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Obstetrical characteristics and neonatal outcome according to aetiology of preterm birth: a cohort study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Preterm birth (PTB) can be categorised according to aetiology into: spontaneous preterm labour (SPL), preterm prelabour rupture of membranes (PPROM), and iatrogenic (iatro) PTB. Outcomes could differ between these groups, which could be of interest in counselling. We aimed to explore differences between aetiologic groups of PTB in maternal demographics, obstetrical characteristics and management, and neonatal outcomes.

Methods

This is a cohort study (2012–2018) in Ghent University Hospital, Belgium, of deliveries from 24 + 0 to 33 + 6 weeks. We compared perinatal demographics, management, and outcomes between the aetiologic types of PTB. Point and interval estimates for differences between aetiologic types were estimated using a Generalised Estimating Equations approach to handle clustering due to multiple gestations.

Results

813 mothers and 987 neonates were included. Prevalences of different aetiologic types of PTB were similar. Maternal BMI was higher in the iatrogenic group (iatro-SPL: + 1.92 kg/m2, 95% CI 1.02, 2.83; iatro-PPROM: + 2.06 kg/m2, 95% CI 1.15, 2.96). There was an inversed sex ratio (0.82, 95% CI 0.65, 1.03), more growth restriction (iatro-SPL: + 22.60%, 95% CI 17.08, 28.13; iatro-PPROM: + 24.64%, 95% CI 19.44, 29.83), and a higher caesarean section rate in the iatrogenic group (iatro-SPL: + 57.23%, 95% CI 50.32, 64.13, iatro-PPROM: + 56.79%, 95% CI 50.20, 63.38) and more patients received at least one complete course of antenatal corticosteroids (iatro-SPL: + 17.60%, 95% CI 10.60, 24.60, iatro-PPROM: + 10.73%, 95% CI 4.52, 16.94). In all types of PTB, adverse neonatal outcomes had a low prevalence, except for respiratory distress syndrome. A composite of adverse neonatal outcome was more prevalent in the SPL- compared to the PPROM group, and there was less intraventricular haemorrhage in the iatrogenic group.

Conclusion

Additional to gestational age at birth, the aetiology of PTB is associated with neonatal outcome. More data are needed to enable individualised management and counselling in case of threatened PTB.

Trial registration number

NCT03405116.

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Availability of data and material

The dataset used and analysed during this study is available from the corresponding author on reasonable request.

Abbreviations

ACS:

Antenatal corticosteroids

BMI:

Body mass index

CLD:

Chronic lung disease

GEE:

Generalised estimating equations

iatro:

Iatrogenic preterm birth

IUGR:

Intra-uterine growth restriction

IVH:

Intraventricular haemorrhage

NEC:

Necrotising enterocolitis

NICU:

Neonatal intensive care unit

PDA:

Persistent ductus arteriosus

PPROM:

Preterm prelabour rupture of membranes

PTB:

Preterm birth

PVL:

Periventricular leukomalacia

REDCap® :

Research Electronic Data Capture

RDS:

Respiratory distress syndrome

ROP:

Retinopathy of prematurity

SPL:

Spontaneous preterm labour

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Acknowledgements

We would like to thank Dr. Nathalie Filliers and Dr. Celien Van Poeck for their help with collecting the data.

Funding

The authors declare that there are no sources of funding.

Author information

Authors and Affiliations

  1. Ghent University Hospital, Obstetrics and Gynecology, Ghent, Belgium

    Isabelle Dehaene, Eline Scheire & Kristien Roelens

  2. Intensive Care, Ghent University Hospital, Ghent, Belgium

    Johan Steen & Johan Decruyenaere

  3. Renal Division, Ghent University Hospital, Ghent, Belgium

    Johan Steen

  4. Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium

    Johan Steen

  5. Neonatal Intensive Care Unit, Ghent University Hospital, Ghent, Belgium

    Kris De Coen & Koenraad Smets

Authors
  1. Isabelle Dehaene
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  4. Kris De Coen
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Contributions

ID: project development, data collection and management, data analysis, manuscript writing and editing. Major revisions. ES: data collection and management, manuscript writing. Major revisions. JS: data analysis, manuscript editing. Major revisions. KDC: Data collection and management, manuscript editing. JD: manuscript editing. KS: manuscript editing. KR: manuscript editing.

Corresponding author

Correspondence to Isabelle Dehaene.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This study was performed in line with the principles of the 1964 Helsinki Declaration and was approved by the Medical Ethics Committee of Ghent University Hospital on February 26th, 2018, with registration number BE670201835532.

Consent to participate

Retrospective data were obtained from 2012 till mid-2017 after opt-out consent. From mid-2017, data were collected prospectively, after obtaining informed consent of the couple. Couples were informed about the goal of the study and the destination of their data. Participation was voluntary and never influenced the care in the hospital. Couples could withdraw from the study at any time. All data were handled with professional confidentiality and anonymised for analysis.

Consent for publication

Patients gave consent regarding publishing their data.

Code availability

The software application and custom code are available from the corresponding author on reasonable request.

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Dehaene, I., Scheire, E., Steen, J. et al. Obstetrical characteristics and neonatal outcome according to aetiology of preterm birth: a cohort study. Arch Gynecol Obstet 302, 861–871 (2020). https://doi.org/10.1007/s00404-020-05673-5

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  • DOI: https://doi.org/10.1007/s00404-020-05673-5

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