“Indicated Preterm Birth” – with Dr. Jennifer Lam-Rachlin

One topic that isn’t often discussed about preterm birth and preterm labor is when it’s actually medically recommended in specific scenarios. Dr. Nathan Fox talks with Dr. Jennifer Lam-Rachlin about the delicate balance of determining the safest delivery date for both mother and baby in our continuing miniseries on preterm birth.

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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. All right, Dr. Jennifer Lam-Rachlin. Jen, welcome back to the podcast. How are you doing?
Dr. Lam-Rachlin: Doing great, thank you. How are you?
Dr. Fox: I’m good. Thank you for asking. We did see each other last night. We had a lovely dinner, which was great with us, and a bunch of doctors, which has the potential to be exceedingly boring. But this was actually a lot of fun, interesting people. We had a great time.
Dr. Lam-Rachlin: Because we talk about non-medicine stuff.
Dr. Fox: It appears that all of us, except for you, like to talk about our dogs. So, that was the one thing I noticed, you get to the point in life where you stop talking about your children and you talk about your dogs. I don’t know what that makes us, but whatever. It’s all good. But you’re still talking about your children, so I appreciate that. Good work.
Dr. Lam-Rachlin: I still have to make sure they’re alive. It does to talk about them.
Dr. Fox: And as I learned last night, your children are probably all just at the gym right now for the whole day for free babysitting.
Dr. Lam-Rachlin: Yes.
Dr. Fox: Jen’s got a secret for anyone. You can all email me offline, I’ll tell you her secret for having free babysitting for your kids at the local gym. Cool. But I digress. So, we’re gonna be talking today, you know, we’re doing a whole series on preterm birth. And, you know, a lot of people correctly think of preterm birth as preterm labor, and ruptured membranes, and that whole pathway, and process, and treatment, and prevention, and screening, and, you know, there’s a lot in prenatal care and obstetrics related to that. But there’s a whole sort of other winged in the preterm birth unit, which is called indicated preterm birth, and it doesn’t get as much attention or discussion. And I thought it’d be good for us to talk about that specifically to help our listeners understand, you know, what we’re talking about and why it might be different in terms of, all those same things, screening, treatment, prevention, and whatnot.
Dr. Lam-Rachlin: I agree. I think a lot of focus on patients worry about, you know, whether they’re going to go into spontaneous preterm labor. We kind of forget a little bit about other reasons that people deliver early that is not because they went into labor, but there was something going on with the pregnancy that puts either mom or the baby at risk where we have to deliver them early. And it’s a very important part, I think, of preterm deliveries and how to prevent that.
Dr. Fox: Yeah, I mean, preterm birth as, you know, anyone is listening to this podcast and going through this miniseries knows is, you know, delivery less than 37 weeks. And there definitely comes multiple times when we have to recommend someone get delivered under 37 weeks. Whether that means we induce the labor or do C-section, is not really relevant to the discussion today, you know, how we deliver but when we deliver. We say, “Listen, you know, you have to go get delivered pre-term.” And people are like, “What?” Like, “What are you talking about?”
And so, I think we should, you know, first of all, differentiate, that’s what we’re saying. You know, this is a concept where someone delivers early, not because they went into labor, not because their body sort of put them into labor, but because they’re sitting in a doctor’s office and one of us says, “You need to get delivered either today in your preterm, or we need to plan to deliver you preterm.” Again, there’s different situations which would require each of them. And that’s what we mean by indicated preterm birth, that it’s indicated you need to be delivered, at least for safety purposes, whether for the mother or baby. And we’ll get into that.
And, you know, I always found is interesting, there is some overlap between indicated and spontaneous preterm birth. People, you know, now, that we’ve sort of mentioned what they are, the difference between them and we’re separating them, there is actually a lot of interplay between those two.
