Direct determinants of elective preterm birth and neonatal results - Revista Brasileira de Ginecologia e Obstetrícia

Direct determinants of elective preterm birth and neonatal results |

OBJECTIVE: to characterize the features of pregnant women who had elective preterm delivery, and correlate clinical and obstetrical diagnosis with neonatal results. METHOD: A total of 100 pregnant women admitted in the Obstetric Clinic ward and their respective newborns has been evaluated. The inclusion criteria were: single pregnancy, confirmed gestational age by an early scan, absence of labor symptoms and the presence of a maternal or fetal condition leading to preterm delivery indication. The direct causes of elective preterm delivery were classified in groups, to relate them to the neonatal results, taking into account the gestational age. To assess the neonatal results, the following criteria were analyzed: acidosis; 1st and 5st minute Apgar score lower than 7; intracranial hemorrhage; neonatal death; sepsis and respiratory distress syndrome. Statistical analysis used to correlate the causes of delivery and the gestational age to the neonatal results was done by log-linear models. RESULTS: One patient was excluded from the study due to fetal malformation. The most common direct causes of delivery were prenatal fetal distress (49.5%), hypertensive syndromes (21.2%), intra uterine growth restriction (13.1%) and others (16.2%). Among the main neonatal complications there were asphyxia (33.3%), acidosis (30.4%), respiratory distress syndrome (RDS) (26.3%), sepsis (22.2%), intracranial hemorrhage (21.2%) and neonatal death (13.1%). The cause of delivery was associated with acidosis and RDS by log-linear models and the gestational age was associated with RDS, 1st minute Apgar <7, sepsis, intracranial hemorrhage and neonatal death. CONCLUSIONS: the cause of delivery influences the neonatal results. Nevertheless, the most severe complications are directly dependent on the gestational age of delivery. Therefore, the prenatal diagnosis should be rigorously evaluated by the obstetrician, so that the decision to interrupt the pregnancy could be taken at the suitable moment, thus avoiding neonatal complications.