Recommendations to reduce the rates of preterm birth developed at the Wayne State University School of Medicine and the National Institutes of Health's Perinatology Research Branch were introduced as worldwide best practices in maternal-fetal health Thursday during the World Congress of the International Federation of Gynecology and Obstetrics in Vancouver.
Sonia Hassan, M.D., WSU associate dean for Maternal, Perinatal and Child Health, presented the recommendations on behalf of the Working Group on Best Practice in Maternal-Fetal Medicine for FIGO, the only global organization representing national societies of obstetricians and gynecologists. FIGO has member societies in 125 countries. The 21st FIGO World Congress is taking place in Vancouver Oct. 4-9.
Dr. Hassan, a professor of the Division of Maternal-Fetal Medicine in the WSU Department of Obstetrics and Gynecology, and director of the Center for Advanced Obstetrical Care and Research for the Perinatology Research Branch at WSU, was instrumental in developing the modalities now recommended as worldwide best practices for preterm birth prediction and prevention.
Those recommendations include:
- Sonographic cervical length screening through transvaginal ultrasound in all women between19 and 23 and 6/7 weeks pregnant. Researchers for WSU and the PRB found that women with a short cervix -- one that is less than or equal to 25 millimeters long -- are at risk for premature birth.
- Women with a cervical length less than or equal to 25 mm should be treated with daily vaginal progesterone for the prevention of preterm birth and neonatal morbidity. In 2011, the team at the Perinatology Research Branch, led by Roberto Romero, M.D., D.Med.Sci., and housed at WSU and the Detroit Medical Center, discovered that the use of progesterone in mothers identified as at risk for premature birth cut that risk by nearly half. The study showed that the rate of preterm delivery in women less than 33 weeks into their pregnancy can be reduced by 45 percent by treating the women with a low-cost gel of natural progesterone. The inexpensive gel is applied by the mother intravaginally daily.
- The Working Group on Best Practice declared universal cervical length screening and vaginal progesterone is a cost-effective model for the prevention of preterm birth.
- In cases in which transvaginal ultrasound is not available, other methods to assess cervical length can be considered.
At least 15 million babies worldwide are born prematurely each year, and preterm birth-related deaths are one of the leading causes of infant mortality, killing more than 1 million babies annually. According to the World Health Organization, the rate of preterm births across 184 countries in 2014 ranged from 5 percent to 18 percent.
"Despite decades of research, high rates of preterm birth and infant mortality persist in both high- and low-resource countries," said Gian Carlo Di Renzo, M.D., Ph.D., honorary secretary of FIGO and chair of the FIGO Working Group on Best Practice in Maternal-Fetal Medicine. He is professor and chair of the University of Perugia, Italy, and director of the university's Reproductive and Perinatal Medicine Center. "We now have the scientific methods to greatly reduce the rates of preterm birth around the world."
The WHO reports that more than three-quarters of babies born prematurely can be saved by implementing treatments such as those recommended by FIGO. While more than 60 percent of preterm births take place in Africa and South Asia, the problem is global. Even in higher-income countries, the rate of preterm birth hovers at 9 percent. Among the 10 countries with the greatest number of preterm births, India ranks first, while the United States ranks sixth.
"Thanks to the dedicated work of the researchers at Wayne State University and the Perinatology Research Branch, we have the necessary therapies to reduce the scourge of preterm birth around the world," said Jack D. Sobel, M.D., dean of the Wayne State University School of Medicine. "Now we must convince governments to support and implement these methods to save hundreds of thousands of lives."
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