According to the World Health Organization (WHO), prematurity is defined as birth occurring before 37 completed weeks of amenorrhea, i.e. before the 259th day from the 1st day of the last menstruation, but at least 22 weeks, and this, whatever the weight but at least 500 g . We usually distinguish late prematurity (births between 34 and 36 weeks old), moderate prematurity (32 to 33 weeks old), extreme prematurity (28 to 31 weeks old) and very high prematurity (<28 weeks) . Prematurity remains the main cause of neonatal mortality in both developed and developing countries . The pathologies that cause these newborns to die can also lead to severe lifelong disability in those who survive. A Study of Current Data on the Prematurity: Epidemiological, Etiological, Physiopathological, therapeutic ... is an essential or even essential element to answer the questions and requirements of obstetricians, neonatologists, doctors, parents and decision-makers in order to deal with a pathological entity that goes far beyond the medical framework and sanitary. We therefore want this study to take stock of the epidemiological aspects, and the main risk factors of prematurity in a Moroccan maternity hospital.
2. Material and Methods
The medical records of premature infants admitted to the neonatal and neonatal resuscitation service of the CHU VI of Marrakech with a diagnosis of prematurity in the hospital, between January 2019 and December 2019 were reviewed retrospectively. The following variables were examined from their files: gestational age, mode of delivery, anthropometric data, APGAR score, trophicity, neonatal complications, mortality and causes of death. In the mother, we studied the socio-demographic data, the gyneco-obstetrical history, and the pathologies occurring during pregnancy.
We retained 110 premature newborns over 1 year. During our study period, 585 newborns were hospitalized, a frequency of 18.8%. The population was predominantly male, 71 versus 39, or a sex ratio was 1.8 (Figure 1).
The term was known in 77.2% of cases, and the most common means of precision was the date of the last period (60%). The mean gestational age was 30.4 weeks, with a slight predominance of the age between 28 weeks and 31.6 weeks (36%).
Extremely prematurity and extremely prematurity represented 2% and 38% of the population respectively as shown Figure 2.
The age of the mothers varied from 18 to 45 years with an average of 28.7 ± 5 years, primiparity was found with respective rates of 38.1%. The socio-economic level was considered low in 68.2% of cases, the low level of education in 60% of cases. Residence in rural areas represented 55.4% of percentage against 45% in urban areas. 4 admitted were from single mothers, i.e. a percentage of 3.6%. Pregnancies were only well followed in 38, 1, and consanguinity was found in 16.3 % of cases (Table 1).
Among the gyneco-obstetric history, and the medical history detected during pregnancy, several of them were associated with the onset of prematurity. They were genitourinary infections (30%), arterial hypertension (hypertension) (20%), pre-eclampsia (12%), threat of premature delivery (PAD) (15%), cervico-isthmic open bite (5%), isolated hemorrhages and gestational diabetes (5%).
The average birth weight was 1800 g [900 g - 2100 g], 20% of premature babies were hypotrophic. The Apgar score was below 7 at the 1st minute and at the 5th minute in 34.54 and 10% of cases respectively (38 and 10 cases). The causes of prematurity are dominated by infectious causes 30%, ovular foeto-placental causes 34% of cases, unexplained prematurity in 12% of cases. Morbidities during
Figure 1. Distribution of patients by sex.
Figure 2. Distribution according to the classification of prematurity.
Table 1. Distribution according to maternal characteristics.
hospitalization respiratory distress in 40% of cases, maternal-fetal infection in 30% of cases, hypotrophy in 20% of cases, jaundice in 8% of cases, and the death rate in 40% of cases. Among the causes of death, INC occupies 1st place with 56% of cases.
The prematurity rate varies from country to country and, within a country, from region to region. In all countries, rates are increasing, even in the most developed countries where the advancement of knowledge of risk factors and mechanisms relating to preterm labor, and the introduction of several public health and medical policies should rather lead to a reduction in rates . Preterm births average 12% in poor countries compared to 9% in higher income countries . In our population, it is also noticed a high rate of prematurity, which is consistent with most of the other studies  . In our study, 65% of preterm infants were boys, which is consistent with most other studies  and the cause of male predominance is not yet fully explained . We found that: the low socio-economic level, the low level of education, as well as geographic origin are important risk factors associated with preterm birth and this is consistent with other studies in the literature   . There is a correlation between primiparity and prematurity; a French study on the risk factors of prematurity, demonstrated that primiparity is a risk factor significantly linked to prematurity . Our study cannot claim to confirm or deny the impact of primiparity, but its rate high of 38.1% should be taken into consideration. This work also shows that suboptimal prenatal care and monitoring of pregnancy are significantly associated with the risk of prematurity. These results are confirmed by most of the data in the literature  . Hence the importance of insisting on improving the monitoring of pregnancies with regular monitoring of pregnancies at risk of prematurity. Maternal-fetal infections are also determining causes of prematurity . Maternal-fetal infection is retained as the cause of prematurity in 30% of cases, it represents the 1st cause. These infections should be systematically detected during pregnancy . The other risk factors remain dominated in our study as elsewhere by arterial hypertension (hypertension), pre-eclampsia  , obstetric factors such as the threat of preterm delivery (PAD) , cervico-isthmic open bite , isolated hemorrhages and gestational diabetes .
