Clinical Analysis Of Different Types Of Preterm Birth Risk Factors And Pregnancy Outcomes

Objective:The risk factors and pregnancy outcomes of different types of preterm birth were compared to provide a theoretical basis for preventing preterm birth.Methods:Through the medical record room medical record system,a total of 994 cases of premature pregnant women and 1069 cases of newborn medical records were collected in our hospital from January 2018 to December 2021,and a total of 4 cases of stillbirth were excluded.At the same time,500 pregnant women with full-term delivery were randomly selected as the control group.According to the type of preterm birth,990 pregnant women with preterm birth were divided into spontaneous preterm birth group(617 cases in total)and iatrogenic preterm birth group(373 cases in total).SPSS27.0software was used to compare the gestational age,reproductive history,mode of delivery,number of delivery tests,pregnancy complications,complications(pregnancy-induced hypertension,ICP,GDM,fetal distress,placenta previa,placenta abruption,premature rupture of membranes,intrauterine infection,FGR)of the two groups of pregnant women,so as to understand the high risk factors of spontaneous preterm delivery and iatrogenic preterm delivery.The recent outcomes,Apgar score,birth weight and PH of umbilical artery blood gas of premature infants were analyzed in the spontaneous preterm and iatrogenic preterm groups.Results:1.In the past 4 years,the total number of deliveries in our hospital was 11,965 cases,and the number of premature births was 994 cases,with a total incidence of 8.31%,including 5.17% spontaneous preterm birth and 3.13% iatrogenic preterm birth.2.The mean age of pregnant women in the control group was 28.95±4.27 years old and the gestational age was 38.67±0.93 weeks;the mean age of pregnant women in the spontaneous preterm birth group was 29.45±4.50 years old and the gestational age was 34.40±1.96 weeks;the mean age of pregnant women in the iatrogenic preterm birth group was 30.22 ± 4.95 years old and the gestational age was 33.97 ± 2.33 weeks.Natural preterm group compared with control group: natural preterm group of pregnant women with an average age is greater than the control group,there was no statistically significant difference(P>0.05),natural preterm group pregnant women on average gestational age less than control group,the difference is statistically significant(P?0.05).3.Comparison between spontaneous preterm delivery group and control group:With?25 to 29 years old,compared to women who age 20 pregnant women about natural a 0.86-fold increased risk of premature(OR = 1.86,95% CI 0.56-6.12),age 35 years old pregnant women OR natural about a 7% lower risk of premature birth occurred(OR =0.93,95% CI 0.66-1.43).4.The irregular birth rate of pregnant women in the spontaneous preterm birth group and iatrogenic preterm birth group was higher than that in the control group,the risk of spontaneous preterm birth was increased by about 0.59 times(OR=1.59,95%CI1.08-2.33),and the risk of iatrogenic preterm birth was increased by about 2.81times(OR = 3.81,95% CI2.59-5.57).5.In the control group,primiparas accounted for 74.60%,primiparas 25.40%,pregnant women without abortion history 61.40% and pregnant women with abortion history 38.60%.The proportion of primiparas in spontaneous preterm delivery group was42.46%,that of mentrin was 57.54%,that of pregnant women without abortion history was 62.07%,and that of pregnant women with abortion history was 37.93%.In the iatrogenic preterm delivery group,the proportion of primiparas was 51.21%,the proportion of menthymus was 48.79%,the proportion of pregnant women without abortion history was 34.05%,and the proportion of pregnant women with abortion history was 65.95%.Natural preterm group compared with control group: multipara ratio is higher than the control group,the difference is statistically significant(P?0.05),has a history of abortion pregnant women occupy ratio is lower than the control group,there was no statistically significant difference(P>0.05).Iatrogenic preterm group compared with control group: primipara ratio is higher than the control group,the difference is statistically significant(P?0.05),has a history of abortion pregnant rate is higher than the control group,difference has statistical significance(P?0.05).6.78.60% of