Preterm Labor:  Prevention is Key

Preterm labor occurs before the 37^th week of a 40 week pregnancy which accounts for approximately 12 percent of all births (1 in 8) in the U.S. These premature deliveries make up approximately 70 percent of all neonatal deaths and is a growing problem among women.  Babies born early are at higher risk of longer hospitalization, having long-term health and developmental problems and of dying than babies born at full term.  The financial implications of a preterm delivery are great as well due to excessive hospital costs and lost wages from time off of work.  No one knows what exactly causes preterm labor but early and consistent prenatal care as well as identifying possible risk factors associated with preterm labor go a long way toward preventing preterm labor and delivery.

Preterm labor can happen to any woman but three groups of women have been identified as being at greatest risk.  These groups include women who have had a previous preterm birth, women who are pregnant with twins or triplets, and women with known uterine or cervical abnormalities such as fibroid tumors, a septated or heart shaped uterus, and past surgery on the uterus or cervix.  Other factors thought to increase a woman’s risk include urinary tract or vaginal infection, vaginal bleeding during pregnancy, excessive or infected amniotic fluid, pregnancy before age 17 and after 35, multiple miscarriages or abortions, stressful life events or domestic violence. Having preexisting health problems such as high blood pressure, diabetes, and clotting disorders as well as smoking and illicit drug use can also put a woman at risk.  In addition, obesity, being underweight before pregnancy, less than 6-9 months since a previous pregnancy, and certain birth defects in the baby can lead to preterm delivery.  Identifying risk factors is always helpful bit it should be said that only half the women who have preterm labor actually have a known risk factor.

 Signs of preterm labor include all or some of the following:  persistent contractions (abdominal tightening) every 10 minutes, leaking of fluid or bleeding from the vagina, pelvic pressure, a low, dull back ache, and cramping.  Medical attention should be sought quickly as this will improve the chances that mom and baby will do well.  Medications can sometimes be given to slow or stop labor if they are given early enough and corticosteroids can be given to baby to help speed lung and brain maturity in anticipation of a premature birth.  In addition, there is a new medication called 17P that can be given in weekly injections in certain high-risk women that shows promise for decreasing the incidence of preterm labor and delivery.

There are two commonly used markers used to help predict preterm labor.  The first is assessing cervical length by ultrasound. This is frequently used in high risk patients to look for early shortening or dilation of the cervix.  A less frequently used method tests vaginal secretions for a substance called fetal fibronectin, a protein found typically before 20 weeks of pregnancy then not again until just before the onset of labor.  A positive fetal fibronectin screen would predict the imminent onset of preterm labor.

 Although there are tests to help detect preterm labor, one can help prevent preterm birth by learning the symptoms of preterm labor.  It is important to get regular medical care both before and during pregnancy, stay well hydrated, get plenty of rest, and be watchful of any vaginal or urinary tract infections.  Finally, if you think you have risk factors associated with preterm labor and delivery, share them with your health care provider.   For more information preterm labor and birth, contact your healthcare provider or the March of Dimes.

Understanding Polycystic Ovary Syndrome 

Polycystic ovary syndrome (PCOS) is a condition caused when a woman’s hormones are not in balance, usually resulting in higher levels of androgens (“male” hormones) in her system. Its name comes from the fact that some women with PCOS have enlarged ovaries with many fluid-filled sacs or cysts.  These cysts form from chronic anovulation in which eggs mature in the ovary but are not released into the fallopian tube.  These small cysts are not cancer and are not harmful so do not need to be removed.

Approximately five to ten percent of adolescent girls and women have PCOS.  These women may have a number of symptoms that they may begin to notice during adolescent years, soon after women begin getting their periods.  The features of PCOS are different in each woman but may include:  less frequent or no menstrual periods and/or irregular bleeding; less frequent or no ovulation in which can lead to difficulty becoming pregnant; excessive hair growth (hirsutism) on the face, chest, abdomen, or back; and acne or oily skin.  Weight gain and obesity are present in approximately one half of women with PCOS.  Finally, impaired glucose tolerance and diabetes, high cholesterol and high blood pressure are common, all of which may increase the risk for heart disease over time.  Thinning hair and excessive skin tags in the neck and underarm areas are less common occurrences but are symptoms that may develop.

