Incidence, associated risk factors, and the ideal mode of delivery following preterm labour between 24 to 28 weeks of gestation in a low resource setting Article Swipe
Herbert Kayiga
,
Diane Achanda Genevive
,
Pauline Amuge
,
Josaphat Byamugisha
,
Annettee Nakimuli
,
Andrew Jones
·
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1371/journal.pone.0254801
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1371/journal.pone.0254801
Background Preterm labour, between 24 to 28 weeks of gestation, remains prevalent in low resource settings. There is evidence of improved survival after 24 weeks though the ideal mode of delivery remains unclear. There are no clear management protocols to guide patient management. We sought to determine the incidence of preterm labour occurring between 24 to 28 weeks, its associated risk factors and the preferred mode of delivery in a low resource setting with the aim of streamlining patient care. Methods Between February 2020 and September 2020, we prospectively followed 392 women with preterm labour between 24 to 28 weeks of gestation and their newborns from admission to discharge at Kawempe National Referral hospital in Kampala, Uganda. The primary outcome was perinatal mortality associated with the different modes of delivery. Secondary outcomes included neonatal and maternal infections, admission to the Neonatal Special Care Unit (SCU), need for neonatal resuscitation, preterm birth and maternal death. Chi-square test was used to assess the association between perinatal mortality and categorical variables such as parity, mode of delivery, employment status, age, antepartum hemorrhage, digital vaginal examination, and admission to Special Care unit. Multivariate logistic regression was used to assess the association between comparative outcomes of the different modes of delivery and maternal and neonatal risk factors. Results The incidence of preterm labour among women who delivered preterm babies between 24 to 28 weeks was 68.9% 95% CI 64.2–73.4). Preterm deliveries between 24 to 28 weeks contributed 20% of the all preterm deliveries and 2.5% of the total hospital deliveries. Preterm labour was independently associated with gravidity (p-value = 0.038), whether labour was medically induced (p-value <0.001), number of digital examinations (p-value <0.001), history of vaginal bleeding prior to onset of labour (p-value < 0.001), whether tocolytics were given (p-value < 0.001), whether an obstetric ultrasound scan was done (p-value <0.001 and number of babies carried (p-value < 0.001). At multivariate analysis; multiple pregnancy OR 15.45 (2.00–119.53), p-value < 0.001, presence of fever prior to admission OR 4.03 (95% CI .23–13.23), p-value = 0.002 and duration of drainage of liquor OR 0.16 (0.03–0.87), p-value = 0.034 were independently associated with preterm labour. The perinatal mortality rate in our study was 778 per 1000 live births. Of the 392 participants, 359 (91.5%), had vaginal delivery, 29 (7.3%) underwent Caesarean delivery and 4 (1%) had assisted vaginal delivery. Caesarean delivery was protective against perinatal mortality compared to vaginal delivery OR = 0.36, 95% CI 0.14–0.82, p-value = 0.017). The other protective factors included receiving antenatal corticosteroids OR = 0.57, 95% CI 0.33–0.98, p-value = 0.040, Doing 3–4 digital exams per day, OR = 0.41, 95% 0.18–0.91, p-value = 0.028) and hospital stay of > 7 days, p value = 0.001. Vaginal delivery was associated with maternal infections, postpartum hemorrhage, and admission to the Special Care Unit. Conclusion Caesarean delivery is the preferred mode of delivery for preterm deliveries between 24 to 28 weeks of gestation especially when labour is not established in low resource settings. It is associated with lesser adverse pregnancy outcomes when compared to vaginal delivery for remote gestation ages.
