There can be nothing more wonderful than the gift of new life. A woman carries her unborn through gestation, births, nurtures and cares for her offspring through their growth, development until adulthood. This is not an ideal fantasy, it is a picture of reality, a picture of reality that plays out millions of times a year in every corner of the world.Â
According to the United Nations, around 140 million babies are brought into this world every year. Sadly, a small proportion of these births do not fit into the ideal picture of bringing new life to excitedly expectant parents. It is estimated that, every year, almost 13.5 million babies are born preterm. The United Nations also reports that almost a million of these innocents are still born.
This sad reality is, at least partially, avoidable, through preventative prenatal care. Modern medical science enables skilled physicians to identify high, and at risk, expectant mothers. These diagnostics allow for the correct monitoring, and interventive treatment to aid expectant mothers to carry full term, and to give preterm babies the best chance to grow strong, healthy and to develop fully through childhood.
With these goals in mind, Samitivej Hospital established their Preterm Prevention Clinic in Bangkok. The clinic is a state-of-the-art facility staffed by highly skilled, specialist doctors, nurses and support staff dedicated to reducing the numbers of preterm births and to ensure the health and wellbeing of early born babies.
The 3P Concept
With their goal to reduce the numbers, and effects, of preterm births, the clinic has adopted their 3P concept. The 3Ps being Prediction. Prevention. Promotion of health. This logical 3 step approach has enabled the clinic to reduce the numbers of preterm births, and the negative health effects that it can inflict upon newborns.
Prediction
In any aspect of medical care, prevention is always better than cure, and never is it truer than when it applies to expectant or prospective mothers. This begins with predicting the possibility of conditions that puts an expectant mother into a risk category. Initially, a detailed background analysis of the woman’s health history, and that of any family history of preterm births.
Following this, a thorough physical examination is conducted, this includes screening of the woman’s cervix. Studies have shown that a cervix of less than 25 millimeters in length severely increases the risk of a preterm birth. Traditionally this screening would be undertaken between 16 and 24 weeks of gestation. However, and unlike many other similar facilities, Samitivej’s Preterm Prevention Clinic is now able to accurately measure the cervix from 12 weeks.
Having the ability to accurately screen the cervix much earlier also enables the clinic to ascertain whether any sediment of the amniotic fluid has settled in the uterine cavity. Should that be the case, medication can then be prescribed to counter the possible negative effects that this can cause.
A swab test will also be carried out to detect any signs of fetal fibronectin, or fFn. This is a protein produced by the cells within the fetus and maintain the attachment of the amniotic sac to the uterine wall. Should there be a positive indication of fFn in the vagina, then there is a high risk of preterm birth. Consequently, this will require closer monitoring for the expectant mother.
Should any of these issues be apparently nullifying, or at least minimizing the possible problems they can cause, is immediately treated. Initially, this will be done by prescribing natural progesterone. This is a steroid hormone that is produced during the early part of pregnancy and acts to prevent uterine contractions. Administering progesterone can reduce preterm birth risk by up to 50%.
Should progesterone fail to have a positive effect on the cervix the clinic’s doctors may opt for the use of a cervical pessary. This is a device specially designed to support the cervix during pregnancy. Alternatively, the doctors may recommend a cervical cerclage. This involves the physical closing of the cervix by stitching it shut.
Babies will also undergo screening for genetic disorders during the first trimester. This is conducted via fetal ultrasound and mother’s blood testing. Baby will be checked for any chromosomal abnormalities, including Downs, Edwards, and Jacobs syndrome.
Genetic disorders will also be highlighted, some of which are Marfan syndrome, hemophilia, sickle cell anemia, cystic fibrosis, and Tay-Sachs disease. The other conditions that the clinic’s team will test for are albinism, spina bifida, Turner syndrome and von Willebrand Disease. Additionally, Duchenne muscular dystrophy, thalassemia and polycystic kidney disease will also be detected by the clinic’s comprehensive screening program.
Promotion of Health
Should any of the preventative procedures fail to abate preterm contractions the medical team at the clinic will administer medication that will cause the uterine contractions to cease. This will result in a minimum of a 48-hour delay in full on labor. During this time both expectant mother and unborn baby will be closely monitored.
This delay is necessary for the medical team to administer steroids to the unborn child. Commonly, the corticosteroids dexamethasone and betamethasone are those that are prescribed. The steroids are able to cross the placenta and stimulate baby’s lungs, thus avoiding any hemorrhaging in the brain.
Following this delay, and the vital treatment of the unborn child, the mother will be allowed to go into full labor and give birth in the normal way. Concluding the successful birth, the baby will be moved directly to the neonatal intensive care unit, or NICU, and given over to the care of the specialist neonatologists.
As would be expected, the NICU at Samitivej’s Preterm Prevention Clinic is a facility that is second to none. All necessary equipment is on hand, which includes radiant warmers, phototherapy machines, incubators, neonatal ventilators, and bubble CPAP. CPAP bubble continuous positive airway pressure which is a non-invasive method of respiratory support for those newborns experiencing any level of difficulty with their respiratory function.
Not only is the NICU facility fitted with the most up to date, and most technologically advanced equipment, it is staffed by a team of highly skilled neonatologists and support staff. For any preterm baby, this melding of technology and skills means there is no safer place for preterm babies.
