ICL 14.4: Preterm Birth and Infant Mortality

Question 1

what is preterm birth?

Answer 1

delivery prior to 27 weeks gestation

Question 2

what is a late preterm birth?

Answer 2

delivery between 24-27 weeks gestation

Question 3

what is very preterm birth?

Answer 3

delivery prior to 34 weeks gestation

Question 4

what is low birth weight?

Answer 4

infant weight less than 2500 grams at birth

Question 5

what is very low birth weight?

Answer 5

VLBW is an infant weight less than 1500 grams at birth

Question 6

what is infant mortality?

Answer 6

death of an infant after birth but before first year of life has completed

Question 7

what is maternal mortality?

Answer 7

death of the mother while pregnant and up to 6 weeks postpartum

Question 8

how does the US lie in terms of maternal mortality, infant mortality and preterm birth?

Answer 8

24/25 in maternal mortality

33/35 in infant mortality

34/34 in preterm birth

so we suck….our rates are horrible

Question 9

what is the greatest risk factor for preterm deliver?

Answer 9

prior pregnancy with spontaneous preterm delivery

other risks:
1. infection –> dental, TUI, vaginal, chorioamnionitis

2. bleeding –> placental abruption, vaginal bleeding
3. uterine distention/mass –> multiple gestations, polyhydramnios, fibroids, uterine anomalies
4. stress –> SES, smoking, short inter-pregnancy interval, low maternal body weight

Question 10

why is preterm birth so important?

Answer 10

it predicts infant mortality, childhood disability and adult chronic disease

Question 11

what are the leading causes of infant death in ohio?

Answer 11

prematurity related conditions:

1. complications related to birth before 37 weeks pregnancy like breathing problems, feeding difficulties, cerebral palsy, vision problems, developmental delayes
2. birth defects
3. maternal obstetric conditions
4. external injury
5. sudden infant death syndrome

Question 12

how do you prevent recurrent preterm delivery?

Answer 12

1. 17-alpha-hydroxyprogesterone caproate (IM injection on weekly basis)
2. vaginal progesterone
3. cervical cerclage
4. patient counseling on intentionality and birth spacing
5. maternal health optimization of chronic health conditions like mental health, tobacco, drug cessation etc.
6. early prenatal care! including folate, prenatal screening and early diagnosis of birth defects