Risk factors associated with preterm (<37+0 weeks) and early preterm birth (<32+0 weeks): univariate and multivariate analysis of 106 345 singleton births from the 1994 statewide perinatal survey of Bavaria.

OBJECTIVE: The study was conducted to identify medical, obstetrical and social risk factors associated with early preterm births (<32+0 gestational weeks). STUDY DESIGN: The Statewide Perinatal Survey of Bavaria is a collection of perinatal data from all Bavarian maternity units using a uniform numbered questionnaire. Data on 106345 singleton births from the 1994 Survey were analysed using univariate and multivariate logistic regression analysis. RESULTS: In the multivariate analysis, early preterm birth was associated with premature rupture of the membranes (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.37-1.86), treatment for infertility (OR 1.7, 95% CI 1.19-2.34), previous induced abortion (OR 1.8, 95% CI 1.57-2.13), maternal age >35 years (OR 1.8, 95% CI 1.47-2.16), premature cervical dilatation (OR 2.3, 95% CI 1.86-2.94), a history of stillbirth (OR 3.2, 95% CI 2.13-4.83), a history of preterm birth (OR 3.3, 95% CI 2.45-4.48), maternal age <18 years (OR 3.4, 95% CI 2.03-5.61), malpresentation (OR 3.9, 95% CI 3.10-4.93), preeclampsia (OR 4.0, 95% CI 3.20-4.94), uterine bleeding (OR 5.0, 95% CI 4.08-6.02), preterm labour (OR 7.0, 95% CI 5.94-8.22), and chorioamnionitis (OR 22.3, 95% CI 17.40-28.66). CONCLUSION: These data identify a subgroup of women at an increased risk for early preterm birth and may benefit from an intensified prenatal care. Risk factors related to the obstetrical history, genital infections, preeclampsia and maternal age are the most relevant for early preterm birth.

The impact of timing and frequency of prenatal visits on the outcome of pregnancy in the perinatal registry of Bavaria 1987-1988.

A retrospective analysis was made on the singleton births included in the Bavarian statewide perinatal registry (Bayerische Perinatalerhebung, BPE; 99,252 births from BPE 1987 and 79,661 births from BPE 1988) with respect to the timing of the first prenatal consultation and the frequency of visits during pregnancy. If the first prenatal visit was scheduled after 21 weeks, the rates of infants transferred to pediatric units relative risk (RR = 1.34, P < 0.0001, chi 2-test), of low birth weight (RR = 1.41, P < 0.0001) and of stillbirths (RR = 1.70, P < 0.025) were higher than if the first visit was at 9-12 weeks. Similarly, after < 4 prenatal visits, the rates of infants transferred (RR = 3.91), of low birth weight (RR = 9.18), of stillbirths (RR = 7.65) and of neonatal deaths (RR = 29.5) were significantly (P < 0.0001) higher than after > 10 visits. Prenatal care was defined as 'standard' if the initial consultation was scheduled at or before 12 weeks and whether 10-12 visits were completed during a normal duration of pregnancy. 'Below standard' prenatal care was associated with a higher rate of infants transferred (P < 0.01) and of stillbirths (P < 0.0005). Prenatal care was more frequently (P < 0.0001) classified as 'below standard' in mothers older than 39 years (40.45%, RR = 2.45) and in adolescent mothers (58.67%, RR = 5.12) than in those 25-29 years of age (21.71%), in fourth and subsequent (48.22%, RR = 3.44) than in first pregnancies (21.32%) and in foreign (39.65%, RR = 2.18) than in German mothers (23.19%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Changes in obstetrics--retrospect and prospects]. / Geburtshilfe im Wandel--Rückblick und Ausblick.

The panorama in obstetrics has completely changed during this century in our regions. It is characterized by a dramatic decrease of births, a high rate of deliveries in hospitals with extensive decentralization, obstetrical management by doctors with the assistance of midwives, a high level of technicalization, continuous improvement of the performances and an increase in legal regulations.

[Method of delivery of premature infants--abdominal or vaginal?]. / Zum Geburtsmodus bei Frühgeborenen--abdominal oder vaginal?

In regard to the present perinatal mortality for prematures with cephalic presentation, a general cesarian section below certain limits in weight and gestation cannot be recommended. The management of prematurity must be individualized and depends on additional risk factors. In case of doubt, the abdominal delivery is to prefer especially in a patient with less than 32 weeks of gestation or an estimated fetal weight of 1500 g or less. At least a potential risk for the fetus by anaesthesia and surgery has also to be considered. Vaginal delivery is justifiable especially in patients with unruptured membranes, high pelvic score and expected rapid delivery and with no additional fetal or maternal risk factors. Special attention must be paid to a gentle delivery of the head. These statements are based on present data of fetal mortality and probably of the same significance for fetal morbidity, especially the development of intraventricular hemorrhage.

[The placental insufficiency syndrome (a clinical concept) (author's transl)]. / Das Plazentainsuffizienzsyndrom (Ein klinisches Konzept).

Placental insufficiency means insufficient exchange or metabolic efficiency of this organ for the growing foetus. The placenta should not be considered as an isolated, autonomically functioning organ but rather as an integral part of a maternofoetal or foetoplacental functional unit. The extension of the concept "placental insufficiency syndrome" is in line with such a concept. Pathophysiologically we can differentiate between three main froms of insufficiency: 1. haemodynamic placental insufficiency, 2. insufficiency of the placental membrane, 3. cellular parenchymatous insufficiency. The haemodynamic placental insufficiency must be considered as an overriding principle of the insufficiency of all partial functions of the placenta. It is probable that the intrauterine growth of the foetus depends mainly on the placental blood flow factors, the oxygen uptake appearing to be the actually limiting factor. For clinical purposes it is advisable to follow the well-tried principle of dividing the placental insufficiency syndrome into three parts, namely, a chronic, a subchronic and an acute form. The possibilities of early detection, of clinical diagnosis, prevention and treatment of placental insufficiency are discussed.