pregnant women in the control group had vaginal delivery,21.40%had caesarean section,the average length of hospitalization was 5.51±2.24 days,and the hospitalization cost was 7172.27 ± 39.1073 yuan.In the spontaneous preterm group,75.04% of pregnant women delivered naturally,24.56% underwent cesarean section,the average length of hospitalization was 5.37±6.25 days,and the hospitalization cost was8883.91±5345.55 yuan.In the iatrogenic preterm delivery group,25.74% of pregnant women underwent vaginal delivery,21.40% underwent cesarean section,the average length of hospitalization was 8.43±5.40 days,and the hospitalization cost was14569.24±7861.23 yuan.Natural preterm group compared with control group,two groups of difference on the delivery way and hospitalization days no statistical significance(P?0.05),natural preterm group hospitalization cost is higher than the control group,difference has statistical significance(P?0.05).Iatrogenic preterm group compared with control group: iatrogenic preterm group cesarean section rate,hospitalization days and hospitalization expenses were higher than the control group,the difference is statistically significant(P?0.05).7.Acute chorioamnitis(OR=2.984,95%CI 1.829-4.867,P=0.000),pregnancy with thyroid disease(OR=1.774,95%CI 1.193-2.639,P=0.005),irregular birth examination(OR=2.205,95%CI 1.184-4.106,P=0.013),gestational diabetes mellitus(OR=1.670,95%CI 1.153-2.419,P=0.007)were risk factors for spontaneous preterm birth,and gestational hypertension reduced the risk of spontaneous preterm birth(OR=0.304,95%CI 0.178-0.522,P=0.000).Hypertensive disease during pregnancy(OR=6.150,95%CI4.147-9.122,P=0.000),GDM(OR=1.726,95%CI 1.094-2.722,P=0.019),thyroid disease during pregnancy(OR=2.512,95%CI 1.683-3.852,P=0.000),ICP(OR=9.815,95%CI2.854-33.758,P=0.000);Increased age(OR=1.063,95%CI 1.023-1.105,P=0.002),FGR(OR=4.815,95%CI 1.915-12.107,P=0.000),fetal distress(OR=8.622,95%CI4.930-15.007,P=0.000),placenta previa(OR=10.673,95%CI 5.117-22.260,P=0.000),Placental abruption(OR=6.513,95%CI 3.967-10.693,P=0.000)and irregular birth examination(OR=1.835,95%CI 1.145-3.823,P=0.011)were risk factors for iatrogenic preterm labor.8.Outcomes of premature infants: The incidence rates of NRDS,neonatal pneumonia and neonatal asphyxia were 15.29%,52.14% and 2.19% in the spontaneous preterm delivery group,and 23.61%,41.96% and 6.51% in the iatrogenic preterm delivery group,respectively.This difference has significant statistical significance(P?0.05).In terms of NEC,neonatal sepsis and neonatal death,there was no significant difference in early neonatal outcome between the two types of preterm delivery(P>0.05).9.There were 381 males and 273 females in the spontaneous preterm group and219 males and 196 females in the iatrogenic preterm group.Male infants had a significantly higher risk of preterm birth than female infants(OR=1.25,95% CI0.96-1.60).10.General situation of neonates: The birth weight of neonates in the spontaneous preterm group was 2471.12± 1969.30 g,and that in the iatrogenic preterm group was2170.65±1070.96 g,with a statistically significant difference(P? 0.05).There was no significant difference in PH value of umbilical artery between the two groups(P>0.05).The hospitalization cost of neonates in the spontaneous preterm group was17619.36±21096.33 yuan,while that in the iatrogenic preterm group was23140.63±21915.24 yuan.The difference was statistically significant(P? 0.05).Conclusion:1.Acute chorioamnitis,gestational diabetes mellitus,young age,irregular birth time spontaneous preterm birth risk factors,gestational hypertension disease,ICP,FGR,fetal distress,placenta previa,old age,previous history of abortion are high risk factors for iatrogenic preterm birth.2.Neonatal pneumonia was more common in the spontaneous preterm group,and the incidence of NRDA and neonatal asphyxia was higher in the iatrogenic preterm group than in the spontaneous preterm group..3.The iatrogenic preterm birth group brings heavier family and social burden to the pregnant women and newborns.Clinicians should conduct detailed and comprehensive medical history inquiry in practical work,screen and identify pregnant women at high risk of preterm birth,and timely standard diagnosis and treatment according to different risk factors,so as to improve adverse outcomes of pregnant women and newborns..