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Understanding Pregnancy Basics Can Make Childbirth Safer: Shots



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

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Adrienne Grunwald for NPR
        
    

Their research is still in the early stages, but Kristin Myers (left), a mechanical engineer, and Dr. Joy Vink, an OB-GYN, both at Columbia University, have already learned that cervical tissue is a more complicated mix of materials than doctors have 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 one was rough, and the baby came early.

To try to avoid 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 began having contractions. She was given magnesium sulfate to stop them, and made it through the night. Crystal believed there was a future for her coming baby, whom she named Iris.

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

That evening, however, the contractions began 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 was dead," 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 close the amniotic sac 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 being cured in this day and age, but we do not know what triggers full-time labor , "Crystal recalls." "It just collectively blown away everyone in the room."

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

"It's 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 the labor, "Vink says. "Because we do not understand the normal basic mechanisms, we can not figure out how things go bad – and then how we fix it when things go bad."

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

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

She's focused first on the cervix, she says, because if doctors can get the cervix to stay closed in those final, crucial nursing weeks, 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 interact in these things? How do they change in pregnancy?" she asks, laying out some of the unknowns. By the end of pregnancy, a woman's cervix goes from being stiff, like the tip of a nose, to very soft.

One of her first findings, she (she), is a woman who has been diagnosed with her pregnancy. says that the cervix is ​​not made mostly of collagen, as doctors have long thought.

While Vink studies what the cervix is ​​made of, one of her university 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 automobile 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 a healthy cervix to open and close at right times 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. Understanding the forces that lead a healthy cervix to open and close at right times can be key to preventing some premature births.

Adrienne Grunwald for NPR
            
        

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

That reaction reminded her adviser how a bulging aneurysm bursts . He suggested that she focus her curiosity on the mechanics of the human body. When she arrived at 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," says Dr. Michael House, an OB-GYN at Tufts University who also has a background in engineering. "There is just enough 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 gimbal problem can affect the pregnancy very early."

About 1 in 10 babies are born prematurely in the US. every year If these babies are born close to term – after about 35 weeks – they can do quite well. But a woman with a problematic cervix can go to work much sooner, which can lead to a 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 baby's kick puts in the whole system."

"We are building computational models of female pregnancy I will answer those questions, "Myers says.

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

"These [are] types of machines you will see in all different types 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're testing the mechanical strength of, [say]railroad ties."

She is measuring just how much the cervical tissue changes During pregnancy, starting with the capability and consistency of a tendon, and becoming something like a loose rubber band.

"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 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 the 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. The stiffness of the cervix changes by "three orders of magnitude" over the nine months Myer has found.

Adrienne Grunwald for NPR
            
        

All these measurements go into a databank. And when women in Vink's practice get an ultrasound, 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 to work too soon. It's a first step, Vink hopes, towards better interventions to stop that labor.

That's what Brittney Crystal is aiming for as well. 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 have a life," Crystal says. "But we really want her to have a very strong legacy."


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