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Risk assessment and treatment plan for reducing the risk of preterm birth

Building 2 (Sukhumvit Wing), 1st Floor
Daily (7 days /week) - 07:00-22:00
66 (0) 2 022 2255-6
svhobgyn@samitivej.co.th

Clinical outcomes:

  • With the 3P Concept, the risk of preterm birth is reduced by 50% (compared to the WHO’s target).
  • Genetic diseases can be prevented with pre-pregnancy screening (99% accuracy)

 

The Samitivej Sukhumvit Hospital has an extensive team of Maternal Fetal Medicine specialists with expertise and experience in caring for pregnant women with a high risk of complications. The team is specialized in administering preventive care to reduce the risks of premature births because these risks are the cause of the most serious complications during pregnancy.

The Preterm Prevention Clinic will assess your condition and plan adequate treatment to reduce the risks of a premature birth. We hope to help prevent cases of premature births and in turn create a model for preterm preventative care.

Preterm Birth is when an infant is born before 37 weeks of pregnancy. The risk factors that can lead to preterm births are: a history of preterm births, short cervical length, being pregnant with twins, or medical complications, such as high blood pressure, SLE (Lupus) disease, and diabetes.

Preterm births are the most common cause of neonatal deaths, as well as both short-term and long-term complications. A child born preterm is at risk of respiratory disease, brain hemorrhage, intestinal problems, blindness and slowed development.

Care Guidelines

Protocols for the 3 P’s Concept

  1. Prediction. This starts with a thorough background history check. If it is found that the patient has a history of preterm births, we will immediately place them into the high-risk category.In addition to this, all pregnant women will undergo screening that includes having the length of their cervix measured using a transvaginal ultrasound scan. If the length of the cervix is less than or equal to 25 millimeters, this is a warning sign that the mother is at risk of a preterm birth. The standard cervix measurement is taken at 16-24 weeks into the pregnancy, but from past experience, we have found that the measurement can actually be taken at 12-13 weeks. The benefit of measuring at 12 weeks is that we can also see if there is sediment (amniotic fluid ‘sludge’) in the uterine cavity, which may indicate a problem. If we perform an ultrasound at 12-13 weeks, we can see any sediment clearly, then immediately administer medication to reduce the inflammation and the risk of a preterm birth. If left untreated, there is the possibility of a preterm birth.We also provide a swab test to monitor for fetal fibronectin. This is a substance that is found between the amniotic sac and the endometrium. The contractions of the uterus cause this substance to be created in the vagina. If it is detected, it indicates that the mother is likely to give birth prematurely.
  2. Prevention. Once we come across a patient with any of these risk factors, we will administer natural progesterone medication to prevent uterine contractions. In some cases, the natural progesterone medication does not bring about a positive outcome and the patient may still have a short cervix length. In this case, we will use a cervical pessary or cervical cerclage to increase the strength of the cervix. Nowadays, the ‘cervical pessary’ choice is far more popular as it is more convenient and much cheaper. After the procedure, the patient can go home immediately.
  3. Health Promotion This method is used when the first 2 methods have no positive outcome and the patient still feels pain during preterm labor. We will issue medication to stop the uterine contractions and delay labor for at least 48 hours. We will then issue steroids to stimulate the lungs of the infant and prevent brain hemorrhaging. Only then will we allow the infant to be born and enter preterm natal care in the NICU room. Fitted with the latest medical equipment, specially developed for treating newborns requiring intensive care, the NICU room is also staffed by neonatologists whose expertise lies in the care of newborn infants. In addition to all of this, The Preterm Prevention Clinic will also continue to monitor the situation of the prematurely born infant by performing regular checkups and evaluating the growth of the infant.

Genetic Screening/Testing (Precise and Personalized Medicine)

  • Check for genetic disease carriers in couples considering having a baby
  • Check for genetic causes of infertility
    • Genetic Testing of Infertile Couples
      • Pre-pregnancy genetic screening: with the autosomal recessive and X-linked screening, the at-risk couple detection rate is 3.4%.
      • Pre-implantation diagnosis or PGD (NGS): embryos are screened for recessive genetic conditions before implantation, so that future children are free of genetic problems with an accuracy rate of 95%.
      • Pre-implantation screening or PGS (NGS): screening embryos for chromosomal abnormalities can increase pregnancy rates (from 30% to 55%) and detect the chromosomal abnormalities present in more than 50% of embryos.
      • Embryo selection: using Mitochondrial DNA content as a viability score in embryos can increase the implantation rate from 0% to 59-81%.
      • Endometrium receptivity analysis (238 gene expression): 25% of women were found to have a non-receptive uterine lining at a time it was expected to be receptive, causing a pregnancy rate reduction by half and leading to a 100% chance of miscarriage.
      • Gene testing in infertility (in process): finding the cause of infertility through genetic testing.
    • Immunological infertility issues causing implantation failure and recurrent miscarriage:
      • Autoimmune antibodies: anti-thyroid peroxidase, ANA, anti-mitochondria antibodies (in process)
      • Thrombophilia screening
      • Immune tests:
        1. Natural killer cell assay and immune-phenotype
        2. Th1 (T helper 1) / Th2 (T helper 2) intracellular cytokine ratios (Successful pregnancy rate 39%)
  • Check for genetic diseases in the unborn fetus
    • Pre-pregnancy or early pregnancy genetic screening: autosomal recessive and X-linked screening
    • Non-invasive prenatal testing: testing of cell-free fetal DNA in the maternal plasma for Down’s syndrome
    • Prenatal Diagnosis (PND): Chorionic Villus Sampling (CVS), Amniocentesis, Cordocentesis
    • Karyotyping / Chromosomal Microarray Analysis (CMA) / Next Generation Sequencing (NGS)
    • Genetic Diagnosis in Fetus: whole exome sequencing, whole genome sequencing (research)
  • Check the immune system of those with infertility and who experience failed embryo transfers and repeated miscarriages

A Maternal Fetal Medicine Specialists team

About Preterm Birth


For women who are thinking of starting a family or have been trying to conceive, Samitivej Pregnancy Care offers a predictive and preventive approach through precise and personalized medicine, making certain that every step from conception to birth is as smooth, safe and healthy as possible. … Learn more


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