A Descriptive study of low risk women presenting in suspected preterm labour at Tygerberg hospital
Thesis (MMed)--Stellenbosch University, 2018.
Introduction: Preterm birth refers to delivery before 37 completed weeks’ gestation and is often, but not always, preceded by spontaneous preterm labour. Prematurity due to preterm birth is the leading cause of direct neonatal mortality worldwide, as well as a cause for significant neonatal morbidity and long-term sequelae. The estimated preterm birth rate varies worldwide and represents 5-18% of all live births with approximately 15 million babies born preterm annually worldwide. Early identification and adequate management of preterm labour and subsequent preterm birth is paramount. However, the signs and symptoms of preterm labour are non-specific, and can lead to over diagnosis and over treatment with unnecessary interventions and medications, which could be harmful to both the mother and the foetus. Thus, there remains a great challenge in clinical practice to be able to differentiate true preterm labour from false labour and to be able to risk stratify high risk women with features necessitating admission and intervention, and low risk women with features that make conservative, non-interventional management safe. Aims and Methods The study was a retrospective descriptive audit of all women presenting to TBH with suspected preterm labour between 24 and 34 weeks gestation in a predetermined 6-month period from 01/01/2015 to 30/06/2015. The primary aim was to determine the incidence of preterm birth in women who present in suspected preterm labour between 24 and 34 weeks at Tygerberg Hospital. Secondary aims were to identify the demographic and obstetric characteristics, evaluate the management performed, assess the obstetric and neonatal outcomes, and to determine risk factors for preterm delivery in women presenting in suspected preterm labour between 24 and 34 weeks at Tygerberg Hospital. Results Of the 5103 women triaged in Tygerberg Hospital during the 6-month study time- period, a total of 102 low risk women (42 women included in the study, 60 women in active labour at presentation) presented with suspected preterm labour had subsequently delivered at a preterm gestation less than or equal to 34 weeks. The total number of babies delivered in this time period was 3940. Thus, the incidence of preterm birth from suspected preterm labour for the study period was 2.59%. One hundred (100) low risk women were included in the study and 48% of the women were in their first or second pregnancies. This precluded them from routine screening for risk of preterm labour as they were not identified as high-risk patients with 2 or more previous trimester two losses or preterm births. The correct use of clinical obstetric criteria that fulfil the diagnosis of preterm labour is essential in correctly diagnosing true preterm labour and differentiating it from false preterm labour. Less than a third (32%) of the women included in the study presented with both pain and a show. Only 19% of patients had a cervical dilatation greater than 2cm and in addition to this, only half (50%) had a cervical length less than 20mm. Sixty eight percent (68%) of women, though, were admitted and interventions such as suppression, antibiotics and steroids were given. Risk factors identified for preterm birth (with an interval to delivery from presentation of less than one week), include pain and show as presenting symptoms (P<0.001), cervical dilatation >2cm (P0.001), cervical length <20mm (P0.006), clinical presence of a show (P<0.001), and when objective criteria are met for preterm labour according to set protocols (P<0.001). Conclusion The incidence in the index study of 2.59% is a population-based reflection of risk of preterm birth in low risk women that present with suspected preterm labour. The risk factors for preterm birth that were identified are thus invaluable in understanding this condition that is still of global concern. Risk factor identification and correct clinical diagnosis of true preterm labour is essential to correctly admit and provide management for only those at high risk of preterm birth. This would prevent increasing the workload of an already overburdened health system. Vigilance with these factors will aid in decreasing the morbidity and mortality related to preterm labour and preterm births.
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