الفهرس 
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Abstract
Despite medical advances, PTB remains as an important perinatal health problem across the globe. It is defined by the WHO as birth before 37 completed weeks of gestation. Globally, PTB is estimated to be around 10–11% of all births, or 15 million births per year. In Yemen it was estimated as 13.2 per 100 births. Thus, it is considered among the 10 countries in the Eastern Mediterranean Region with highest maternal and under-5 mortality rates.
In addition, PTBs are classified into two general categories: spontaneous and indicated. The exact causes of spontaneous PTB are unknown, but it is associated with several factors; including socio-demographic characteristics; chronic maternal illnesses; reproductive history; gynecological problems as well as behavioral and lifestyle conditions. However, preterm babies may face short or long-term adverse consequences, which impose a huge burden on families, communities and health system.
The aim of this study was to identify the factors associated with spontaneous preterm birth among Yemeni women in Hodeida city.
The study comprised a purposive sample of 100 laboring women with spontaneous PTB (20-<37 weeks of gestation); 50 from each of the two governmental hospitals available in Hodeida city; namely Al- Thawra and Al-Salkhanah hospitals.
One tool was developed and used by the researcher to collect the necessary data: factors associated with spontaneous PTB structured interview schedule. It consisted of four parts: Part I: socio-demographic factors; Part II: reproductive factors; Part III: medical/surgical/ gynecological factors; and Part IV: lifestyle and behavioral factors.
A pilot study was carried out on 10laboring women (excluded from the study subjects) to test the feasibility of the study. Tool was clear and relevant; however, few words had been modified. Following this pilot study, the tool was revised, reconstructed and made ready for use.
Data were collected over a period of 3 months, starting from the beginning of July till the end of September 2018. Data were collected 4 days/week during the morning shift, where 2-3 laboring women were interviewed/ day. The average time needed to complete the interview ranged between 30-45 minutes, depending upon the degree of laboring women’s understanding and response.
The collected data was categorized, coded, computerized, tabulated and analyzed using Statistical Package for Social Sciences (SPSS) version 23 program.
The main findings of the study were:
Bio-socio - demographic factors:
- Maternal age demonstrated that approximately one-half (49%) of laboring women were in the reproductive age extremes.
- Consanguinity was reported by almost one-half (51%) of laboring women.
- Maternal race exhibited that more than one-half (55%) of laboring women were white, while less than one-half (45%) of them were black.
- Type of family clarified that a sizeable proportion of laboring women (73%) had nuclear family, while only (27%) of them had extended one.
- Socio-economic level expounded that the vast majority of laboring women (86%) had low and very low level, while a minority of them (14%) had moderate one.
Previous reproductive factors:
- High gravidity (4-14) was reported by nearly one-half (48%) of laboring women.
- Nulliparity& high parity constituted about two-thirds (66%) of laboring women.
- It was obvious that about two-thirds (64%) of laboring women had either no or 4-8 living children.
- Meanwhile, almost three-fifths (61.91%) of laboring women had male & female children.
- Previous pregnancy complications were reported by the vast majority of laboring women (89.74%), mainly anemia (62.86%), infections (51.43%) & PTB (48.57%).
Current reproductive factors:
- Short IPI (< 18 months) was reported by a sizeable proportion of laboring women (71.8%).
- It was clarified that almost two- thirds (67%) of laboring women had moderate to late PTB.
- It was also displayed that almost three-fifths (61%) of laboring women attended <4 visits, while more than one- fifth (23%) of them didn’t attend any visit.
- It was obvious that three-quarters (75%) of laboring women had male fetus during current pregnancy.
- Present pregnancy complications were reported by most of laboring women (92%), mainly anemia (83.70%), followed by infection (45.65%).
Medical & gynecological factors:
- Previous or current medical diseases were reported by the vast majority of laboring women (85%), mainly malaria (54.11%) followed by GIT (48.23%)
- Family diseases were reported by a sizeable proportion of laboring women (74%), mainly DM (64.86%), followed by hypertension (43.24%).
- Previous or current gynecological diseases were reported by the vast majority of laboring women (89%), mainly infection, which reported by almost all of them (97.75%).
Lifestyle & behavioral factors during current pregnancy:
- Daily intake of carbohydrates was reported by almost all of laboring women (98%), while daily intake of sugars was reported by a sizeable proportion of them (77%).
- Meanwhile, most of laboring women (90%) reported daily intake of fats.
- Daily intake of vegetable proteins was reported by almost all of laboring women (99%), while daily intake of animal proteins was reported by a sizeable proportion of them (64%).
- Insufficient daily intake of vegetables and fruits was reported by roughly one-half of laboring women.
- Drinking tea and / or coffee daily was reported by the vast majority of laboring women (93%), where more than one-half (52.69%) of them were drinking 3-10 cups /day.
- Exposure to passive smoking was reported by more than one- half (53%) of laboring women.
- Chewing Qat was also reported by one-half (50%) of laboring women.
- Taking supplements were reported by almost three-fifths (58%) of laboring women, where folic acid was the only supplement taken by all of these women (100%).
- Exercises were not performed by almost all laboring women (97%) during current pregnancy.
- Inadequate duration of sleep/day was reported by a sizeable proportion of laboring women (68%).
Recommendations:
- Maternity nurses should attend training programs, implemented by the responsible authorities, to improve their knowledge and skills regarding PTB.
- They should strictly monitor every pregnant woman to identify those at high-risk for PTB.
- Maternity nurses should teach pregnant women at high–risk for PTB about the common, subtle symptoms, so they can recognize them early and seek prenatal care.
- They should provide high quality prenatal care for pregnant women at high–risk for PTB, to prevent worsening of their risk.
- Further studies should be conducted with a larger sample size to verify the findings of this study.