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Understanding Pregnancy Basics Could Make Childbirth Safer: Shots



Their research is still in early stages, but Kristin Myers (left), mechanical engineer, and Dr. Joy Vink, an OB-GYN, both at Columbia University, has already learned that cervical tissue is a more complicated blend of material than doctors ever realized.
                
                
                    
                    Adrienne Grunwald for NPR
                    
                

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Adrienne Grunwald for NPR
        
    

Their research is still in early stages, but Kristin Myers (left), mechanical engineer, and Dr. Joy Vink, an OB-GYN, both at Columbia University, has already learned that cervical tissue is a more complicated blend of material than doctors ever realized

Adrienne Grunwald for NPR
            
        

Brittney Crystal was just over 25 weeks pregnant when her water broke

It was her second pregnancy – the first had been rough, and the baby came early

To try to avoid a second premature birth, Dr . Joy-Sarah Vink, an obstetrician and co-director of the Preterm Birth Prevention Center at Columbia University Medical Center, arranged for Crystal to be transported by ambulance from her local Connecticut hospital to New York City, where Vink could direct her care [19659010] Scientists Search For Causes Of Preterm Birth And Better Ways To Test For Risk “/>

Two weeks later Crystal started having contractions. She was given magnesium sulphate to stop them, and made it through the night. Crystal believed there was a future for her coming baby, whom she had named Iris.

"I went to the mirror and I talked to Iris," Crystal says. "I said," you know, this was a rough day. "But then the next day comes and the sun comes up and we move forward." "

That evening, however, the contractions started again. Crystal was whisked into an operating room for a Cesarean section. She was a little under 28 weeks pregnant

"I think I knew before I opened my eyes that she had died," Crystal says, her voice cracking as she reaches for a tissue

Afterward, as she was recovering in the hospital and mourning the loss of Iris, Crystal and her family asked a lot of questions. Why can not you seal the amniotic sac if your water breaks early?

"And that's when Dr. Vink told us that, you know, rare diseases are cured in this day and age, but we do not know what triggers full-term labor , "Crystal recalls. "That just collectively blew away everyone in the room."

It was surprising but true. When it comes to pregnancy, research on some basic questions has stalled decades ago, Vink says. If a pregnancy is normal, it does not matter much. But when things go wrong, those gaps in knowledge become issues of life and death.

"It's a mind-boggling that in this day and age, we still do not understand [even] in a normal pregnancy how women go into labor – what triggers labor, "says Vink. "Because we do not understand the normal fundamental mechanisms, we can not tell how things go bad – and then how do we fix it when things go bad."

Crystal, for example, had undergone a procedure called cervical cerclage: Vink had stitched Crystal's cervix closed in hopes of preventing it from opening too soon. The technique has been around for over 40 years, and it's about the only treatment available for what doctors call "an incompetent cervix."

Most basic knowledge about pregnancy comes from research conducted in the 1940s, Vink says, and she's working hard to update that information.

She's focused first on the cervix, she says, if the doctors can get the cervix to stay closed in those final, crucial weeks of gestation, the baby will not be born too soon, even if the amniotic sac breaks.

"So, what is the cervix made out of? What proteins are there, what cells are there? How do they change in pregnancy?" she asks, laying out some of the unknowns. By the end of pregnancy, the woman's cervix goes from being stiff, like the tip of a nose, to very soft. But how

To help answer those questions, Vink and her graduate researchers are taking, for analysis, cervical tissue samples from women in her medical practice who have at different stages of pregnancy

One of her first findings, she says, is that the cervix is ​​not made mostly of collagen, as doctors long thought.

While Vink studies what the cervix is ​​made of, one of her college colleagues, mechanical engineer Kristin Myers, is trying to determine how it works

"I'm kind of an oddball in the department of obstetrics and gynecology, "Myers says. "I teach mechanics classes and design classes here at Columbia."

Myers got her start as an undergraduate, doing research in the automotive industry.

(Left) Myers shows Vink 3D computer simulations of the cervix. (Right) Vink pipettes solution into slides containing cervical smooth muscle cells. Understanding the forces that lead to a healthy cervix can be key to preventing some premature births.
                
                
                    
                    Adrienne Grunwald for NPR
                    
                

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Adrienne Grunwald for NPR
        
    

(Left) Myers shows Vink 3D computer simulations of the cervix. (Right) Vink pipettes solution into slides containing cervical smooth muscle cells.

Adrienne Grunwald for NPR is the key to the prevention of some premature births.
            
        

"So if you take the rubber and you warm it up and you pull it, it gets really, really soft – and then it breaks," Myers says.

That reaction reminded her adviser of how a bulging aneurysm bursts . He suggested that she focus her curiosity on the mechanics of the human body. When she came to MIT for her graduate studies, Myers worked with researchers who were interested in the mechanics of pregnancy.

"It's an important area – an understudied area – and a basic part of pregnancy physiology," Dr. Michael House, an OB-GYN at Tufts University who also has a background in engineering. "There is just a lot to learn."

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

About 1 in 10 babies are born prematurely in the U.S. every year. If these babies are born near term – after about 35 weeks – they can do pretty well. But a woman with a problematic cervix can go into labor much sooner, which can lead to miscarriage or a baby born so early that the child may die or face lifelong health problems

Myers is investigating several aspects of the [19659040] biomechanics of pregnancy – how much the uterus can stretch, how much pressure pregnancy exerts on the cervix, how much force a child's kick puts on the whole system.

"We're building computational models of female pregnancy to answer those questions, "Myers says.

She has two labs at Columbia – one at the hospital and one in the engineering school. In the lab at the engineering school there are a variety of microscopes and scalpels and slides. There is one machine that can inflate the uterine membranes like a balloon, and another, about the size of a microwave that stretches the uterine tissue between two grips

"These [are] types of machines you'll see in all sorts of material testing labs, "Myers explains. "In civil engineering you can have one of these machines that is like two or three stories high and they are testing the mechanical strength of, [say]railroad ties."

She is measuring just how much the cervical tissue changes

"We've mechanically tested various pregnant tissues and non-pregnant tissues of the cervix," Myers says, and its stiffness changes by three orders of magnitude. "

Vink reviews images of smooth muscle cells that her team has isolated from cervical biopsies taken from pregnant women at different stages of pregnancy. The stiffness of the cervix changes by "three orders of magnitude" over nine months, Myer has found.
                
                
                    
                    Adrienne Grunwald for NPR
                    
                

hide caption

toggle caption

Adrienne Grunwald for NPR
        
    

Vink reviews images of smooth muscle cells that her team isolated from cervical biopsies taken from pregnant women at different stages of pregnancy.

Adrienne Grunwald for NPR, Myer has found the stiffness of the cervix changes by "three orders of magnitude" over nine months.
            
        

All those measurements go into a database. And when women in Vink's practice get an ultrasound, the technicians spend an extra few minutes measuring the mother's anatomy as well as the baby's, and send that information to Myers, too

Then the team uses their computer models to look at how the various factors shape, stretch, pressure and tissue strength – interact as a woman moves toward labor and childbirth

Their goal is to be able to examine a pregnant woman early on, and accurately predict whether she will go into work too soon.

That's what Brittney Crystal is aiming for as well. It's a first step, Vink hopes, to better interventions to stop that labor. After baby Iris died, Crystal started a foundation called The Iris Fund, which raised more than $ 150,000 for Vink's and Meyers' research.

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


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