Clinical and Economic Challenges of Moderate Preterm Babies Born between 32+0 and 36+6 Weeks of Gestation
ABSTRACT Preterm births show a worldwide increasing incidence. The majority of preterm births occur between 32+0 and 36+6 weeks of gestation and are associated with an increased rate of maternal and neonatal morbidity. The focus of our research is the clinical and economical analysis of all preterm births between 32+0 and 36+6 weeks of gestation in a German level 1 perinatal centre over a period of 3 years.
A retrospective analysis of all preterm births between 32+0 and 36+6 weeks of gestation in the University Hospital Mainz from 2007 to 2009 was undertaken. Data were collected using our electronic documentation system. Gestational age at delivery, mode of birth, indication for delivery, duration of the peripartum treatment, treatment of the newborn in the children's hospital, birth weight and therapy costs were evaluated.
We recorded 407 moderate preterm births in total; this amounts to a rate of of 10% of all births. Major causes of prematurity were PPROM, preterm labour and preeclampsia/HELLP. Maternal and fetal systemic diseases were more uncommon. Rates of Caesarean sections (62%) and of neonatal inpatient treatment needs (58.5%) were high. Maternal treatment costs were 332 Euro/day. The mean duration of maternal inpatient treatment was 13.15 days.
Moderate preterm birth is associated with maternal morbidity frequently due to a high rate of Caesarean sections. Neonatal morbidity is also increased. In comparison with previous research, we saw an increased rate of pregnancy complications. This could be typical for a level 1 perinatal centre. Moderate preterm birth is seen as the cause of considerable treatment costs.
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ABSTRACT: This paper is the first in a three-part series on preterm birth, which is the leading cause of perinatal morbidity and mortality in developed countries. Infants are born preterm at less than 37 weeks' gestational age after: (1) spontaneous labour with intact membranes, (2) preterm premature rupture of the membranes (PPROM), and (3) labour induction or caesarean delivery for maternal or fetal indications. The frequency of preterm births is about 12-13% in the USA and 5-9% in many other developed countries; however, the rate of preterm birth has increased in many locations, predominantly because of increasing indicated preterm births and preterm delivery of artificially conceived multiple pregnancies. Common reasons for indicated preterm births include pre-eclampsia or eclampsia, and intrauterine growth restriction. Births that follow spontaneous preterm labour and PPROM-together called spontaneous preterm births-are regarded as a syndrome resulting from multiple causes, including infection or inflammation, vascular disease, and uterine overdistension. Risk factors for spontaneous preterm births include a previous preterm birth, black race, periodontal disease, and low maternal body-mass index. A short cervical length and a raised cervical-vaginal fetal fibronectin concentration are the strongest predictors of spontaneous preterm birth.The Lancet 02/2008; 371(9606):75-84. DOI:10.1016/S0140-6736(08)60074-4 · 39.21 Impact Factor
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ABSTRACT: Im September 2006 wurde die Leitlinie 015/025 Medikamentse Wehenhemmung bei drohender Frhgeburt (http://www.dggg.de, http://www.awmf-online.de) publiziert. Sie zeigt den Korridor auf, innerhalb dessen die Verwendung von Tokolytika bei vorzeitiger Wehenttigkeit dem derzeitigen Stand der Wissenschaft und der sog. guten klinischen Praxis entspricht. Fenoterol, Atosiban, Indometacin und Nifedipin sind quieffektiv, unterscheiden sich aber im Nebenwirkungsprofil, Kontraindikationen, Kosten und Zulassung. Erlutert werden die Empfehlungen, zusammengefasst werden die wesentlichen Ziele der medikamentsen Wehenhemmung: Durchfhrung der Lungenreifeprophylaxe bei drohender Frhgeburt, Schwangerschaftsverlngerung bei vorbergehenden Ursachen vorzeitiger Wehenttigkeit (z.B. Durchfhrung einer Cerclage, Pyelonephritis) sowie Ermglichung des Transportes der Schwangeren in ein Perinatalzentrum.In September 2006, the German Guidelines 015/025 on tocolysis Medikamentse Wehenhemmung bei drohender Frhgeburt (Pharmacological inhibition of contractions for threatened premature birth, http://www.dggg.de, http://www.awmf-online.de) were published. These guidelines were designed to aid obstetricians in the decision of when und how to use tocolytics to prevent preterm labour based on scientific knowledge and good clinical practice. Fenoterol, atosiban, indomethacin and nifedipine are equi-effective, but differ with respect to side effects for both mother and fetus, contraindications, cost, and not all are licensed for use in pregnancy. This article comments on the recommendations made in these guidelines and explains the main goals when treating preterm labour: administration of antenatal glucocorticoids to prevent neonatal respiratory distress syndrome, prolongation of pregnancy if self-limiting causes of preterm labour are present (e.g. during elective cerclage or pyelonephritis), and enabling transport of the pregnant woman into a perinatal care center.Der Gynäkologe 01/2007; 40(4):279-289. DOI:10.1007/s00129-007-1963-1
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ABSTRACT: To analyse preterm birth rates worldwide to assess the incidence of this public health problem, map the regional distribution of preterm births and gain insight into existing assessment strategies. Data on preterm birth rates worldwide were extracted during a previous systematic review of published and unpublished data on maternal mortality and morbidity reported between 1997 and 2002. Those data were supplemented through a complementary search covering the period 2003-2007. Region-specific multiple regression models were used to estimate the preterm birth rates for countries with no data. We estimated that in 2005, 12.9 million births, or 9.6% of all births worldwide, were preterm. Approximately 11 million (85%) of these preterm births were concentrated in Africa and Asia, while about 0.5 million occurred in each of Europe and North America (excluding Mexico) and 0.9 million in Latin America and the Caribbean. The highest rates of preterm birth were in Africa and North America (11.9% and 10.6% of all births, respectively), and the lowest were in Europe (6.2%). Preterm birth is an important perinatal health problem across the globe. Developing countries, especially those in Africa and southern Asia, incur the highest burden in terms of absolute numbers, although a high rate is also observed in North America. A better understanding of the causes of preterm birth and improved estimates of the incidence of preterm birth at the country level are needed to improve access to effective obstetric and neonatal care.Bulletin of the World Health Organisation 01/2010; 88(1):31-8. DOI:10.2471/BLT.08.062554 · 5.11 Impact Factor