Dr. Lam-Rachlin: Yeah, I agree. It’s not unusual when we see a patient for their subsequent pregnancy if they had this spontaneous preterm delivery and then they say, “Oh, but the baby was also very small or my blood pressure was very high.” And it’s hard to say that they’re all kind of isolated out of each other and that they’re not interrelated. And in those scenarios, I usually tell patients that, you know, sometimes the pregnancies are much smarter than we are. You know, if we don’t know to bail out, then we’ll just go into labor because…bail itself out, right?
Dr. Fox: Yeah, I mean, yes…
Dr. Lam-Rachlin: But those are the scenarios, right?
Dr. Fox: Yeah, I mean, so much of this is related to, you know, with the placenta, for example. So, if the placenta’s not working great, it can manifest as the baby being too small or maybe a blood pressure going up. And those might get to be profound enough that we say, “All right, you need to deliver.” But it also may just cause her body to say, “All right, you know, enough is enough, going into labor.” And in future pregnancies, one of the really fascinating sort of data that we’ve seen over the years is, everybody knows that if you have a history of a spontaneous pre-term birth and the next pregnancy you have an increased risk of a spontaneous preterm birth, but you also have an increased risk of an indicated pre-term birth. And the reverse is true, if you had an indicated preterm birth, you have an increased risk of a spontaneous preterm birth. And it sort of doesn’t make a ton of sense on the surface, but when you really get deep into all the reasons for preterm birth and all the complex pathways, it does make sense that this whole process of when a pregnancy’s “supposed to end,” it makes sense that they’d be related to each other.
Dr. Lam-Rachlin: Yeah, I agree with that. I think there’s more and more evidence that there’s some, at least some overlap, right? I wouldn’t say every single spontaneous preterm labor, there’s an overlap with some of these placental-related issues, but there’s multifactorial ideologies for why people go into labor early. And one of them could be these underlying, maybe placental, or some other factor that have such a big overlap with these medical indications for pre-term delivery, too.
Dr. Fox: Right. And we’re gonna go into specific diagnoses or specific reasons why we might recommend a preterm birth, you know, an indicated preterm birth. But just from a general level, like an overarching level, what is the concept? Like, why would we recommend someone get delivered, you know, a month early, five weeks early, whatever it is in the preterm period? Like, what would make us do that?
Dr. Lam-Rachlin: You know, it’s always the continuation of pregnancy versus delivery is a balance of a variety of risks, right? Like, there’s the risk of delivery and prematurity, and then off balanced by the risks to either the baby or the mom. So, generally, when we recommend an early delivery or preterm delivery as an indicated preterm delivery, it’s either because to continue the pregnancy is either too risky for the mom, or too risky for the baby, or too risky for both. And that’s off balanced by the minor risk maybe at that time of pre-maturity.
Dr. Fox: When we’re sort of training the medical students and residents. And one of the things I remember when I was trained is, at almost every prenatal visit, either consciously or subconsciously, we’re thinking, “Is it better to continue the pregnancy, you know, another week, another two weeks, another month, or to deliver?” Now, obviously, very early in pregnancy, that’s not really a decision. But as you get sort of at or past the due date, that’s always something we’re thinking. But if there are certain conditions going on, it becomes quite relevant. And when you think about continuing a pregnancy, right, from 34 weeks to 35 weeks to 36 weeks, the biggest benefit of getting more pregnant would be for the baby, right? Because the later the baby is born up to a certain point, there’s, you know, decreased risk of going to the NICU, decreased risk of complications, decreased risk of long-term complications for prematurity. Yeah. So, there’s a benefit.
But there’s always some level of risk of continuing pregnancy. There’s that sort of minuscule risk of stillbirth at baseline to the baby. There is always this sort of small risk of some upcoming health problem related to pregnancy for the mother. And generally, in a typical healthy pregnancy, those risks, those minuscule risks are outweighed by the benefit to the baby to stay pregnant. But when certain conditions come up or certain situations come up, those risks go up, whether it’s a risk to the mother, a risk to the baby. And now we’re like, “All right, we have to really start to get the scales out and decide, you know, this extra week, is that benefit really worth it compared to the risk?” And, obviously, it depends on how much benefit, how much risk. So, the earlier you are in pregnancy, there’s gonna be much more benefit to the baby staying pregnant versus later in pregnancy, and the condition will dictate how much risk to the mother or baby. So, it’s a really sort of complex calculation we always have to do when these conditions come up.
