Late Preterm Birth

Abstract

The newborn with 34-36 weeks of gestation is called prematurely late. Prematurity is a major cause of perinatal morbidity and mortality. In recent years, the percentage of premature births has increased from 10% to 12-13% and the total of premature infants about 73% are represented by the late prematurity. The premature mortality rate is 7.7% versus 2.5%, which is the mortality rate for newborns.

 

Table of Contents:

1. Introduction

2. Objectives

3. Material and method

4. Results

5. Conclusions

 

1. Introduction

Definition

The newborn with 34-36 weeks of gestation is called prematurely late. Prematurity is a major cause of perinatal morbidity and mortality. In recent years, the percentage of premature births has increased from 10% to 12-13% and the total of premature infants about 73% are represented by the late prematurity. The premature mortality rate is 7.7% versus 2.5%, which is the mortality rate for newborns.[1, 3, 6]

 

Etiology of prematurity

Late prematurity has a multifactorial etiology and is incompletely elucidated to this day. In recent years in Romania, the incidence of premature birth with VG between 34-36 weeks is rising .The etiology of late premature birth can be represented by maternal and fetal causes. [2, 3, 4, 7] Maternal Causes:

-    Multiple pregnancies whose incidence has increased due to assisted reproductive techniques and an increase in the number of mothers over 30 years of age who are at increased risk for multifetal pregnancies. [1, 3, 4, 5, 8, 9]

-    Maternal smoking, drugs

-    Preeclampsia

-    Diabetes mellitus

-    Antepartum haemorrhage

-    Hypertension-Maternal obesity

-    Chronic maternal illness

-    Inessive assessment of gestational age

-    Caesarean section without medical indication (at the request of the mother)

-    Poor socio-economic status

-    Premature rupture of membranes Fetal causes

-    Various malformations

-    Chromosomal genetic diseases

-    RCIU.Neonatal sepsis

-    Age of gestation incorrectly appreciated Complications that may occur in newborn infants are:

-    Respiratory distress

-    pneumothorax

-    EUN

-    Sepsis

-    Intraventricular haemorrhage

-    Pneumonia

-    Hypoglycemia

-    hyperbilirubinemia

-    Hypothermia

-    Difficulties in eating

-    Neurological disorders

-    Neonatal transient tachypnoids

 

2. Objectives

The effect of cesarean surgery on adapting to the extrauterine life of the newborn premature late.

 

3. Material and method

We conducted a prospective study for a period of 2 years (2016-2017) during the maternity of the St. Andrew’s Emergency Clinical Hospital, Galati. Data were taken from the observation sheets of the newborn premature infants.

In the study, the following parameters were assessed:

-    Age of gestation

-    Weight at birth

-    APGAR score

-    Kind of birth

-    Resuscitation at birth

-    complications

-    Indications of cesarean surgery

-    Average length of hospitalization

-    Evolution

 

4. Results

Between 2016 and 2017, a total of 3413 births were recorded, of which late preterm (34-36 weeks) of 470 cases. After gestation age, we have an increased incidence in newborns 36 weeks of age.

Of the total number of cases, an increased weight had babies weighing between 2501-2600 grams, with a low rate being those weighing over 3000 grams.

Newborn newborn infants were classified according to the birth weight at the age of gestation in:

-    Newborn with adequate weight for VG (AGA) – weight between percentiles 10-90-172 cases

-    Newborn baby with low weight for VG (SGA) – weight below percentile 10-162 cases

-    New born baby with heavy weight for VG (LGA) – over 90 percentile weights Regarding the type of birth, the prevalence of the Cesarean delivery was established (366 cases).

Cesarean birth indication was:

-    Scar tissue

-    Mother request

-    Diabetes mellitus

-    IUGR

-    Hypertension

-    Multiple pregnancy

-    Abnormal presentations

-    Placenta praervia

-    Fetal suffering

-    Minor mothers

-    Fetal malformations

-    In vitro fertilization

-    HIV

-    Uterine malformations

The most common cesarean indication was the scarring uterus followed by cesarean delivery at the mother’s request (fear of fetal and maternal risks) with a significant increase in newborns extracted via caesarean section at 36 weeks of gestation age.

Newborn premature babies born at birth APGAR score ranging from 5 to 9 with an increased frequency of cases with APGAR score 7.39% of cases required reanimation maneuvers in the nursery at 42 newborn babies with pressure ventilation balloon and mask positivity, 68 cases of free-flowing oxygen and 74 tactile stimulation.

Of the studied group, 30% (205 cases) were admitted to the neonatal intensive care unit for monitoring and treatment.

The highest share of newborns admitted to TIN after gestational age were cases in the 34 weeks age category, with a lower incidence in newborns with gestation age 36 weeks, with an increased incidence in newly born newborns by cesarean surgery.

In the studied group there was revealed a significantly higher frequency of newborns extracted by cesarean surgery admitted in intensive care compared to those born from natural birth.

Newborn infants admitted to neonatal intensive care unit had APGAR 5 score with newborn infants with APGAR 9 score. 38% of newborn infants latex developed respiratory distress, 73 had neonatal hypoglycemia, 59 had transitory tachipneea with low incidence being those who experienced intraventricular haemorrhage.

Newborn admitted to therapy received medical, supportive treatment.The medical treatment that was performed in this category of newborns consisted of:

-    Endoveneous perfusion

-    antibiotics

-    Diuretics (Furosemide)

-    Caffeine citrate

-    Phenobarbital i.m.

Supportive treatment consisted of:

-    Dopamine to maintain vital functions within normal limits

-    Oxygen

105 newborns benefited from oxygen in the cephalic tent or free-flowing oxygen, 53 cases required nasal CPAP, 40 newborn mechanical ventilation in IPPV mode and 7 high-frequency ventilation (HFOV).

4% of cases did not have a therapeutic response, with the prognosis being unfavorable.

In the case of premature infants who have had a difficult adaptation to extrauterine life, the length of hospitalization is higher for newborns extracted via caesarean than those born naturally.

 

5. Conclusions

Because of the excess short and long term neonatal morbidity and associates costs, obstetrics care providers should reevaluate the need for delivery during the late preterm period. A reduction in the number of newborns exposed to unnecessary risks due to elective delivery in the latern preterm period would have great social benefit. Because published data reveal that some harm may occur as a result of unnecessary late preterm births, the practice of preterm delivery without a clear indication merits strict reevaluation.

 

Authors:

MITREA Geta [1],[2]

PATRICIU Mihaela [1], [3]

BACIU Ginel [2]

CALIN Alina [1],[2]

[1] St. Andrew Emergency Dept. Hospital-Galati, Neonatology Dept (ROMANIA)

[2] Medical Faculty of the Lower Danube University Galati (ROMANIA)

[3] Gr. T. Popa University of Medicine-Iasi, (ROMANIA)

 

Contributo selezionato da Filodiritto tra quelli pubblicati nei Proceedings “SOGR 2018 – 17th National Congress of the Romanian Society of Obstetrics and Gynecology & First Advanced Colposcopy Course - 2018”

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Contribution selected by Filodiritto among those published in the Proceedings “SOGR 2018 – 17th National Congress of the Romanian Society of Obstetrics and Gynecology & First Advanced Colposcopy Course - 2018”

To buy the Proceedings click here.