Advancements help prevent preterm labor, recognize genetic abnormalities

2013-09-10T08:00:00Z 2013-09-13T12:16:06Z Advancements help prevent preterm labor, recognize genetic abnormalitiesChristine Bryant nwitimes.com
September 10, 2013 8:00 am  • 

Despite advancements in the medical field, more than half a million babies are born too soon in the United States.

According to the March of Dimes, this country's premature birth rate has risen by 36 percent over the last 25 years.

Those sobering numbers is a serious cause for concern, doctors say, especially because babies born early - even just a few weeks - are at a greater risk for health problems and disabilities.

However, recent innovations and educational campaigns in pregnancy care have focused on finding ways to bring more babies to full-term and discovering potential problems through genetic testing.

Preterm labor

"Preterm labor and birth has been an issue that has plagued obstetricians forever," said Dr. Dexter Arrington, an OB/GYN with Advocate South Suburban Hospital.

Although there are several risk factors for preterm labor and delivery, such as a history of pre-term birth, prior cervical surgery and persistent infections, not all cases have warnings.

Advancements in identifying biomarkers - measured characteristics that may indicate some biological state or condition - have helped physicians predict when a patient may be at increased risk of experiencing preterm labor.

During one test, for example, doctors collect secretions from the pregnant woman and test them to see if fetal fibronectin - thought of as the adhesive that binds the fetal sac to the uterine lining - is leaking.

"This test is especially helpful when combined with measurements of cervical length, which are obtained by ultrasound," Arrington said. "The use of these tools has increased in recent years and contribute greatly to allowing the obstetrician to identify those at risk for early delivery."

Elaine Merkel, director of the Women and Children's Pavilion at Porter Regional Hospital, said despite the medical conditions that occur in premature babies, some parents-to-be push their obstetricians into delivering their babies early.

November is Prematurity Awareness Month when the March of Dimes and other healthcare providers focus on the high number of preterm births in the United States. Many providers, like Merkel, are concerned with elective inductions and scheduled cesareans before reaching at least 39 weeks, especially considering premature birth is the No. 1 cause of newborn death in this country.

Recent initiatives nationwide, including at Porter Regional Hospital, have urged parents to wait until the baby is full-term.

"Elected preterm deliveries at Porter is 0 percent, unless there is a medical reason," Merkel said. "And this just isn't about Porter, so that is good."

Genetic advancements

Prenatal and preconception genetic testing also have seen recent advancements that have assisted physicians in spotting potential problems that can occur during pregnancy.

"The mainstay or gold standard for many years to determine if the developing fetus had a chromosomal abnormality has been the amniocentesis," Arrington said. "Although a procedure that has been done routinely for years, it still is not without risks."

Amniocentesis is typically performed between the 15th and 20th week of pregnancy. Performing the test any earlier can result in fetal injury.

Now, more doctors are using a number of blood tests that can be done early in pregnancy and are nearly 99 percent accurate in identifying similar chromosomal abnormalities, he said. These tests also can be done before a couple ever gets pregnant.

"If a couple has a family history of a hereditary condition, such as cystic fibrosis or sickle cell anemia, it is possible to perform testing prior to pregnancy to evaluate the couple and determine their risk for having a child with a similar condition."

Many patients wait until they are pregnant to consider evaluation for hereditary disorders they are aware of, Arrington said.

"I strongly encourage patients to be evaluated prior to conception to identify any factors that may place them at risk for having pre-term labor and/or an identifiable genetic abnormality," he said.

Evolution of C-section

Campaigns in the past few years have pushed for skin-to-skin contact immediately after birth.

Now, more doctors are encouraging skin-to-skin contact immediately after a C-section as well, Merkel said.

"Historically, C-sections were completely a surgical procedure," she said. "We now try to make it more like a birth experience."

Skin-to-skin contact allows the newborn baby to hear the mother's heartbeat, and helps the baby's temperature and breathing to stabilize, she said.

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