Dr. Lam-Rachlin: Yeah, I agree. I think subconsciously or consciously that have always the balance that we’re doing in as obstetrician [inaudible 00:08:59] when we see a patient telling them, “You know, we’ll see you next week, or let’s go to the hospital and have the baby.” That’s the rhythm balance, right? And then there aren’t certain things that do occur that kind of tips the scale in one way or the other, right? And that’s when we do these indicated preterm deliveries.
Dr. Fox: Right. So, let’s start talking about them. And again, for each of these, we’re not gonna cover the topic, you know, thoroughly or exhaustively because each one of these could be its own podcast or its own series. But just to sort of get a flavor of what are the conditions or the situations in pregnancy where we might start recommending preterm and early delivery. So, the first one I wanted to talk about is preeclampsia. So, on a very general level, what is preeclampsia, and why might we deliver early because of it?
Dr. Lam-Rachlin: The most general way of describing preeclampsia would be that it is a maternal manifestation of probably a inherent placental problem. And the usual presentation would be a sudden spike in the mom’s blood pressure, usually, happening in the third trimester. And the more severe forms can put her at risk of stroke, seizures, and then, the organ damage like heart failure, liver failure, kidney failure. And the only treatment, once someone gets preeclampsia, is really to make them not pregnant anymore. So, to deliver the baby in the placenta and allow the body to fully recover. Typically, thankfully, this happens in the late third trimester. And typically, it’s mild, so it’s not a hard decision to make. But in rare cases, it can occur very early. And in those cases, it becomes a little harder decision because basically, we’re gonna deliver this baby prematurely for the benefit of the mom’s health.
Dr. Fox: Yeah, I mean, preeclampsia, like you said, most of the time is mild enough that either it doesn’t manifest until she’s full term, until she’s 37-plus weeks, in which case we do recommend delivery for preeclampsia, but it’s a full-term birth. Or if it happens before 37 weeks, it’s usually mild enough that we sort of believe the risk is low enough to the mother that we can wait to let this baby develop a little bit further and get to 37 weeks. So, for most people with preeclampsia, if it’s mild, we’re gonna wait till around 37 plus weeks till full term to deliver. But as you said, if the condition is more severe and how we determine it’s severe is sort of based on how bad the blood pressure is or blood tests or other things going on, the risk to the mother starts going up and up. And this is also a situation where the risk of the baby probably goes up as well. This is one of the situations where generally if the mother’s sick enough that she needs to be delivered preterm, it’s probably better for the baby also. It’s rarely mother versus baby in this diagnosis.
Dr. Lam-Rachlin: Correct.
Dr. Fox: And how early might someone need to get delivered for severe preeclampsia?
Dr. Lam-Rachlin: It could be as early as 24 weeks. In very rare cases, it can even present prior to 24 weeks, but those are extraordinarily rare.
Dr. Fox: Yeah, I mean, this is one that can be really, really early if the mother is very, very sick. But again, fortunately, that is unusual and usually either they get to 37 weeks if it’s mild or sort of close to 37 weeks. Like, generally, if they’re severe but sort of stable, we can push it off to maybe 34 weeks. But occasionally, it has to be earlier. So, if someone’s sort of dealing with the diagnosis of preeclampsia very early in the third trimester, even in the second trimester, that’s a lot riskier because there’s a higher chance they’ll end up needing it delivered early or very early. Whereas if it sort of manifests later in pregnancy, you’ve already passed that point, fortunately.
All right. How about fetal growth restriction or sometimes called intrauterine growth restriction, IGR, or FGR? What’s going on there, and why might we recommend early delivery?