Diagnosing PCOS involves several steps. First, a health care provider will need to take a detailed history about the woman’s menstrual cycle and reproductive events.  Menstrual irregularity always accompanies PCOS and many women report having infertility or difficulty conceiving due to infrequent ovulations.  A physical exam should be performed and is very important in making a correct diagnosis.  A sampling of the uterine lining, called an endometrial biopsy may be performed to assess thickening of the endometrium.  Thickening of this lining, called hyperplasia, tells the practitioner if ovulation is occurring.  In addition, endometrial hyperplasia from persistent anovulation increases the woman’s risk for endometrial cancer if left untreated.  If the provider suspects PCOS he or she may want to draw labs, including a hormone panel to check ovarian function, cholesterol and insulin levels, as well as perform a pelvic ultrasound of the ovaries.  The diagnosis of PCOS does not require the presence of polycystic ovaries, however, this is common in approximately 80% of women with PCOS.

Although no cure exists, PCOS can be treated in several ways, often with excellent results.  Birth control pills are often prescribed to take control of ovarian function and reduce PCOS symptoms.  Birth control pills make the menstrual periods more regular, and reduce male hormones to normal levels which in turn helps clear acne and slow the growth of excess hair.  Regular exercise and a low-calorie diet can also help restore weight and reduce high lipid and insulin levels to normal which reduces the risk of heart disease and diabetes.  Most women see marked improvement after 6-12 weeks of dietary restriction and exercise. For women with PCOS who are having trouble becoming pregnant, medicines are available by prescription to help bring about ovulation, restore normal menstrual cycles, and improve chances of pregnancy. 

If you have irregular periods, excessive hair growth, are overweight, or having difficulty achieving pregnancy, you may have polycystic ovary syndrome. Contact us for an evaluation.

Cord Blood Banking

If you are having a baby, you may have noticed that there are many choices about baby’s birth that you need to think about.  From breast or bottle to epidural or natural childbirth, perhaps you should add whether or not to “bank” baby’s cord blood after delivery.

Chances are you have read about saving cord blood stem cells in magazines or you may know someone who has done it.  You may be unsure what cord blood is, and why or how it is done. 

Cord blood is the remaining blood from a baby’s umbilical cord and placenta after birth.  Cord blood is rich in stem cells, the same type of pure cells that create your baby’s organ tissue, blood, and immune system.  Stem cells are also found in bone marrow and the blood that circulates throughout the body; however, the cells from cord blood have unique qualities.  The cells from cord blood are eight to ten times more proliferative than those found in bone marrow so have the ability to regenerate into other types of cells in the body.  They are also immunologically immature so have a higher chance of matching between family members in the event that a loved one would need them.  In addition, these cells do not experience the same cell aging and virus exposure as adult stem cells so decrease the rate of transplant rejections.

A few years ago, cord blood was simply discarded as medical waste after birth. However, in the past few years, doctors have recognized that the stem cells have unique qualities which can be used in treatment of certain cancers.  The most common medical use is for transplantation in situations where bone marrow is considered.  Researchers believe that in the future, stem cells may be used to repair brain damage after stroke, repair spinal cord injuries, grow blood vessels, and treat diseases like leukemia, Alzheimer’s, Parkinson’s, and diabetes. 

Harvesting and banking cord blood is a fairly simple procedure that can be performed during vaginal or caesarian deliveries without disrupting the birthing process.  The doctor collects the cord blood with a special kit after the umbilical cord has been clamped.  The collection is not painful or risky to mother or baby.  The cord blood is collected then picked up by a cord blood bank employee or currier.  The cord blood is then processed in a laboratory to remove red blood cells, white blood cells, and is then frozen using liquid nitrogen where it can remain for an unlimited time.

While the future looks promising for cord blood, critics say that is a fairly expensive form of insurance and point to the uncertainty that a family will ever use the cord blood.  Most accredited cord blood banks charge between $1,200 and $1,500 for the enrollment, collection, and processing.  An annual maintenance fee of approximately $100 is expected for yearly storage.  Smaller, non-accredited banks will charge less, however, they may also offer lower-quality service.

According to research, the odds that a child will need to use his or her own stem cells for current uses is about 1:2,700, and the odds that a family member would need to use those cells are about 1:1,400.  These estimates do not include emerging treatments for disorders such as lupus, arthritis, nor for use in other undiscovered therapies.  For the many that collect the stem cells and do not need to use them, the biological insurance has given them peace of mind and consider it money well spent.  In light of the discoveries for the various uses of cord blood stem cells, it seems a shame to waste this irreplaceable biological material.  Even if collection and storage is out of your price range, consider the option to donate your baby’s cord blood to a blood cord registry for research or use by another individual. 

If you are interested in collecting and banking your baby’s cord blood, research policies, procedures, and contracts to ensure that you pick a reputable cord blood registry.  If this is a feasible process for you and you think you would look back and regret not saving your baby’s cord blood, then you should probably look into cord blood collection.  It could save a loved one’s life or even your own!