Influence of risk factors on perinatal outcome of infants born at the age of 22-34 weeks of gestation

Purpose of the study. Studying the influence of pregnancy risk factors on the perinatal outcome of premature infants born at 28-34 weeks of gestation to optimize the medical care provided to them.

Material and research methods. The object of the study were premature babies. The nature of our sample was continuous and included all cases of preterm birth in the gestational age from 22 to 34 weeks from 2018 to 2022. The study was conducted at the clinical base of the Department of Neonatology of the State Educational Institution “IPO in Northwestern RT” of the State Institution “City Maternity Hospital No. 1” in Dushanbe.

An analysis of some factors that have an adverse effect on the condition of the fetus was studied based on the results of a survey of 325 developmental histories of mothers, surviving newborn children and 196 developmental histories of mothers of deceased children. Monitoring of postpartum women included analysis of general somatic and obstetric-gynecological history, the course of pregnancy and childbirth. In newborns, the course of the early neonatal period, morbidity, mortality and causes leading to it were analyzed.

Depending on the duration of pregnancy, the subjects were distributed according to gestational age (up to 28 weeks; 29-31 weeks and 32-34 weeks of gestation) and received a full course of RDS prevention - group 1; those who received an incomplete course of RDS prevention – group 2; those who did not receive RDS prevention – group 3; those who received a full course of RDS prevention followed by labor stimulation/excitation – group 4.

Research results and discussion. Late age of a pregnant woman is an independent risk factor for the development of pathology, both in the mother and in the fetus, and, accordingly, its unfavorable outcome. It was revealed that in mothers who gave birth before 28 weeks of gestation, the average age was critical, and the outcome of the children was fatal, despite the complete prevention of RDS in the group.

Multiparous women predominated in all examined groups, especially in the group who did not receive RDS (62.6%). The least number of them was among postpartum women who received stimulation of labor. At the same time, the vast majority of primigravidas were primigravidas, especially in groups that received a full course of RDS prevention (on average 91.5%). This group also led in reproductive losses and medical abortions. Thus, 14.2% of women who received a full course of RDS prevention and 8.3% of women who received a full course of RDS prevention with stimulation had a history of medical abortion. The rates of spontaneous abortion and stillbirth, indicating the corresponding quality of health, were higher in these groups of patients: 17.9% and 16.6% of women, respectively. It should be noted that spontaneous miscarriages and medical abortions were detected more often (2.4 times) in mothers who gave birth to children weighing less than 1500 g.

Also, in all groups there was a connection between preterm birth in family history and in the woman’s personal history. At the same time, a history of premature birth was most indicated in the group of mothers who received a full course of antenatal corticosteroid therapy (22.4% and 18.7%). Perhaps, based on the experience of previous pregnancies, this contingent tried to be under more careful control of medical institutions, and accordingly receive the necessary amount of medical care.

When distributed by sex depending on the gestational age among the surviving and deceased children, boys predominated mainly, especially among the deceased, to a greater extent in the group that did not receive RDS prophylaxis (regardless of gestational age) and in the group with labor stimulation (up to 28 weeks and 29-31 weeks of gestation).

Conclusions.

1. Among the unfavorable factors that have the greatest impact on the timing of gestation and maturation of the fetus are inflammatory diseases of the respiratory and urinary systems, as well as anemia.
2. The role of the threat of miscarriage has been established as a factor influencing the perinatal outcome of all studied groups.
3. The connection between preterm birth in the family history and in the woman’s own history with miscarriage of her current pregnancy, noted in all groups, dictates the need to identify the risk group and ensure appropriate monitoring and treatment.
4. The importance of prenatal prevention of RDS has been established, determined by its influence on increasing the survival rate of premature infants.

1. Kozlov P.V., Ivannikov N.Yu., Kuznetsov P.A., Bogaeva I.I. Epidemiology, etiology and pathogenesis of late premature birth // Obstetrics, gynecology, reproduction. – 2015. – Volume 9. – No. 1. – P. 68-76;

2. Mamedalieva N.M., Kim V.D., Keidarova S.A. // Features of perinatal outcomes of late premature birth. Bulletin of KazNMU. No. 2. 2016 Pp. 9-13;

3. Manapova R.M. Critical conditions of newborns and its influence on the neurological status / R.M. Manapova, A.M. Aliskandiev, Kh.M. Omarova, E.S. Ibragimova, S.Z. Allahkulieva // Ural Medical Journal. – 2018. – No. 1 (156). – Pp. 13-16;

4. Mustafina M. Yu. Peculiarities of health status, individual indicators of metabolism and cellular energy exchange in the dynamics of the first year of life in children born at very early preterm birth. Dissertation of Doctor of Medical Sciences. Ekaterinburg 2018. 114 p.;

5. Nizamova E. R. Scientific rationale for improving the organization of medical care for premature infants./ Dissertation for the degree of candidate of medical sciences. Moscow. – 2020. – P. 189;

6. Sakharova E.S. Prematurity as a medical and social health problem. Part 1 / E.S. Sakharova, E.S. Keshishyan, G.A. Alyamovskaya // Russian Bulletin of Perinatology and Pediatrics. – 2017. – No. 3. – T. 62. – P. 15-19;

7. Kunkel M.D. Influence of Maternal Factors in Neonatologists’ Counseling for Periviable Pregnancies / M.D. Kunkel, S.M. Downs, B.T. Edmonds // American Journal of Perinatology. – 2017. – No. 34(08). – Pp. 787-794. – DOI: 10.1055/s-0037-1598247;

8. Sweet D.G., Carnielli Virgilio P., Greisen G. et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2022 Update // Neonatology 2023;120:3–23 DOI: 10.1159/000528914.