Assessing Preterm Birth with Gross Examination of the Placenta of Patients Attending Korle Bu Teaching Hospital

Abstract

Background: Preterm births are the single greatest direct cause of neonatal deaths, responsible for 35% of the world's 3.1 million deaths a year. Preterm deliveries in Ghana is unacceptably higher than that of global estimates. An understanding of the placental morphological characteristics is essential for advancing our knowledge of the cause and mechanisms through which placental characteristics influence preterm births as well as identifying pregnancies at risk of these adverse perinatal outcomes. General Objective: The objective of this study was to assess preterm births with gross examination of the postpartum placenta of pregnant women who deliver preterm at Korle Bu Teaching Hospital. Methods: This was a cross sectional study which involved the consecutive sampling of pregnant women with preterm labor attending Korle Bu Teaching Hospital. After obtaining the patient’s consent, demographic characteristics were collected from the patient’s folder. Once the baby was delivered and the placenta was removed from the womb, various morphological characteristics of the placenta and its associated structure were recorded. Information on the pregnancy (preterm or term deliveries) was also recorded. The associations between dependent variable and each selected independent variable were analyzed using a multiple logistic regression. Results: The prevalence of preterm deliveries among the study population during June 2019 was 12.6% (99 of the 785 singleton deliveries). The results revealed that umbilical cord pseudoknots are strong predictors of preterm delivery. The odds of preterm birth are 2.17 times greater when a pseudoknot is present on the umbilical cord as compared to when it is absent [Adjusted Odds Ratio (AOR) = 3.17 (95% CI = 1.19 – 8.48), p=0.02]. Conclusion: Proportion of preterm deliveries in the study population is high. Umbilical cord pseudoknots are strong predictors of preterm deliveries. Early detection of umbilical cord pseudoknots through ultrasonography and close monitoring may assist in management. Keywords: Preterm, Placenta morphology, Pseudoknots, Determinants, Gross Examination