Flood K, Malone FD, Elsevier. 2011. Prevention of preterm birth Seminars in Fetal and Neonatal Medicine [Internet]. Seminars in Fetal and Neonatal Medicine [Internet] Volume 17:59–61. Available from: http://www.sciencedirect.com/science/article/pii/S1744165X11000898
Dr. Karen Flood and Dr. Fergal D Malone are both very accomplished physicians and specialists in the field of obstetrics and gynecology. Malone is an associate professor on this subject at Columbia University’s College of Physicians and Surgeons and Flood is currently the head doctor for the early pregnancy service and recurrent pregnancy loss clinic.
In their journal article, Flood and Malone provide a detailed summary and analysis of preterm birth (PTB) prevention. Flood and Malone launch into a brief overview of primary prevention which includes the many lifestyle habits that increase a patient’s risk of PTB, however, the main focus of this article is methods of secondary prevention. Secondary prevention (cervical cerclage, progesterone injections, antibiotics and anti-inflammatory administration, and omega-3 intake) is aimed at preventing recurrent PTBs in women who have already experienced one, as previous PTBs increase the risk of future PTBs. The article analyzes each method, providing a historical background and the potential for research and improvement for each.
Flood and Malone have provided a useful resource for my research of the prevention of PTB in high risk patients, as this is the article’s main focus. The scope of the article is also refreshingly broad, ranging from cervical cerclage (stitching the cervix closed) that was first developed in the 1950s, to the administration of antibiotics that still requires more research. In this way, the article provides a sound, holistic analysis of these methods, enabling my research to display both a historical depth as well as the potential for innovation in the area.
The American College of Obstetricians and Gynecologists. (2013). 17P Plus Cerclage Decreases Preterm Labor Risk. Retrieved from http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/17P-Plus-Cerclage-Decreases-Preterm-Labor-Risk
Published by the American College of Obstetricians and Gynecologists (ACOG), this article reports recent findings presented at the ACOG’s Annual Clinical Meeting of 2013 that prove the effectiveness of coupling cervical cerclage (stitching the cervix closed) with injections of 17P (a progesterone-based hormone) in preventing PTB. It was Dr. Temming’s research that produced these positive results and the article discusses how her results were different than those of other studies, probably due to the fact that a majority of her participants were at a higher risk of PTB.
This article highlights the need for physicians and researchers to “think outside the box” and try combinations of methods. While my research is mainly focused on relaying information about PTB prevention to those at high risk, a secondary goal is to emphasize the importance of versatile thinking in the medical field and demonstrate to my audience that although medical breakthroughs are much like puzzles; we probably already have the pieces, but we need to research to figure out how they fit together. The fact that Dr. Temming’s research shows that such a method is most effective in high risk patients makes this article specific to my area of research as well.
TIME Magazine. (2011). Prolonging Pregnancy: New Drug Helps Prevent Premature Birth. Retrieved from http://healthland.time.com/2011/02/08/prolonging-pregnancy-new-drug-helps-prevent-premature-birth/
Bonnie Rochman is a freelance journalist who specializes in writing about pregnancy, fertility and parenting. She frequently writes articles for TIME magazine.
Rochman’s article in TIME was written in response to the FDA approval of Makena, another name for 17P (a progesterone-based hormone) that helps prevent PTB. To usher in the good news, Rochman uses the story of a mother who is at high risk of PTB after her first child was born prematurely. However, as a result of 17P injections, her next two children are born at 39 weeks (PTB is before 37 weeks). The article briefly discusses the biological implications of progesterone injections, revealing that progesterone is responsible for the strengthening of fetal membranes. However, this also leads to restrictions in who qualifies for this treatment, because, as Rochman points out, women who have multiples (e.g. twins), or do not have issues with their fetal membranes breaking too soon, are not eligible for the treatment. Rochman’s article is hopeful about this new treatment, but overtly states that new methods are still needed and that the issue of PTBs is nowhere near solved (only 2% of PTBs are estimated to be prevented by 17P).
This article is essential to my research, as it details the method of 17P administration and its effects in high risk pregnancies. This article in combination with the article 17P Plus Cerclage Decreases Preterm Labor Risk better equips my research to reflect the evolution of medicine in this area. Rochman’s hopeful anecdote/case study is also a useful framework for conveying the message of my research.
Stewart DR. 2011. Method of preventing premature delivery United States Patent Application Publication [Internet]. United States Patent Application Publication [Internet] 17:1–7, 12. Available from: https://docs.google.com/viewer?url=patentimages.storage.googleapis.com/pdfs/US20110166070.pdf
Dennis R Stewart is an inventor researching the use of synthetic hormones in PTB prevention.
In the background section of his paper, Stewart outlines the leading causes of PTB, such as previous PTBs, preterm labor or miscarriages, a multiple pregnancy (e.g. twins) and being younger than 18 or older than 35 years of age. He also details the various disabilities and complications that are either fatal to the premature infant, or leave them seriously disabled as a result of PTBs (e.g. mental retardation, cerebral palsy). In an attempt to patent the use of a protein-based hormone known as relaxin, Stewart explains how relaxin strengthens the cervix, and how a woman with a strong cervix will not be able to give birth, despite any uterine contractions she may be experiencing. Stewart also presents his surprising finding that such a hormone can prevent PTBs in humans, while inducing birth in animals. After giving a background and explanation of PTB and relaxin, Stewart outlines his experimental procedure and presents his results, which appear positive.
This paper is an excellent resource for my research, but only in its capacity to explain the various causes and consequences of PTB, thus providing my readers with a background knowledge of the topic. The actual results of the experiment with relaxin have been disputed by other sources. The author, Stewart, is also the inventor of the synthetic relaxin drug, and such bias does not permit this paper to be a credible source as far as relaxin administration is concerned.
Bain E, Heatley E, Crowther CA, Hsu K, Wiley. 2013. Relaxin for preventing preterm birth (Review) The Cochrane Collaboration [Internet]. The Cochrane Collaboration [Internet]:1–12. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010073.pub2/pdf
This review is one of many produced by the Cochrane Library for the sole purpose of providing the public with an informed view of the various medical methods of treatment available, as well as their effectiveness. The Cochrane Library’s reviews are internationally acclaimed as far as evidence-based health care is concerned.
This review provides a brief overview of the history of relaxin research and the many conflicting conclusions researchers have come to over the years. Some research seems to show that relaxin helps to prevent PTB, while other research refutes this claim. This paper seeks to holistically analyze the cumulative results of past research by evaluating it for bias. The methods used for each experimental trial are detailed, and the conclusion reached by the reviewers is that the majority of the trials contained instances of severe bias. The review contends that currently, there is not enough experimental evidence to either for or against the use of relaxin in the prevention of PTB.
Such a critical paper broadens the scope of my research, allowing me to conclude that Stewart’s patent application, Method of preventing premature delivery, is not entirely credible in its assessment of the effects of relaxin for PTB prevention. I can thus give my readership a snapshot of the medical history of PTB prevention in its ups and downs.