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Changes in incidence of iatrogenic and spontaneous preterm births over time: a population-based study

  • Miha Lucovnik EMAIL logo , Andreja Trojner Bregar , Lili Steblovnik , Ivan Verdenik , Ksenija Gersak , Isaac Blickstein and Natasa Tul
Published/Copyright: December 8, 2015

Abstract

Objective: To examine the proportion of iatrogenic births among all preterm births over a 26-year period.

Patients and methods: A registry-based survey of preterm deliveries between 1987 and 2012 analyzed by the onset of labor: spontaneous with intact membranes, preterm premature rupture of membranes (PPROM) or iatrogenic. Stratification into categories by gestation (22 weeks to 27 weeks and 6 days, 28 weeks to 31 weeks and 6 days, 32 weeks to 33 weeks and 6 days, 34 weeks to 36 weeks and 6 days) was performed. Preterm birth rates were analyzed using the Mantel-Haenszel linear-by-linear association χ2-test (P<0.05 significant). Logistic regression was used to account for potential confounders.

Results: Overall preterm birth rate was 5.9% (31328 deliveries) including 2358 (0.4%) before 28 completed weeks, 3388 (0.6%) between 28 weeks and 31 weeks 6 days, 3970 (0.8%) between 32 weeks and 33 weeks and 6 days, and 21611 (4.1%) between 34 weeks and 36 weeks and 6 days There was an increase in overall preterm birth rate (P<0.001). The rate of iatrogenic preterm births and PPROM increased over time (P<0.001 and P<0.014, respectively). Rates of spontaneous preterm birth decreased (P<0.001). After accounting for potential confounders, year of birth remained an independent risk factor for iatrogenic preterm delivery in all four gestational age categories (P<0.001).

Conclusion: The incidence of iatrogenic preterm birth is increasing with a concomitant decrease in the incidence of spontaneous preterm birth. Attempts to analyze, interpret and decrease preterm birth rates should consider spontaneous and iatrogenic preterm births separately.


Corresponding author: Miha Lucovnik, MD, PhD, Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Centre Ljubljana, 4 Slajmerjeva, 1000 Ljubljana, Slovenia, EU, Tel.: +386 31 318 861, Fax: +386 1 439 75 90, E-mail:

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  1. The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2015-8-1
Accepted: 2015-11-2
Published Online: 2015-12-8
Published in Print: 2016-7-1

©2016 by De Gruyter

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