PREMATURE DELIVERY

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					PREMATURE DELIVERY
Trends from a West Texas Hospital
Edwin E. Henslee MD, PGY-2
Selman I. Welt MD
OBJECTIVE
   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.
OBJECTIVE
 Considerable effort is made by the Maternal-
  Fetal 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.
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.
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.
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.
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
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.
METHOD
   Sample data sheet
       Initials
       Delivery date
       EDD
       Prenatal care- EGA at onset, number vists
       Maternal age
       Insurance status
       County of residence
       Maternal medical problems
METHOD
     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.
         My sincerest appreciation to
Dr. Welt and Dr. Prien for their assistance with
             this research project.