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- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1371/journal.pone.0254801
- https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0254801&type=printable
- OA Status
- gold
- Cited By
- 3
- References
- 49
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W3186392603
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Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W3186392603Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1371/journal.pone.0254801Digital Object Identifier
- Title
-
Incidence, associated risk factors, and the ideal mode of delivery following preterm labour between 24 to 28 weeks of gestation in a low resource settingWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2021Year of publication
- Publication date
-
2021-07-22Full publication date if available
- Authors
-
Herbert Kayiga, Diane Achanda Genevive, Pauline Amuge, Josaphat Byamugisha, Annettee Nakimuli, Andrew JonesList of authors in order
- Landing page
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https://doi.org/10.1371/journal.pone.0254801Publisher landing page
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https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0254801&type=printableDirect link to full text PDF
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YesWhether a free full text is available
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-
goldOpen access status per OpenAlex
- OA URL
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https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0254801&type=printableDirect OA link when available
- Concepts
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Medicine, Gestation, Obstetrics, Incidence (geometry), Neonatal resuscitation, Neonatal intensive care unit, Pregnancy, Vaginal delivery, Pediatrics, Gestational age, Resuscitation, Emergency medicine, Biology, Genetics, Physics, OpticsTop concepts (fields/topics) attached by OpenAlex
- Cited by
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3Total citation count in OpenAlex
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2025: 1, 2024: 1, 2023: 1Per-year citation counts (last 5 years)
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49Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.outcome | 119 |
| abstract_inverted_index.p-value | 322, 336, 348, 408, 425, 439 |
| abstract_inverted_index.parity, | 170 |
| abstract_inverted_index.patient | 41, 78 |
| abstract_inverted_index.preterm | 50, 93, 149, 216, 222, 246, 355, 479 |
| abstract_inverted_index.primary | 118 |
| abstract_inverted_index.remains | 10, 31 |
| abstract_inverted_index.setting | 72 |
| abstract_inverted_index.status, | 175 |
| abstract_inverted_index.vaginal | 180, 280, 377, 389, 400, 509 |
| abstract_inverted_index.whether | 265, 290, 297 |
| abstract_inverted_index.(91.5%), | 375 |
| abstract_inverted_index.(p-value | 262, 270, 276, 287, 294, 304, 311 |
| abstract_inverted_index.February | 82 |
| abstract_inverted_index.Kampala, | 115 |
| abstract_inverted_index.National | 111 |
| abstract_inverted_index.Neonatal | 140 |
| abstract_inverted_index.Referral | 112 |
| abstract_inverted_index.assisted | 388 |
| abstract_inverted_index.bleeding | 281 |
| abstract_inverted_index.compared | 398, 507 |
| abstract_inverted_index.delivery | 30, 67, 205, 383, 392, 401, 454, 471, 477, 510 |
| abstract_inverted_index.drainage | 342 |
| abstract_inverted_index.duration | 340 |
| abstract_inverted_index.evidence | 18 |
| abstract_inverted_index.factors. | 211 |
| abstract_inverted_index.followed | 89 |
| abstract_inverted_index.hospital | 113, 253, 443 |
| abstract_inverted_index.improved | 20 |
| abstract_inverted_index.included | 132, 415 |
| abstract_inverted_index.logistic | 189 |
| abstract_inverted_index.maternal | 135, 152, 207, 458 |
| abstract_inverted_index.multiple | 317 |
| abstract_inverted_index.neonatal | 133, 147, 209 |
| abstract_inverted_index.newborns | 104 |
| abstract_inverted_index.outcomes | 131, 199, 505 |
| abstract_inverted_index.presence | 325 |
| abstract_inverted_index.resource | 14, 71, 496 |
| abstract_inverted_index.survival | 21 |
