Evolución y costes de la prematuridad por indicación médica en un hospital de tercer nivel

Abstract

Introduction and objectives: To evaluate the incidence, evolution, causes and costs of premature births (PB) due to medical indication (iatrogenic) in a tertiary care university hospital Methods: Retrospective cohort study of all deliveries with gestational age between 24 and 36+6 weeks, in two periods 2001-2005 and 2011-2016. Iatrogenic births were identified. Clinical, epidemiological, diagnostic and economic variables were analysed. Results: A sample size of 620 iatrogenic deliveries was obtained. We found a 9.7% relative increase in iatrogenic prematurity rate in the second period as well as an increase in maternal age from 27.7 to 32.9, obesity from 32.2% to 55.5% and the use of assisted reproductive techniques from 6% to 11.1%. Preeclampsia and intrauterine growth restriction were found to be the main causes of iatrogenic premature delivery. In these cases the rates of cesarean section increased from 66.9% to 78%. The average stay per patient and the cost calculated by diagnosis related group (DRG) also showed a statistically significant increase from 7.8 days and 3,068.6 euros to 9.6 days and 7,331.9 euros. Conclusions: We observed an increase in iatrogenic prematurity in the second period despite the unchanged rate of spontaneous PB. Demographic changes in the population, as well as an increase in obstetric related conditions, seem to be responsible for this increase. Primary and secondary prevention of clinical characteristics may reduce the incidence and costs derived from this type of prematurity.