Understanding the basics of pregnancy could make childbirth safer: shots

Brittney Crystal was more than 25 weeks pregnant when her water broke.

It was her second pregnancy – the first had been rough and the baby arrived early.

To try to avoid a second premature birth, Dr. Joy-Sarah Vink, obstetrician and co-director of Columbia University Medical Center's Premature Birth Prevention Center, arranged for Crystal to be transported by ambulance from her home. Connecticut local hospital in New York. City, where Vink could direct his care.

Two weeks later, Crystal began to contract. She was given magnesium sulfate to stop them and she went through the night. Crystal thought that there was a future for her baby to come, that she had called Iris.

"I went in the mirror and talked to Iris," says Crystal. "I said:" You know, it was a tough day … you're going to have them, but the next day comes and the sun comes up and we move on. "

That night, however, the contractions resumed. Crystal was taken to an operating room for a cesarean section. She was pregnant less than 28 weeks old.

"I think I knew before I opened her eyes that she was dead," Crystal said, her voice breaking as she searched for a tissue.

Then, while she was recovering at the hospital and she was crying over the loss of Iris, Crystal and her family asked a lot of questions. Why can not you seal the amniotic bag if your water breaks early? Why can not you reliably stop premature labor?

"And that's when Dr. Vink told us that, you know, rare diseases are healing nowadays, but we do not know what triggers the work term," recalls Crystal. "It just collectively swept everyone in the room."

It was surprising but true. Regarding pregnancy, research on some fundamental issues has been stalled for decades, says Vink. If a pregnancy is normal, it does not matter. But when things go wrong, these gaps in knowledge become life and death problems.

"It is astonishing to note that in our time, we still do not understand [even] Vink explains, "As part of a normal pregnancy, women give birth – which triggers the work," he explains. "Because we do not understand normal fundamentals, we can not determine how things go wrong, or how to fix them when they deteriorate. "

Crystal, for example, had undergone a procedure called cervical cerclage: Vink had sewn Crystal's neck, closed in the hope of preventing it from opening too early. The technique has been around for over 40 years and is the only treatment available for what doctors call "an incompetent cervix". But most of the time, it's not enough to stop an untimely birth.

Most basic knowledge about pregnancy comes from research done in the 1940s, says Vink, and she works hard to update this information.

It focuses first on the cervix, because if doctors manage to keep the cervix closed during these crucial weeks of gestation, the baby will not be born too soon, even if the amniotic sac is torn.

"So, what is the cervix of the uterus? What are the proteins, what are the cells, how do these interactions interact, how do they evolve during pregnancy?" she asks, exposing some of the unknowns. At the end of pregnancy, the cervix becomes stiff, like the tip of the nose, and becomes very soft. But how?

To help answer these questions, Vink and her graduate researchers take samples of cervical tissue from women in her medical office at different stages of pregnancy for analysis.

One of her first discoveries, she says, is that the cervix is ​​not primarily made up of collagen, as doctors have thought for a long time. He also has a lot of muscle.

While Vink is studying the composition of the cervix, one of her university colleagues, Kristin Myers, a mechanical engineer, is trying to figure out how it works.

"I am a little weird in the department of obstetrics and gynecology," said Myers. "I teach mechanics and design courses here at Columbia."

Myers began her undergraduate studies as a materials researcher in the automotive industry. At the time, she tested the reaction of the tires to heat.

(Left) Myers shows Vink 3D simulations of the cervix. (Right) Pipette the Vink solution into slides containing cervical smooth muscle cells. Understanding the strengths that bring a healthy cervix to open and close at the right time can be critical in preventing some premature births.

Adrienne Grunwald for NPR

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(Left) Myers shows Vink 3D simulations of the cervix. (Right) Pipette the Vink solution into slides containing cervical smooth muscle cells. Understanding the strengths that bring a healthy cervix to open and close at the right time can be critical in preventing some premature births.

Adrienne Grunwald for NPR

"So, if you take rubber and heat it and shoot it, it becomes really soft – and then it breaks," says Myers.

This reaction reminded his counselor of how a bulging aneurysm erupts. He suggested that he focus his curiosity on the mechanisms of the human body. When she arrived at MIT for her graduate studies, Myers worked with researchers interested in the mechanisms of pregnancy.

"This is an important area – a little studied field – and a fundamental part of the physiology of pregnancy," says Dr. Michael House, an OB-GYN from Tufts University, who also has a background in engineering. "There is just a lot to learn."

House has been a mentor for Myers and continues to collaborate with her. He emphasizes that the focus on the cervix is ​​particularly important, "because a cervical problem can affect pregnancy very early".

About 1 in 10 babies is born prematurely in the United States every year. If these babies are born close to maturity, after about 35 weeks, they can very well succeed. But a woman with a problematic collar can get to work much sooner, which can lead to miscarriage or a baby born early that the child may die or face health problems for life.

Myers is studying several aspects of the Biomechanics of pregnancy – the extent of the uterus to stretch, from the pressure exerted by the pregnancy on the cervix to the uterus until the force exerted by the Kick a baby on the entire system.

"We are building computer models of female pregnancy to answer these questions," said Myers.

She has two labs in Columbia – one at the hospital and one at the engineering school. In the laboratory of the school of engineers, there are a variety of microscopes, scalpels and blades. One machine can inflate the uterine membranes like a balloon, and another, the size of a microwave, extends the uterine tissue between two handles.

"These [are] Myers explains, "In civil engineering, you can use one of these machines from a height of two or three floors and test the mechanical strength of, [say], railroad links. "

It measures how much cervical tissue changes during pregnancy – starting with the capacity and consistency of a tendon and becoming rather an elastic band.

"We have mechanically tested various gravid and non-pregnant cervical tissues," explains Myers, "and its rigidity changes by three orders of magnitude."

Vink examines images of smooth muscle cells that his team has isolated from cervical biopsies taken from pregnant women at different stages of pregnancy. The rigidity of the cervix changes by "three orders of magnitude" over nine months, Myer said.

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Vink examines images of smooth muscle cells that his team has isolated from cervical biopsies taken from pregnant women at different stages of pregnancy. The rigidity of the cervix changes by "three orders of magnitude" over nine months, Myer said.

Adrienne Grunwald for NPR

All these measures go into a database. And when Vink's women get an ultrasound, the technicians spend a few more minutes measuring the anatomy of the mother, as well as that of the baby, and sending that information to Myers as well.

Then the team uses their computer models to examine how the various factors – shape, stretching, pressure and strength of tissues – interact when the woman walks to work and delivery.

Their goal is to be able to quickly examine a pregnant woman and accurately predict whether she will give birth too soon. Vink hopes it is a first step towards better interventions to stop this work.

That's what Brittney Crystal also aims for. After the death of baby Iris, Crystal created a foundation called The Iris Fund, which raised more than $ 150,000 for research by Vink and Meyers.

"She did not have a life," Crystal says. "But we really want her to have a very strong legacy."