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Prevention of Prematurity - transcript
From 23rd Annual Society for Maternal-Fetal
Medicine (SMFM) Conference held in San Francisco, California - February
2003
Prevention of Prematurity
Vincenzo Berghella, MD interviewed by Hans van der Slikke, MD, PhD
Hans van der Slikke, MD, PhD: “It is the 6th of February. We are at the meeting of The Society for Maternal Fetal Medicine in San Francisco and next to me is Vincenzo Berghella from Jefferson’s, Philadelphia; welcome Vincenzo.”
Vincenzo Berghella, MD: “Thank you, good to be here.”
Hans van der Slikke, MD, PhD: “Yesterday we had a terrific afternoon session about prematurity, pre-term labour and you were the chairman. You composed this meeting and you agreed to talk with us about some aspects and first we want to talk about the prevention of prematurity.”
Vincenzo Berghella, MD: “Yes, my idea for the meeting was to first approach the clinical aspect of pre-term births. I showed that pre-term birth actually is increasing in the US despite major research, and the clinician, I think, is frustrated at having to find preventative strategies and intervention therapies for the patient who is at risk for pre-term birth. I think that there are actually some methods that already have evidence, from randomised studies, that could prevent pre-term births. I talked first about the high risk woman, who has had maybe a premature birth in the past and how to approach that problem and also how to approach the problem of the woman who comes symptomatically to you with pre-term labour and how to approach that.”
Hans van der Slikke, MD, PhD: “Yes. So, there are several approaches and each woman has a different approach because you stated that pre-term labour is not a disease but it is a syndrome of all different kinds of diseases.”
Vincenzo Berghella, MD: “Yes. There’s two you know; my point was where we are today with pre-term birth, I think we’ve made a lot of progress actually despite the incidence of pre-term birth increasing. We understand that it is just a common pathway of many different aetiologies with many different associations and different women at risk for pre-term birth should be treated differently. There are going to be specific markers and we are discovering more and more of those risk factors, again associations that hopefully will focus on different little groups of women for which we’ll have a specific therapy or maybe sometimes more than one specific therapy. For example, if we have a woman that we know smokes, has had a prior pre-term birth and that woman has no other risk factors, we should probably, let’s say, not place a cerclage or put her at bed rest but maybe focus on those risk factors and do a very aggressive cessation advice for smoking. And we would consider some of these newer therapies coming around, like progesterone, omega 3 fatty acids or other interventions to prevent her going not only to pre-term birth but even into symptomatic pre-term labour and pre-prom.”
Hans van der Slikke, MD, PhD: “Where do you think we can have the most success? Which are the risk factors which are the most important?”
Vincenzo Berghella, MD: “Again, it is estimated that in 10% to 15% smoking is related to pre-term birth. For example, if we could decrease the incidence of smoking in pregnancy, there will be a tremendous success both preconceptually, and to the woman who comes and wants advice for her getting pregnant and we should give her advice about stopping smoking and that at each phase during the pregnancy, just like measuring blood pressure, we should tell her about how to stop smoking, giving her written material, giving her oral material. If there is a program that we like, send her to that and kind of relentlessly tell her about that risk factor. There is also good information that screening, for example, for asymptomatic bacteriuria, for bacteria in the urine. If you find bacteria that’s certainly associated with an increased risk for pre-term birth and if you give antibiotics, that would certainly decrease that risk. So those are two easy, not really any fancy, kind of protocols, that you can implement in any of your clinics and prevent pre-term birth in any population.”
Hans van der Slikke, MD, PhD: “What is the status now about vaginal infections, like
garderella vaginalis and other conditions?”
Vincenzo Berghella, MD: “Yes, there is certainly an association between bacterial vaginosis, Trichomoniasis and other infections. Unfortunately, the intervention studies using antibiotics have not been shown to really prevent pre-term birth, at least not as much as we were expecting. There is a trend, if you put a lot of the randomised studies together, if there is somebody for example who has bacterial vaginosis and a prior pre-term birth, there seems to be a trend towards the benefit of getting metronidazole treatment for that woman. But it is not sufficient yet to reach statistical significance, so I think further research needs to be done in that area.”
Hans van der Slikke, MD, PhD: “Okay, thank you very much.”
Vincenzo Berghella, MD: “You’re welcome.”
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