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Maternal-fetal medicine: Innovation in preterm birth diagnostics

By Carl P. Weiner, MD, MBA, FACOG, maternal-fetal medicine

Carl WeinerIn 2014, one out of every 10 women delivered prematurely, or before 37 weeks of gestation.1 Preterm birth is the most significant cause of infant mortality, as well as a leading cause of long-term disabilities and neurological impairments in children.

Preventing preterm birth remains challenging. While testing is available, the standard predictive value for various risk factors associated with preterm labor is 18%. In addition, no current treatment has been shown to delay delivery more than 96 hours when compared to placebo.

New research developments offer accurate assessment

For the last seven years, my research has focused on identifying and interpreting biomarkers that interfere with normal uterine quiescence during pregnancy. These markers are related to the gestational age at which women deliver and can be identified as early as 12 weeks of pregnancy, rather than the standard 18-22 weeks. The biomarkers interact with specific genes altered only in the uterus of the mother destined for preterm birth, making it more susceptible to contraction.

Through research conducted at the Center for Advanced Fetal Care at the University of Kansas Medical Center, we have found that our diagnostic evaluation using these specific biomarkers can predict preterm birth with 95-100% accuracy at 12-18 weeks of pregnancy. Currently, there is no other mode of assessment that can identify the risk of preterm birth with this level of precision. In the future, we believe we will be able to predict the time window of delivery. By finding these markers early in a woman’s pregnancy, we can better prepare to ensure both mother and baby receive optimal care for maximum outcome.

Advancing the standard of care

Our effort to develop a better diagnostic tool that more accurately predicts preterm birth is just one example in which the Center for Advanced Fetal Care is pioneering a new standard of care in maternal-fetal medicine. Many current sophisticated fetal diagnostics and treatments were first performed here. In many cases, the Center for Advanced Fetal Care is the only facility in the Kansas City region to provide these complex services.

Our center was the first in the region to offer fetoscopy for direct visualization of the fetus. Intrauterine surgical procedures using laser on the umbilical cord and placenta are important steps forward in the treatment of severe complications of multiple pregnancies, such as twin-to-twin transfusion syndrome.

Our work has also contributed to the modern management of fetal alloimmune disease, the role of fetal viral infection in adverse fetal outcome and the application of fetal Doppler velocimetry in sequential vascular beds to fetal surveillance and diagnosis.

The Center for Advanced Fetal Care

The center provides advanced, comprehensive diagnostic testing and state-of-the-art fetal surgical or medical therapy. A team of six perinatologists works alongside sonographers, perinatal nurses and genetic counselors to provide a complete range of services in the evaluation and treatment of fetal abnormalities. Collectively, our team has more than 40 years of experience and has published more than 300 articles and several textbooks.

Dr. Weiner is an obstetrician-gynecologist at The University of Kansas Hospital. He is the K.E. Krantz professor and chair of the Department of Obstetrics and Gynecology at the University of Kansas Medical Center, where he is also professor of integrative and molecular physiology. He is the associate director of the Institute for Reproductive Health and Regenerative Medicine, and leads the Center for the Developmental Origins of Health and Disease.

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