Title:

Audit of Late pre-term((34-36+6 weeks) deliveries requiring admission to neonatal unit.

Objective:

• Look into causes of preterm delivery ( 34-36+6 weeks)  and explore reasons for Increased admissions to NICU for these babies in early  2023 compared to last year
• To Establish whether optimization of care in late preterm births occurred or not.
• To figure out areas where change in practice can reduce admission rate for these neonates in NICU

 

Design:

• Joint retrospect audit with neonatal team at Royal Bolton Hospital NHS Foundation Trust
• Cases of late preterm births (34 – 36+6 weeks gestation) were analyzed over a period of 4 months (1^st January 2023 – 30^th April 2023)

 

Method:

• 78 cases of neonatal admissions were identified and all of these deliveries were audited
• Data collected using Performa by Review of E3, K2 and EPR(hospital system)and analysed via excels

 

Results:

• 93%(70) cases of preterm deliveries had one or multiple complications  in index pregnancy (PPROM 41%, IUGR 36% , Smoking 21% and Hypertension 17 % being most common)
• Majority women (58%)were White British with age group (76%) 20-35 years.

• 40% of late preterm births were spontaneous while  22% women were induced ( indications being severe IUGR with abnormal dopplers ,reduced Fetal movements and oligohydramnios)
• 34% delivered  without labour (89% emergency c/secions  Due to pathological CTG, Abruption , APH with previa  ,HELLP ,PET )
• Patient group who were not given steroids contributed 3.9%
• Reasons for not administering steroids included cat 1 c/section , precipitous delivery and maternal choice

 

 

 

Conclusion:

• Iatrogenic deliveries with valid indication in most cases and involvement of senior team members in decision making with timely intervention where needed.
• Avoiding delays in administration of steroids/intrapartum antibiotics when indicated to improve neonatal outcome
• Meticulous documentation is vital ,some deficiencies noted during data collection where important data could not be found
• Addressing the modifiable antenatal risk factors (Diagnosis and optimization of Blood pressure, stressing on stop smoking )can indirectly reduce preterm deliveries and poor neonatal outcomes.