Abstract

Preterm birth (PTB) is the leading cause of perinatal morbidity and mortality. Adverse effects of preterm birth have a direct correlation with the degree of prematurity, in which infants who are born extremely preterm (24–28 weeks gestation) have the worst outcomes. We sought to determine prominent risk factors for extreme PTB and whether these factors varied between various sub-populations with known risk factors such as previous PTB and multiple gestations. A population-based retrospective cohort study was conducted. Risk factors were examined in cases of extreme PTB in the general population, as well as various sub-groups: singleton and multiple gestations, women with a previous PTB, and women with indicated or induced PTB. A total of 334,415 deliveries were included, of which 1155 (0.35%) were in the extreme PTB group. Placenta previa (OR = 5.8, 95%CI 4.14–8.34, p < 0.001), multiple gestations (OR = 7.7, 95% CI 6.58–9.04, p < 0.001), and placental abruption (OR = 20.6, 95%CI 17.00–24.96, p < 0.001) were the strongest risk factors for extreme PTB. In sub-populations (multiple gestations, women with previous PTB and indicated PTBs), risk factors included placental abruption and previa, lack of prenatal care, and recurrent pregnancy loss. Singleton extreme PTB risk factors included nulliparity, lack of prenatal care, and placental abruption. Placental abruption was the strongest risk factor for extreme preterm birth in all groups, and risk factors did not differ significantly between sub-populations.

Highlights

  • Preterm delivery, defined as delivery prior to 37 weeks of gestation, is a leading cause of perinatal morbidity and mortality worldwide, with an incidence of 5–13% depending on location [1]

  • We further examined whether different risk factors and outcomes for preterm delivery were more important in various subgroups; induced vs. spontaneous preterm birth, those with vs. without previous Preterm birth (PTB), and multiples vs. singletons

  • The most notable outcome we found was that placental abruption was the risk factor with the highest significance in all of the populations and sub-populations

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Summary

Introduction

Preterm delivery, defined as delivery prior to 37 weeks of gestation, is a leading cause of perinatal morbidity and mortality worldwide, with an incidence of 5–13% depending on location [1]. Many factors can predispose to the development of preterm delivery, but it is useful to categorize preterm birth into three general etiologic groups: spontaneous labor with intact membranes, preterm premature rupture of membranes (PPROM) leading to preterm delivery, and labor induction due to maternal or fetal factors [4,10] These categories each have their own common risk factors; for example, risk factors for PPROM-induced delivery include intrauterine infection [11], tobacco use [12], abruption [13], multiple gestations [14], previous PPROM [15], and cervical factors [16,17], among others. These risk factors are not exclusive to each etiologic group, and some can be risk factors for multiple groups

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