A Prospective Study to Assess the Neonatal Mortality and Morbidity Associated with Preterm labor and Delivery in a Tertiary Care Hospital.

ABSTRACT

Background: Preterm labor and delivery are one of the challenging obstetric complications encountered by obstetricians, as are preterm neonates for the pediatricians. Therefore, this study was planned to identify etiological factors and to assess the neonatal mortality and morbidity associated with preterm labor and delivery. Methods: This prospective study was conducted over a 6 months period (September 2014 to February 2015) in the department of Obstetrics/Gynaecology and Paediatrics at Patliputra Medical College, Dhanbad, Jharkhand. 325 antenatal women admitted with threatened preterm labor, with or without rupture of membranes, were recruited. They were followed up from admission till delivery and discharge. Gestational age at onset of preterm labor, associated risk factors, response to tocolytics if given, gestational age at delivery, and neonatal outcome were recorded and analyzed.Results: Incidence of preterm labor was found to be 28.26% and that of preterm deliveries 25.9%. Preterm rupture of membranes and infection were the commonest causes of preterm labor. Irrespective of the use of a course of betamethasone, neonatal mortality was significantly higher (P<0.0001) in babies delivering before 34 weeks (30.4%) as compared to that in babies delivering after 34 weeks (3.4%). Septicemia, respiratory distress syndrome (RDS) and birth asphyxia were the important causes of neonatal morbidity.Conclusion: Our results revealed a high incidence of preterm labor and preterm births in comparison to developed countries. Infection is one important modifiable risk factor which can be reduced. Prolongation of delivery for 48 hours by giving tocolytics for getting the benefit of betamethasone coverage reduces morbidity due to RDS but does not reduce overall neonatal mortality below 34 weeks.