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Trends in singleton preterm birth in Victoria, 2007 to 2017: a consecutive cross-sectional study.

Abstract：

INTRODUCTION:Preterm birth is a major cause of perinatal morbidity and mortality worldwide. In many countries preterm birth rates are increasing, largely due to increases in iatrogenic preterm birth, while in other countries rates are stable or even declining. The objective of the study is to describe trends in singleton preterm births in Victoria from 2007 to 2017 in relation to trends in perinatal mortality to identify opportunities for improvements in clinical care. MATERIAL AND METHODS:We conducted a consecutive cross-sectional study in all women with a singleton pregnancy giving birth ≥20 weeks of pregnancy in Victoria, Australia, between 2007 and 2017, inclusive. Rates of preterm birth and perinatal mortality were calculated and trends analysed in all pregnancies, in pregnancies complicated by fetal growth problems, hypertension, (pre)eclampsia or prelabor rupture of membranes (PROM), and in (low-risk) pregnancies not complicated by any of these conditions. RESULTS:There were 811 534 singleton births between 2007 and 2017. Preterm birth increased from 5.9% (4074 births) to 6.4% (4893 births; P<0.001), due to an increase in iatrogenic preterm birth from 2.5% (1730 births) to 3.6% (2730 births; P<0.001). Comparable trends were seen in pregnancies complicated by fetal growth problems and hypertension and in pregnancies not complicated by small for gestational age (SGA), hypertension, (pre)eclampsia or PROM (all P<0.001). In pregnancies complicated by SGA, hypertension, (pre)eclampsia or PROM the perinatal mortality rate from 20 weeks of gestation fell (13 to 12 per 1000 births; P<0.001). In pregnancies not complicated by SGA, hypertension, (pre)eclampsia or PROM there was no significant change in the perinatal mortality from 28 weeks and no decrease in the preterm weekly prospective stillbirth risk. CONCLUSIONS:The singleton preterm birth rate in Victoria is increasing, driven by an increase in iatrogenic preterm birth, both in pregnancies complicated by SGA and hypertension, and in pregnancies not complicated by SGA, hypertension, (pre)eclampsia or PROM. While perinatal mortality decreased in the pregnancies complicated by SGA, hypertension, (pre)eclampsia or PROM, no significant reduction in perinatal mortality from 28 weeks or preterm weekly prospective stillbirth risk was noted in the pregnancies not complicated by any of these conditions.

journal_name

Acta Obstet Gynecol Scand

journal_title

Acta obstetricia et gynecologica Scandinavica

authors

Burger RJ,Temmink JD,Wertaschnigg D,Ganzevoort W,Reddy M,Davey MA,Wallace EM,Mol BW

doi

10.1111/aogs.14074

subject

Has Abstract

pub_date

2020-12-31 00:00:00

eissn

0001-6349

issn

1600-0412

pub_type

杂志文章

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Trends in singleton preterm birth in Victoria, 2007 to 2017: a consecutive cross-sectional study.