Dr. Lam-Rachlin: Again, I guess the best way to describe it, the fetal manifestation of a placental problem, right? So, you know, it most likely is a result of something going on that’s not healthy in variety of parts of the placenta where the baby’s not growing to his or her growth potential. And they’re much smaller than what they’re supposed to be. And in some cases of fetal growth restriction, we might have to deliver prior to 37 because, on top of the baby being small, there’s already sign of significant placental failure, where if we don’t deliver the baby, there’s a much higher risk of stillbirth and something abruptly occurring in that waiting time period.
Dr. Fox: Yeah, I think people find it somewhat counterintuitive at first, why if the baby’s not growing well would you deliver early? They’re like, “Well, wouldn’t you wanna wait as long as possible to let the baby sort of eke out every ounce that he or she can, you know, in growth?” And I would say the answer to that is, yes, if we knew the baby were gonna make it another week. And so, generally, for fetal growth restriction, like preeclampsia, we do wait till the baby’s full term, till 37 weeks, 38 weeks, whatever it is, because it’s usually mild enough that we’re not that worried about the risk of stillbirth. But if there’s certain findings on ultrasound, for example, that are really concerning, we’re like, “Listen, you know, your baby might not make it another week.” And in that situation, the higher that chance goes, the more likely we are to deliver early. And so we try to get as far as possible, but sometimes it just looks too dangerous and we need to deliver the baby at whatever gestational age to “save the baby” from stillbirth, essentially.
Dr. Lam-Rachlin: Correct.
Dr. Fox: Yeah, that’s a hard one when it’s very early because, you know, I think a lot of moms are okay maybe pushing the limit a little bit on their own health and their own blood pressure. I mean, I’m not saying it’s a great idea to do that, but they’re sort of conceptually gonna fight to stay pregnant a little bit longer. But when we’re telling them, you know, staying longer might help your baby but you may have a stillbirth, that’s a really hard situation to be in. And we do have criteria that we use that are pretty predictive of they’re not being a stillbirth over the next week or the next half week. And so, we generally will hang our hat on those and say, “All right, you know, these tests, you know, like, the doppler studies, the fluid, the movement, we’ll say, ‘These studies are good enough that we’re comfortable waiting a week or a half week.’” But every time you come, like those tests might change, we might need to recommend delivery, and it could be quite preterm. That is a tough situation to be in. Sort of like preeclampsia, if you’re dealing with this earlier, the more likely it’s gonna be a significant problem as you get towards the end of the third trimester.
Dr. Lam-Rachlin: Yeah, I would say that is probably one of the more common scenarios where we’re sending patients over for delivery day of a scan, right? Like either abnormal doppler, or low fluid, or bad physical profiles and starting of growth restriction. And it’s still not, you know, the majority of pregnancies, it’s the, yes, well, the more common reasons for indicated preterm delivery
Dr. Fox: Right. Now, what about placental abruption or a suspected abruption? What’s going on there?
Dr. Lam-Rachlin: So, again, the placental problem, but more specifically, it is parts of the placenta is actually shearing off or are being non-adherent to the urine wall. And that could generally present as some form of abdominal pain and bleeding. Obviously, that’s a scary scenario. And when you talk about like parts of the placenta is actually shearing off the uterine wall that’s like the baby’s not only growth resource but it’s the baby lifeline there. So, in the setting of a bad abruption where it’s causing either fetal distress, so there’s just excessive long bleeding that’s not stopping, that is another reason for an indicated preterm delivery.
Dr. Fox: Yeah. And the three we just mentioned, the preeclampsia, the fetal growth restriction, and the placental abruption, you correctly, first thing you said is that’s a placental problem. And those three are the most interrelated that if you have one, you might have the other, you might have the third. If you have a history of one, you might have a recurrence of the other or all three. I mean, those three are all really just, you know, sort of different manifestations of the same problem. There’s something off with the placenta. And so, those three frequently go hand in hand. And again, based on the severity is gonna dictate whether the delivery needs to be preterm or not.