| abstract_inverted_index.unclear. | 32 |
| abstract_inverted_index.<0.001 | 305 |
| abstract_inverted_index.Caesarean | 382, 391, 470 |
| abstract_inverted_index.Secondary | 130 |
| abstract_inverted_index.September | 85 |
| abstract_inverted_index.admission | 106, 137, 183, 330, 463 |
| abstract_inverted_index.analysis; | 316 |
| abstract_inverted_index.antenatal | 417 |
| abstract_inverted_index.delivered | 221 |
| abstract_inverted_index.delivery, | 173, 378 |
| abstract_inverted_index.delivery. | 129, 390 |
| abstract_inverted_index.determine | 46 |
| abstract_inverted_index.different | 126, 202 |
| abstract_inverted_index.discharge | 108 |
| abstract_inverted_index.gestation | 101, 487, 513 |
| abstract_inverted_index.gravidity | 261 |
| abstract_inverted_index.incidence | 48, 214 |
| abstract_inverted_index.medically | 268 |
| abstract_inverted_index.mortality | 122, 164, 359, 397 |
| abstract_inverted_index.obstetric | 299 |
| abstract_inverted_index.occurring | 52 |
| abstract_inverted_index.perinatal | 121, 163, 358, 396 |
| abstract_inverted_index.preferred | 64, 474 |
| abstract_inverted_index.pregnancy | 318, 504 |
| abstract_inverted_index.prevalent | 11 |
| abstract_inverted_index.protocols | 38 |
| abstract_inverted_index.receiving | 416 |
| abstract_inverted_index.settings. | 15, 497 |
| abstract_inverted_index.underwent | 381 |
| abstract_inverted_index.variables | 167 |
| abstract_inverted_index.Background | 0 |
| abstract_inverted_index.Chi-square | 154 |
| abstract_inverted_index.Conclusion | 469 |
| abstract_inverted_index.antepartum | 177 |
| abstract_inverted_index.associated | 59, 123, 259, 353, 456, 500 |
| abstract_inverted_index.deliveries | 235, 247, 480 |
| abstract_inverted_index.employment | 174 |
| abstract_inverted_index.especially | 488 |
| abstract_inverted_index.gestation, | 9 |
| abstract_inverted_index.management | 37 |
| abstract_inverted_index.postpartum | 460 |
| abstract_inverted_index.protective | 394, 413 |
| abstract_inverted_index.regression | 190 |
| abstract_inverted_index.tocolytics | 291 |
| abstract_inverted_index.ultrasound | 300 |
| abstract_inverted_index.<0.001), | 271, 277 |
| abstract_inverted_index.association | 161, 196 |
| abstract_inverted_index.categorical | 166 |
| abstract_inverted_index.comparative | 198 |
| abstract_inverted_index.contributed | 241 |
| abstract_inverted_index.deliveries. | 254 |
| abstract_inverted_index.established | 493 |
| abstract_inverted_index.hemorrhage, | 178, 461 |
| abstract_inverted_index.infections, | 136, 459 |
| abstract_inverted_index.management. | 42 |
| abstract_inverted_index.0.14–0.82, | 407 |
| abstract_inverted_index.0.18–0.91, | 438 |
| abstract_inverted_index.0.33–0.98, | 424 |
| abstract_inverted_index.Multivariate | 188 |
| abstract_inverted_index.examination, | 181 |
| abstract_inverted_index.examinations | 275 |
| abstract_inverted_index.multivariate | 315 |
| abstract_inverted_index.streamlining | 77 |
| abstract_inverted_index..23–13.23), | 335 |
| abstract_inverted_index.64.2–73.4). | 233 |
| abstract_inverted_index.independently | 258, 352 |
| abstract_inverted_index.participants, | 373 |
| abstract_inverted_index.prospectively | 88 |
| abstract_inverted_index.(0.03–0.87), | 347 |
| abstract_inverted_index.resuscitation, | 148 |
| abstract_inverted_index.corticosteroids | 418 |
| abstract_inverted_index.(2.00–119.53), | 321 |
| cited_by_percentile_year.max | 95 |
| cited_by_percentile_year.min | 89 |
| corresponding_author_ids | https://openalex.org/A5052167859, https://openalex.org/A5084836426, https://openalex.org/A5017491401, https://openalex.org/A5076505283, https://openalex.org/A5001333478, https://openalex.org/A5027581358 |
| countries_distinct_count | 2 |
| institutions_distinct_count | 6 |
| corresponding_institution_ids | https://openalex.org/I28407311, https://openalex.org/I4210103694, https://openalex.org/I72227227 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/8 |
| sustainable_development_goals[0].score | 0.5400000214576721 |
| sustainable_development_goals[0].display_name | Decent work and economic growth |
| citation_normalized_percentile.value | 0.59776676 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |