; 95% CI: 1.4-12.9).

CONCLUSION

Preterm birth is still public concern in the study area. The concerned administrative body should implement health education programs and improve the quality of health care delivered to pregnant mothers to control these associated factors and, consequently, promote public health in the study area.

Using an innovative stacked ensemble algorithm for the accurate prediction of preterm birth

Objective:

A birth before the normal term of 38 weeks of gestation is called a preterm birth (PTB). It is one of the major reasons for neonatal death. The objective of this article was to predict PTB well in advance so that it was converted to a term birth.

Material and Methods:

This study uses the historical data of expectant mothers and an innovative stacked ensemble (SE) algorithm to predict PTB. The proposed algorithm stacks classifiers in multiple tiers. The accuracy of the classiffication is improved in every tier.

Results:

The experimental results from this study show that PTB can be predicted with more than 96% accuracy using innovative SE learning.

Conclusion:

The proposed approach helps physicians in Gynecology and Obstetrics departments to decide whether the expectant mother needs treatment. Treatment can be given to delay the birth only in patients for whom PTB is predicted, or in many cases to convert the PTB to a normal birth. This, in turn, can reduce the mortality of babies due to PTB.

Factors Associated with Singleton Preterm Birth in Shire Suhul General Hospital, Northern Ethiopia, 2018

Background

Preterm birth is the leading cause of neonatal mortality and significant health consequences to the newborn, families, and communities and tens of emotional and economic costs. Therefore, the aim of this study was to assess the magnitude of singleton preterm birth and associated factors in Shire Suhul General Hospital, Northern Ethiopia.

Methods

Institutional based cross-sectional study was conducted among systematically selected 325 postnatal mothers in Shire Suhul General Hospital, Northern Ethiopia, from January to March 2018. The data were collected through both face-to-face interview and chart review by using pretested semistructured questionnaires. SPSS version 20 was employed to enter and analyze the data. Both bivariate and multivariate logistic regression models were run to identify factors associated with singleton preterm birth at the level of P values ≤ 0.25 and <0.05 for each model, respectively.

Result

The magnitude of singleton preterm birth in Suhul Hospital was 16.9%. Smoking cigarette/drinking alcohol during pregnancy [AOR=3.61: CI 95%; 1.59-8.23], previous abortion [AOR=2.37: CI 95%; 1.15-4.88], hemoglobin level < 11gm/dl [AOR=2.44: CI 95%; 1.14-5.22], visible physical neonatal congenital anomaly [AOR=10.42: CI 95%; 1.66-65.23] , and history of giving low birth weight baby [AOR: 2.78 CI 95%; 1.39-5.55] were the factors statistically associated with singleton preterm birth.

Conclusion

The magnitude of preterm birth in this study was higher than the average prevalence of preterm birth reported in Ethiopia. Smoking cigarette/drinking alcohol during pregnancy, mothers who had previous abortion, low maternal hemoglobin level, presence of visible physical congenital anomalies of newborn baby, and history of bearing low birth weight baby were found to have statistically significant association with singleton preterm birth. Supplement of daily iron with folic acid (folic acid ideally before pregnancy) for all pregnant mothers with good adherence monitoring and giving attention to preconceptional health care service to avoid any cigarette smoking/alcohol drinking and risk detection were set as recommendations.