There’s a few more that are sort of a little bit different. One of them is, for some unknown reason, we’re concerned about the baby’s wellbeing. Like, the baby’s not growth restricted, the placenta’s not separate, her blood pressure’s fine, but for whatever reason, the heart rate is low, or baby’s not moving, or some concern like that. And why, in that situation, would you recommend an early delivery?
Dr. Lam-Rachlin: So, the fetal status is not reassuring whether, for instance, if you said like the heart rate doesn’t look great on the monitor or the movements are not great. The concern would be whether there’s either a metabolic reason that the baby is not “happy.” And then, that might be an ominous sign for, if we continue the pregnancy, then there might be a stillbirth that will occur in the near future or other reasons why maybe the baby is not as happy as he or she wants to be. So, to do a preterm delivery in that setting is really just to avoid the possibility of potentially stillbirth in the future.
Dr. Fox: Yeah, I mean, I would say it’s pretty rare that this happens out of nowhere, that there’s decreased movement and we sort of identify a problem and need to deliver early. I mean, it happens, but it’s pretty rare. I think more times, this is happening in a setting where we’re already worried about the baby, like, you know, a situation where there’s some condition that’s been identified, whether it’s fetal anemia, for some reason, or some heart rhythm abnormality, or something that’s going on with the baby that puts the baby at risk for this. And even though it’s not specifically a problem with the placenta, it’s conceptually the same thing that we’re worried that if continuing pregnancy is gonna really lead to stillbirth or some damage to the baby, we have to deliver earlier. These, again, are fortunately pretty unusual in the typical setting. I mean, even we’re a pretty high-risk practice and these are even unusual in our practice, fortunately, but they do happen from time to time, but it might be a reason why someone’s recommended to deliver early.
Dr. Lam-Rachlin: Yeah.
Dr. Fox: Now, having your water broken, premature rupture membranes or PPROM because it’s preterm is its own podcast. But that’s a really interesting overlap, where, on the one hand, the process is sort of spontaneous because their water broke on their own, but another hand, they’re not in labor at that time. But generally, we do recommend delivery preterm if the water’s broken. And what is the main reason we would recommend delivery if the water’s broken?
Dr. Lam-Rachlin: So, there’s a few but the main reason would be the longer she stays pregnant, the higher the chances of intrauterine infection or chorioamnionitis. And in that setting, you know, to already have a preterm baby, and then, on top of that, potentially having an infection that kinda complicates that post-delivery course for the baby. So, after the membranes are ruptured, the longer you wait, the higher the potential of that. And then, also, there could be, you know, a higher rate of stillbirth also, although, you know, it’s still not like the majority of PPROMs. But the stillbirth rate is higher than if you weren’t ruptured, right? Then there could be a cord accident and stuff like that. So, obviously, we weigh kind of the balance on that, on the risk scale. It’s not the moment that you break your water, you get delivered. It depends on gestational age and all the factors surrounding it at that time.
Dr. Fox: And there is a lot of discussion and controversy over what is the best time to deliver in this circumstance. But it’s definitely one of the reasons why someone might recommend delivery early. I mean, we generally recommend delivery after 34 weeks. Sometimes they’ll stretch it to 35 or, you know, maybe a little bit longer sometimes. It’s very unusual. People are stretching it. But I don’t know if anyone’s stretching it past 37 weeks around the country. I don’t know if I’ve seen anyone do that for ruptured membranes.
Dr. Lam-Rachlin: Yeah, yeah, definitely, not past 37 weeks. I think, in very rare case-by-case scenarios, we may consider waiting. For instance, if we know the baby maybe has heart feedback, we’ll potentially need heart surgery. The bigger the baby is, the more successful the surgery. So, even with the membranes are ruptured, we know that there might be a chance of infection by waiting, but there might be some benefit of just allowing a few more weeks so that the baby’s growing bigger so that the surgery’s most successful. So, those are kind of those rare scenarios where we have to factor in timing of delivering with the best time.
