Small steps, big hopes | Action Medical Research

Touching Lives - November 2007

Small steps, big hopes

For many thousands of couples, having a baby will be far from easy and may end in tragedy, particularly if labour occurs prematurely. Not only will many babies spend a life-time coping with possible long-term effects of having been born too soon, but some will die and doctors may not be able to tell their parents why the pregnancy ended abruptly. Not knowing why something bad happens can be almost as painful as the experience itself. Mothers are left wondering if their next pregnancy will end the same way. Victoria Shiells is one such woman. Her first baby, Chloe, was born nine weeks early. Doctors told Victoria it was probably ‘just one of those things’ and today, Chloe is a healthy, bright six-year-old. So when Victoria and her husband Paul decided to try for a second baby, they assumed it would be straightforward.Victoria says, “I was told it would be unlikely that I’d have another premature baby but was offered the chance to participate in a research programme which meant I’d be scanned every two weeks.” Twenty-two weeks into her pregnancy,Victoria’s cervix (the neck of the womb that needs to open during birth) began to shorten and doctors began scanning her more frequently. “At 25 weeks, I began having some pains and was taken into hospital,” says Victoria. “I was put on complete bed rest until 27 weeks. It was awful, and with a small child at home who needed me, I became very depressed.” At 30 weeks,Victoria went into labour. From start to finish, she delivered her baby in just 20 minutes. Little Violet was just 2lb 14oz and was in intensive care for a week. Happily,Violet is now growing stronger every day and Victoria is pleased to report that her second daughter “has a fine pair of lungs and feeds a lot!” But after such experiences many women are nervous of having another child.Victoria says, “It has put me off having any more children. Maybe I’d change my mind if I knew I’d have a normal birth but when I was on bed rest, it was an awful waiting game. I didn’t know when the baby was going to be born and if it would be all right. I couldn’t face it all again.” Victoria is sure, however, that medical research is the way forward. “Taking part in the research programme helped me as I had regular scans and so in a way, we were prepared. Also, I hope the information that my experiences have provided will help someone else.”

Painful time

Cradling her gorgeous little boy, Kimani, no one would ever guess that Marsha Chung had overcome years of pain to reach motherhood. Marsha, 34, had been trying to conceive for 15 years when, in 2005, she finally gave birth to a daughter. But Marsha’s pregnancy had ended at just six months and the baby died. Marsha said: “She lived for half an hour and then we had to bury my little girl.” No one knew precisely what had triggered Marsha’s premature labour and for the woman who had so long dreamed of motherhood, there was no reassurance that any future pregnancies would be more successful. Eventually, in 2006, Marsha conceived through IVF but suffered a rare complication called ovarian hyperstimulation syndrome, which in severe cases can mean the pregnancy has to be terminated and may prove fatal for the mother. Marsha was admitted to hospital for treatment and then, after suffering heavy bleeding at 16 weeks of her pregnancy, was prescribed bed rest at home. “It was really scary,” recalls Marsha, “I just dared not move.” At 28 weeks, Marsha was diagnosed with gestational diabetes and required to make weekly trips to hospital. Finally, at 38 weeks, her pregnancy was induced and a healthy Kimani entered the world at 8lb 3oz.

Way forward

Marsha is in no doubt about the importance of medical research in helping women like her avoid similar traumas in future. In her second pregnancy, Marsha took part in the same research project as Victoria and from 14 weeks had been checked regularly at St Thomas’ Hospital in London. She now hopes that this information will help medical research to find some answers. “It would have meant so much to me to know what had caused the first premature birth,” she says.

Future hope

Two projects funded by Action Medical Research are among those which could provide future hope for women like Victoria and Marsha. The first, drawing together the skills of top clinicians from the Universities of Manchester,Warwick and Nottingham, could eventually lead to the development of new, targeted drugs which stop the womb from contracting too early on in pregnancy. Using a series of experiments on uterine samples taken at caesarean section, doctors found that oxygen byproducts called reactive oxygen species (ROS) can block some of the electrical messages in the muscle cells that are needed to cause labour contractions. In theory, some of the electrical messages which flow through pores in the cell (called potassium channels), could be blocked by drugs to slow down or stop contractions.The problem will now be for doctors to find out precisely how and which of the potassium channels in the body exclusively serve the uterus so that other organs are not stopped from working efficiently. Dr Michael Taggart, who was based at the University of Manchester during the study, says,”Maybe 20 years ago we could have tried potassium channel blockers to stop contractions, but the drugs were not specific enough and would have badly affected other organs as well.We hope our work provides a chink of light in contributing to drug therapy which is organ specific.” And Professor Steve Thornton of The University of Warwick comments, “This is very helpful work in that it boosts our understanding of the mechanisms that control the muscles of the uterus. Every piece of information like this helps to build up a clearer picture of a very complex process that should one day save babies’ lives.”

Infection

The second project, still on-going, is collecting data from women who have been through pre-term labour. Co-ordinated and overseen by Dr Rachel Tribe of King’s College London, from her base at St Thomas’ Hospital, the project is examining the role of infection in triggering pre-term labour.

Evidence base

Victoria and Marsha are among the many women whose experiences and medical data are helping to build up an evidence base that Dr Tribe hopes will help doctors to determine when and how to treat women at risk of going into early labour. “We know that some cases of preterm labour are associated with infection and inflammation,” says Dr Tribe. “But we don’t know the precise order of events. In some women, the cervix may suddenly shorten and allow bacteria to enter the womb. Or it might be that infection and inflammation in the vaginal tract cause the cervix to shorten in the first place.” Dr Tribe’s team is gathering data from pregnant women with a history of premature labour to determine whether the inflammation begins before or after the cervix shortens. “The results should help us to target women most at risk of going into preterm labour and discover the right treatments to prevent early delivery.” Working together over time, projects like these are supplying strand upon strand of knowledge that may slowly edge further towards the ultimate goal of eradicating premature birth. As Dr Taggart puts it, “It’s only from having enough people willing to be studied and enough long-term financial backing for projects, that advances will be made which will truly make a Violet and mum Victoria in hospital difference.” TL

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