1. P REMATURE D ELIVERY Trends from a West Texas Hospital Edwin E. Henslee MD, PGY-2 Selman I. Welt MD

2. O BJECTIVE  The incidence of premature birth in the United States during the past decade has risen 1-2%.  This in spite of the efforts of healthcare professionals, medical societies, patient groups and national charitable organizations.

3. O BJECTIVE

4. Numerous factors are responsible, Tucker, et. al. OB-GYN 77:347-7 (1991) states that 20% of preterm birth is iatrogenic (DM, IUGR, HTN, placental abnormalities), 20% intraamniotic infections, 30% PPROM, 30% idiopathic preterm labor. We do not believe this is the case at our institution.

5. O BJECTIVE Considerable effort is made by the Maternal- Fetal Medicine service to reduce the incidence of iatrogenic prematurity. Intraamniotic infection and iatrogenic prematurity does not seem to be as prevalent at our facility as literature suggests.

6. O BJECTIVE We believe that our preterm delivery rate is better than that of national statistics (11.5%) That preterm premature rupture of membranes is present in a higher percentage of our preterm deliveries than Tucker’s paper states. It is our intent to evaluate the hypothesis that our patient population and healthcare practice is different than that published in the literature.

7. D ESIGN This will be a retrospective study consisting of a one year UMC chart/data review from December 2007 to December 2008. Since it is a retrospective study and all data exists at present time, no patient consent forms will be required. All identifying information will be removed and discarded.

8. M ETHOD A list of patient’s chart numbers will be obtained with diagnostic code for preterm delivery from UMC. Approximately 220 charts have been identified. Each chart will be reviewed for any identifiable cause for preterm delivery, i.e. preterm labor, PPROM, maternal/fetal conditions. Quality and frequency of prenatal care and any medication/drug usage will be recorded as well.

9. M ETHOD Data collected will include the following: age, gravidity, parity, gestational age, means of gestational age determination, insurance status, medical, surgical and OB-GYN history. Each newborn chart will be reviewed as well to clarify the possible cause of premature birth, confirm gestational age and identify any complications of the newborn secondary to the prematurity of birth

10. M ETHOD Inclusion criteria – Women with delivery of a singleton infant of <37 weeks EGA, who gave birth at UMC between December 1, 2007 through December 31, 2008. Exclusion criteria – Multiple gestation pregnancy, unclear estimated gestational age. IRB approval is pending.

11. M ETHOD Sample data sheet Initials Delivery date EDD Prenatal care- EGA at onset, number vists Maternal age Insurance status County of residence Maternal medical problems

12. M ETHOD  Maternal surgical history  Maternal reproductive history  EGA at time of precipitating event (PTL, PROM, vaginal bleeding)  Medications/illicit drugs  Special circumstances  Delivery means and causation  Postpartum complications  Baby apgars  Baby weight and length  Length of hospital stay and outcome

13. E XPECTED RESULT It is our belief that the data will show that the preterm delivery rate at University Medical Center is better than that of national statistics. Preterm premature rupture of membranes is responsible for over 1/3 of our preterm deliveries. The iatrogenic prematurity and intraamniotic infection rate at our facility is below that of published statistics.

14. My sincerest appreciation to Dr. Welt and Dr. Prien for their assistance with this research project.