Download Premature delivery – Reflections from a West Texas County Hospital

PREMATURE DELIVERY
Trends from a West Texas Hospital
Edwin E. Henslee MD, PGY-2
Selman I. Welt MD
OBJECTIVE
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The incidence of premature birth in the United
States during the past decade has risen 1-2%.
This in spite of the efforts of healthcare
professionals, medical societies, patient groups
and national charitable organizations.
OBJECTIVE
OBJECTIVE
Numerous factors are responsible, Tucker, et. al.
OB-GYN 77:347-7 (1991) states that 20% of
preterm birth is iatrogenic (DM, IUGR, HTN,
placental abnormalities), 20% intraamniotic
infections, 30% PPROM, 30% idiopathic preterm
labor.
 We do not believe this is the case at our
institution.
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OBJECTIVE
Considerable effort is made by the MaternalFetal Medicine service to reduce the incidence of
iatrogenic prematurity.
 Intraamniotic infection and iatrogenic
prematurity does not seem to be as prevalent at
our facility as literature suggests.
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OBJECTIVE
We believe that our preterm delivery rate is
better than that of national statistics (11.5%)
 That preterm premature rupture of membranes
is present in a higher percentage of our preterm
deliveries than Tucker’s paper states.
 It is our intent to evaluate the hypothesis that
our patient population and healthcare practice is
different than that published in the literature.
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DESIGN
This will be a retrospective study consisting of a
one year UMC chart/data review from December
2007 to December 2008.
 Since it is a retrospective study and all data
exists at present time, no patient consent forms
will be required.
 All identifying information will be removed and
discarded.
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METHOD
A list of patient’s chart numbers will be obtained
with diagnostic code for preterm delivery from
UMC. Approximately 220 charts have been
identified.
 Each chart will be reviewed for any identifiable
cause for preterm delivery, i.e. preterm labor,
PPROM, maternal/fetal conditions.
 Quality and frequency of prenatal care and any
medication/drug usage will be recorded as well.
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METHOD
Data collected will include the following: age,
gravidity, parity, gestational age, means of
gestational age determination, insurance status,
medical, surgical and OB-GYN history.
 Each newborn chart will be reviewed as well to
clarify the possible cause of premature birth,
confirm gestational age and identify any
complications of the newborn secondary to the
prematurity of birth
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METHOD
Inclusion criteria – Women with delivery of a
singleton infant of <37 weeks EGA, who gave
birth at UMC between December 1, 2007 through
December 31, 2008.
 Exclusion criteria – Multiple gestation
pregnancy, unclear estimated gestational age.
 IRB approval is pending.
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METHOD
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Sample data sheet
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Initials
Delivery date
EDD
Prenatal care- EGA at onset, number vists
Maternal age
Insurance status
County of residence
Maternal medical problems
METHOD
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Maternal surgical history
Maternal reproductive history
EGA at time of precipitating event (PTL, PROM,
vaginal bleeding)
Medications/illicit drugs
Special circumstances
Delivery means and causation
Postpartum complications
Baby apgars
Baby weight and length
Length of hospital stay and outcome
EXPECTED RESULT
It is our belief that the data will show that the
preterm delivery rate at University Medical
Center is better than that of national statistics.
 Preterm premature rupture of membranes is
responsible for over 1/3 of our preterm deliveries.
 The iatrogenic prematurity and intraamniotic
infection rate at our facility is below that of
published statistics.
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My sincerest appreciation to
Dr. Welt and Dr. Prien for their assistance with
this research project.