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Scientific advances improve care for pregnant women and their infants

Even in this fast age of instant messages, pagers and cell phones, some things still take time – like the nine months it takes to complete a typical pregnancy. But even pregnancy has gone high-tech.

Of course there’s the much-publicized efforts such as in vitro fertilization, where couples use technology to get pregnant. Then there is the pregnancy itself. Advances in technology and research are also changing standards of care for pregnancy, labor, neonatal and postpartum care at an incredibly rapid pace.

“Prenatal counseling, maternal-fetal medicine, and neonatal care involve some of the most exciting frontiers in medicine,” said Robert Israel, professor of obstetrics and gynecology. “What is available today in terms of treatment and counseling is more sophisticated than what was available even five years ago.”

Israel and the physicians of the USC Perinatal Group, who run the perinatology and neonate programs at LAC+USC Women’s and Children’s Hospital, deliver state-of-the-art perinatal care at no-cost for USC employees on the USC Network Plan through their private practice at Good Samaritan Hospital.

The perinatologists – who offer pre-pregnancy counseling (including genetic counseling), prenatal care and delivery services-handle approximately 40 percent of all deliveries at Good Samaritan Hospital. This labor and delivery unit has grown from 60 deliveries a month ten years ago to about 290 deliveries per month today.

The most notable scientific advances, they said, are those that increase successful outcomes for high-risk pregnancies, which are the speciality of the experts of the USC Perinatal Group.

“The risk factors include advanced maternal age, multiple gestations, women with medical conditions such as diabetes mellitus, lupus or other autoimmune disorders-and then a smattering of obstetrical complications like premature membrane rupture,” said Deborah Wing, assistant professor of obstetrics and gynecology. “The outcomes are better in part due to technology and in part because we’ve learned how to better manage these cases from preconception through the postpartum period. We’re keeping the babies in utero and we’re turning over better babies because they’re healthier.”

The USC Perinatal Group does more than just diagnose problems in a pregnancy – member physicians actually follow pregnancies from preconception through birth.

And technology helps, too. For example, in the past seven years perinatologists have made wider use of corticosteriods in utero to enhance lung development in premature babies. “The drugs reduce the likelihood that the neonate suffers complications,” said Wing. “Postnatally that’s followed by use of surficant therapy to reduce respiratory insufficiency.”

One area of significant research focus is prenatal diagnosis, or “looking at different and less invasive ways to improve outcomes,” said Wing. Blood tests, for example, are improving in sensitivity and may become better for detecting problems than they have been in the past. In addition, “We’re looking at restructuring ultrasound techniques. The standard procedure now for a woman of advanced maternal age is ultrasound and amniocentesis between 15 and 20 weeks. But research has shown first trimester ultrasound and serum screening can be very effective for detecting some defects like Down’s syndrome.”

New ultrasonography-which would show three dimensional images instead of the standard two dimensions-also holds promise for better diagnosing, she said, but “widespread application of that technology is about a decade away.”

Some of the most rapid advances today have to do with prenatal genetic screening, said Giuliana Songster, associate professor of obstetrics and gynecology. One of the most common prenatal tests is chromosome analysis-the test to detect the extra chromosome that would indicate Down’s syndrome. But today, “There’s a very large number of genetic diseases that have genetic tests that can be tested for if there’s a known risk,” she said. “It’s nothing like running a chemistry panel when you’re hospitalized, but the field is moving so fast we don’t just have one printed list. We consult a genetic database-there’s always new tests being developed and made available.”

Disorders that can be screened prenatally today include cystic fibrosis, thalassemia and sickle cell anemia. “We offer genetic counseling for those who have a genetic disorder or family history to see if we can refine their risk,” she said.

The USC Perinatal Group is offering patients a chance to participate in a statewide study that may eventually eliminate the need for amniocentesis, at least when it comes to detecting Down’s syndrome. Participants who have already chosen to undergo amniocentesis also give urine and blood samples that are then tested for the hormone hyperglycosylated HCG that is high in pregnancies affected with Down’s syndrome.

“Since women undergoing amniocentesis are at risk for losing the pregnancy, it would be beneficial to be able to do the test less invasively,” said Songster. “They won’t have these results for a couple of years, but it might come down to being able to test for Down’s syndrome on urine specimens alone.”

Wing’s research interest involves the onset of labor. “We don’t really know what triggers labor,” she said. “We say the etiologies are multifactoral. There are many issues involved – for example, if a woman has a multiple or twin pregnancy, or a fetus with a birth defect, she is more likely to deliver early. Another example would be if a woman gets a serious infection in mid-pregnancy, she would be more likely to start labor.” A better understanding of what triggers the onset of labor, she said, might allow perinatologists to delay premature births.

USC employees interested in the services of the USC Perinatal Group should call: (213) 977-2385.

Scientific advances improve care for pregnant women and their infants

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