Thus, we must insist on: improving the monitoring of pregnancies with regular monitoring of pregnancies at risk of prematurity in a level III maternity; screening and treatment of the infection responsible for the majority of cases of prematurity in our series.
Insufficient monitoring of pregnancy, a factor closely linked to prematurity, results in the lack of a perinatal care system and a very strong social environment unfavorable, this is demonstrated by Blondel B. . Indeed, the analysis of our results shows that the absence of pregnancy follow-up was frequently attributable to the low socioeconomic status of parturients, or their rural origin, given that the concept of pregnancy monitoring for these mothers was difficult to assimilate.
The low level of education, the poor follow-up of pregnancy, genitourinary infections, hypertension, pre-eclampsia, PAD, and isolated hemorrhages, are associated with an increased chance of preterm birth, while the combination of adverse socio-economic risk factors appears to have a cumulative effect on the risks of prematurity. Large retrospective and prospective studies at the national level are needed to determine the exact prevalence and other risk factors for prematurity in Morocco.
 Ananth, C.V. and Vintzileos, A.M. (2006) Epidemiology of Preterm Birth and Its Clinical Subtypes. The Journal of Maternal-Fetal & Neonatal Medicine, 19, 773-782. https://doi.org/10.1080/14767050600965882
 Blencowe, H., Cousens, S., Oestergaard, M., Chou, D., Moller, A.B., Narwal, R., et al. (2012) National, Regional and Worldwide Estimates of Preterm Birth. Lancet, 9, 2162-2172. https://doi.org/10.1016/S0140-6736(12)60820-4
 Zeitlin, J., Saurel-Cubizolles, M.J., De Mouzon, J., Rivera, L., Ancel, P.Y., Blondel, B., et al. (2002) Fetal Sex and Premature Birth: Are Men More at Risk? Hum Reprod, 17, 2762-2728. https://doi.org/10.1093/humrep/17.10.2762
 Cooperstock, M. and Campbell, J. (1996) Male Excess in Premature Infants: Interactions with Gestational Age, Race and Multiple Births. Obstetrics & Gynecology, 88, 189-193. https://doi.org/10.1016/0029-7844(96)00106-8
 Torchin, H. and Ancel, P.Y. (2016) Epidemiology and Risk Factors for Prematurity. Journal de Gynécologie Obstétrique et Biologie de la Reproduction, 45, 1213-1230. https://doi.org/10.1016/j.jgyn.2016.09.013
 Ndiaye, O., Fall, A.L., Drame, A., Sylla, A., Gueye, M., Cisse, C.T., et al. (2006) Etiological Factors of Prematurity at the Regional Hospital Center of Ziguinchor Senegal. Bulletin de la Societe de Pathologie Exotique, 99, 113-114.
 Sullivan, K.M., Dean, A. and Soe, M.M. (2009) On Academics: OpenEpi: A Web-Based Epidemiologic and Statistical Calculator for Public Health. Public Health Reports, 124, 471-474. https://doi.org/10.1177/003335490912400320
 Foix-L’Helias, L., Ancel, P.Y. and Blondel, B. (2000) Risk Factors for Prematurity in France and Comparisons between Spontaneous Prematurity and Induced Prematurity. Journal de Gynécologie Obstétrie et Biologie de la Reproduction, 29, 55-65.
 Cisse, C.A.T., Tall Diaw, C., Sow, S., Bnouhoud, M., Dina, G., Martin, S.L., et al. (1998) Premature Childbirth: Epidemiology and Prognosis at the Dakar University Hospital. Journal of Obstetrics and Reproductive Biology, 27, 71-76.
 Ancel, P.Y. (1999) Epidemiology of Premature Rupture of Membranes. Risk Factors and Consequences in Terms of Health: Maternal, Neonatal and Early Childhood Morbidity and Mortality. Journal de Gynecologie, Obstetrique et Biologie de la Reproduction, 28, 607-625.
 Balaka, B., Baeta, S., Agbere, A.D., Boko, K., Kessie, K. and Assimadi, K. (2002) Risk Factors Associated with Prematurity at Lomé University Hospital in Togo. Le Bulletin de la Société de Pathologie Exotique, 95, 280-283.
 Blondel, B. and Marshall, B. (1998) Poor Antenatal Care in 20 French Districts: Risk Factors and Pregnancy Outcome. Journal of Epidemiology & Community Health, 52, 501-506. https://doi.org/10.1136/jech.52.8.501