Premature Delivery

1
Premature Delivery

• Trends from a West Texas Hospital
• Edwin E. Henslee MD, PGY-2
• Selman I. Welt MD

2
Objective

• The incidence of premature birth in the United
  States during the past decade has risen 1-2.
• This in spite of the efforts of healthcare
  professionals, medical societies, patient groups
  and national charitable organizations.

3
Objective
4
Objective

• Numerous factors are responsible, Tucker, et. al.
  OB-GYN 77347-7 (1991) states that 20 of preterm
  birth is iatrogenic (DM, IUGR, HTN, placental
  abnormalities), 20 intraamniotic infections, 30
  PPROM, 30 idiopathic preterm labor.
• We do not believe this is the case at our
  institution.

5
Objective

• Considerable effort is made by the Maternal-Fetal
  Medicine service to reduce the incidence of
  iatrogenic prematurity.
• Intraamniotic infection and iatrogenic
  prematurity does not seem to be as prevalent at
  our facility as literature suggests.

6
Objective

• We believe that our preterm delivery rate is
  better than that of national statistics (11.5)
• That preterm premature rupture of membranes is
  present in a higher percentage of our preterm
  deliveries than Tuckers paper states.
• It is our intent to evaluate the hypothesis that
  our patient population and healthcare practice is
  different than that published in the literature.

7
Design

• This will be a retrospective study consisting of
  a one year UMC chart/data review from December
  2007 to December 2008.
• Since it is a retrospective study and all data
  exists at present time, no patient consent forms
  will be required.
• All identifying information will be removed and
  discarded.

8
Method

• A list of patients chart numbers will be
  obtained with diagnostic code for preterm
  delivery from UMC. Approximately 220 charts have
  been identified.
• Each chart will be reviewed for any identifiable
  cause for preterm delivery, i.e. preterm labor,
  PPROM, maternal/fetal conditions.
• Quality and frequency of prenatal care and any
  medication/drug usage will be recorded as well.

9
Method

• Data collected will include the following age,
  gravidity, parity, gestational age, means of
  gestational age determination, insurance status,
  medical, surgical and OB-GYN history.
• Each newborn chart will be reviewed as well to
  clarify the possible cause of premature birth,
  confirm gestational age and identify any
  complications of the newborn secondary to the
  prematurity of birth

10
Method

• Inclusion criteria Women with delivery of a
  singleton infant of lt37 weeks EGA, who gave birth
  at UMC between December 1, 2007 through December
  31, 2008.
• Exclusion criteria Multiple gestation
  pregnancy, unclear estimated gestational age.
• IRB approval is pending.

11
Method

• Sample data sheet
• Initials
• Delivery date
• EDD
• Prenatal care- EGA at onset, number vists
• Maternal age
• Insurance status
• County of residence
• Maternal medical problems

12
Method

• Maternal surgical history
• Maternal reproductive history
• EGA at time of precipitating event (PTL, PROM,
  vaginal bleeding)
• Medications/illicit drugs
• Special circumstances
• Delivery means and causation
• Postpartum complications
• Baby apgars
• Baby weight and length
• Length of hospital stay and outcome

13
Expected result

• It is our belief that the data will show that the
  preterm delivery rate at University Medical
  Center is better than that of national
  statistics.
• Preterm premature rupture of membranes is
  responsible for over 1/3 of our preterm
  deliveries.
• The iatrogenic prematurity and intraamniotic
  infection rate at our facility is below that of
  published statistics.

14

• My sincerest appreciation to
• Dr. Welt and Dr. Prien for their assistance with
  this research project.