Dr. Fox: Yeah. Another diagnosis that sometimes leads to an indicated preterm birth is cholestasis. Again, we had a separate podcast cholestasis. And when exactly to deliver for that is also an area of controversy. But sort of the early end of the typical recommendation is around 36 weeks. So, that’s technically preterm because it’s a week before 37 weeks. It’s not generally earlier than that unless there’s really something unusual. But that is possibly a situation where someone might be advised to deliver before 37 weeks with cholestasis.
Dr. Lam-Rachlin: Yeah.
Dr. Fox: And then, what about situations where we might deliver someone before 37 weeks simply because we don’t want them going into labor for, like, surgical reasons or something like that? So, what might some of those conditions be?
Dr. Lam-Rachlin: Typically, it’s either because they’ve had surgery on their uterus and we don’t want them to labor against that prior scar and have the uterus open up, and that’s called uterine rupture. So, for instance, if someone had surgery for their fibroids, or if they’ve had a prior classical C-section pass. And then those are the patients that we don’t want at labor and consider an earlier delivery just to avoid the [inaudible 00:23:23] labor. And then, the other reasons are typically related to placenta location. So, if the placenta is covering the opening, the cervix area, and that’s called placenta previa or there’s a blood vessel that’s covering the opening cervix or the vasa previa, then he risk of going into labor and significant bleeding from the fetal side is high than those the patients we don’t also wanna go into labor and deliver early.
Dr. Fox: And these are case by case and exactly who gets delivered when. But people are, again, often surprised when they’re meeting with us and they have a placenta previa or they have a prior, you know, classical uterine incision. We see them for their first visit, and we say, “Hey, we’re gonna, you know, schedule your delivery for 36 weeks.” And like, “Wait, a month early? Like, you’re delivering the preterm baby.” And we’re like, “Yeah, you know, there is some risk to the baby obviously and we prefer to wait as long as possible. But if you go into labor, it could be life and death for you and the baby” And so, it’s just not worth that risk. And so, generally, you know, once we explain it they understand it. But that is the balance of why we might deliver early in that situation. Even though it’s these are low percentile chances, it’s not likely to happen. Since it’s such a dramatic outcome, we really do pretty much anything possible to avoid it.
Dr. Lam-Rachlin: Yeah, correct. It’s rare but you don’t wanna be that one case that that happens. And…
Dr. Fox: Yeah. Now, you see, one of the conditions we did not mention and I know you take care of a lot of them are diabetics and gestational diabetics. And so, I’m curious, why don’t diabetics usually get delivered early?
Dr. Lam-Rachlin: I mean, for a variety of reasons. I mean, I look at diabetes as something that’s very treatable in pregnancy. So, for the most part, most patients are going to be “well controlled.” So, if you’re well-controlled, then the overall risk is quite low in pregnancy. But there’s also, you know, in the past, you think of fetal lung maturity and patients with poorly-controlled diabetes, maybe perhaps the baby’s lungs are not as mature as they should be at a certain gestational age. So, you wind up delivering them early, they might act more immature than their actual gestational age. And so, there’s a variety of reasons why we don’t necessarily deliver them early unless they are very poorly controlled despite, you know, increased medication in those cases, but, again, you know, weighing the risk of stillbirth and delivery, then we might err on the side of delivery. But it’s very rare to deliver somebody in the pre-term period because of that.
Dr. Fox: Yeah, I think that’s another thing that surprises people because, in the non-pregnant sort of world, people think diabetes, hypertension, diabetes, hypertension, they like to go hand in hand and, you know, similar risks and similar outcomes and, you know, all this stuff goes together. But in pregnancy, they’re really very different. We know hypertension is something that typically, you know, we can treat the blood pressure but we can’t treat preeclampsia. It’s only delivery. And so, that tends to get worse and worse. Whereas diabetes, as you said, we tend to have the ability to intervene. And so, it’s not really acutely dangerous to the mother or baby. And I would say, it’s very unusual to deliver someone just because of uncontrolled or poorly-controlled diabetes before 37 weeks. I guess it has happened, but very, very rare…
Dr. Lam-Rachlin: Very rare.
