What to Expect When It’s Unexpected


Christopher Piccirillo                                                                                    February 2, 2016
281 Raleigh Street
Chapel Hill, NC 27514

Journal of the American Medical Association
Sarah Boyd
330 N Wabash
Chicago, IL 60611

Dear Ms. Boyd,

I am currently studying chemistry at the University of North Carolina at Chapel Hill and am considering pursuing a career in emergency medicine.  This has prompted my research of emergency medical treatment as well as its prevention.  Particularly, my focus is preterm birth prevention in high risk patients.  This research article, “What to Expect When It’s Unexpected,” will provide your publication with universally relevant medical research that will increase awareness of preventative methods among medical professionals and expectant mothers.

As a mother would know, giving birth is an extremely painful ordeal, but once her child has entered the world, and the mother holds him or her for the first time, all of the suffering and anguish seems to dissipate.  Unfortunately, this is not the case for all births.  Every year, more than 500,000 babies are born prematurely in the US alone, and the complications that arise from these cases can result in sustained suffering for both the child and mother.

Preterm birth (PTB) is considered to be any birth occurring before 37 weeks of gestation (time infant develops in the womb).  PTB not only threatens an infant’s probability of survival, but is detrimental to his or her quality of life.  Many premature babies suffer from mental retardation and physical disabilities such as cerebral palsy.  In the occurrence of a PTB, doctors can only respond to the aftermath.  In high risk patients, however, preventative methods are more effective, as they address the root of the problem before it occurs.  The rationale behind PTB prevention is like spilt milk.  If you remember to put away the carton, the milk will not spill.

Prevention of PTB can be organized into two major categories: primary and secondary prevention.  Primary prevention consists mainly of lifestyle habits that may reduce the risk of having a PTB, such as a balanced diet, while secondary prevention focuses on prolonging pregnancy in women who are at a higher risk of having a PTB.  High risk women include those who have had a PTB previously or are pregnant with multiples (i.e. more than one baby at once).  These patients are the focus of secondary prevention, patients like Nikki Fleming.

For the remainder of the article, Nikki’s story serves as a framework for conveying the methods of secondary prevention that are available.  In 2011, Nikki was prescribed 17P (a progesterone-based hormone) injections, a new method of secondary prevention recently approved by the FDA.  The weekly injections, though painful, prevented her from giving birth to her next two children prematurely.  Parts of her story appear intermittently throughout the article, serving as a means for discussing various research and methods of PTB prevention.  This includes the discussion of the synthetic drug relaxin, which was never approved due to the lack of evidence supporting its effectiveness.  For the majority of the article, successful research in this area is discussed, ranging from surgical procedures to progesterone injections.  In addition, the value of collaborative innovation in the medical field is demonstrated through the combination of separate treatments that resulted in a new and more effective PTB prevention method.

The article concludes by reflecting on the quality of life of Nikki’s children, a direct result of secondary prevention, thus providing a hope for readers who may be confronted with a similar situation.

I thank you for your consideration of this article as a piece in your upcoming publication.


Christopher Piccirillo


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