Dr. Fox: …as compared to hypertension, preeclampsia specifically. There are some other medical conditions that are a little bit, you know, more unusual or rare and that we would deliver early. But most of the time, it’s because they’re leading to things like hypertension, or growth restriction, or abruption, or we have concerns to the baby. I guess they’re occasionally from time to time there is reasons if you know really significant situations, like if someone, you know, unfortunately, gets diagnosed with cancer during pregnancy or something really, you know, sort of out of left field that they may have to get delivered early. But fortunately, those situations are pretty rare, I would say.
Dr. Lam-Rachlin: I agree. The condition such as cancer is one of the scenarios. Also, like, you know, something that comes to mind like heart failure of the moms just either had the underlying heart issue or a new onset heart failure that occurs, then those are potential reasons that we deliver them early, but they’re really devastating.
Dr. Fox: Right. So, I mean, we mentioned a lot of conditions. And obviously, you know, someone is not gonna know if they’re gonna develop any of these things in pregnancy. But are there any sort of preventative measures people can take to avoid getting in a situation where they have an indicated preterm birth?
Dr. Lam-Rachlin: I mean, a lot of the conditions are, I think vast majority is kind of lumped into, like, placental problems or a bad placenta. So, the preventative measures will wait to try to help improve the overall placental health, which really could be two bones. One would be if someone has underlying chronic medical condition like diabetes, pre-gestational diabetes, or hypertension. And you wanna get that really ideally well-controlled prior to conception and then controlling that during their pregnancy, that’s gonna help ensure more, you know, healthier or happy pregnancy. And then the other way, let’s say someone that doesn’t have underlying medical condition, if they just have risk factors for these “placental issues,” then the only kind of medication that we have is to start someone on a low-dose aspirin daily starting around like 10 weeks of pregnancy until they deliver. That’s really the only preventive measure. Otherwise, there’s really nothing else other than monitoring.
Dr. Fox: Yeah, I mean, the low-dose aspirin or the baby aspirin, as a lot of times we call it, is really mostly been shown to lower the risk of severe early-onset preeclampsia specifically, but there might be some benefit for some of the other placental issues that it’s sort of hard to tease out in these studies. But that’s something that’s, you know, different people recommend in different ways. We pretty much recommend it uniformly now, but there’s also, you know, ways to do it just based on risk factors. But certainly, if you have a history of one of these things, it seems to be helpful in the following pregnancy. And so, that’s something, you know, in terms of recurrent indicated preterm birth.
Wow, Jen, great topic. Covered a lot today, covered a lot of situations, but this does happen. I mean, this is really something that obstetricians, particularly, you know, high risk, we think about all the time, on a given day with certain patients. You know, if the pregnancy’s going great and smooth, it’s not gonna be much. But a lot of these conditions come up and it is a balance for us of, you know, either recommending to stay pregnant another whatever week, half week, whatever it might be, versus saying, “Hey, you know, I think that this is the time.” And it’s a complicated calculus and this is I think a really nice overview of sort of who might be in that situation and how we come to those decisions.
Dr. Lam-Rachlin: Yeah. It’s a great topic to cover. Obviously, each one of those reasons can warrant its own podcast too. But definitely, you know, it is probably the tougher scenarios for us, right? Like, when we know that we’re delivering a child prematurely and the qualities from that and really wanting to make sure that we’re making the right call at the right time. And I think that’s the art of what we do.
Dr. Fox: Yeah. Someone shows up in, you know, in advanced labor at 34 weeks, what are we gonna do? Right? I mean, it is what it is. And so, like, okay. But if we have to make a decision to deliver at 34 weeks, that’s obviously, that’s very weighty on us to make sure we’re making the right decision as you said. Jen, thanks for talking this through with me. I appreciate it. Always good to have you on the podcast.
Dr. Lam-Rachlin: Thank you. Anytime.
Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s H-E-A-L-T-H-F-U-L-W-O-M-A-N.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day.
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