Providence Medical Research Center here has added a perinatal research section to its lineup of medical research areas, and is enrolling or preparing for several studies in that new program.

Perinatology, also called maternal-fetal medicine, is a subspecialty of obstetrics and focuses on care of the fetus and complicated pregnancies.

Perinatal research for Providence Medical Research will be carried out through Sacred Heart Medical Center & Children's Hospital's Center for Maternal-Fetal Medicine. Dr. Reinaldo Acosta, director of the Center for Maternal-Fetal Medicine since its inception three years ago and lead researcher on the three current and upcoming studies for Providence Medical Research, says conducting research will help further the center's goal to improve outcomes for high-risk maternity patients and their unborn children.

He asserts that for a hospital the size of Sacred Heart and with the complexity of the cases of the patients seen there, it would be a waste of resources to not do such research.

"We cannot conceive of a perinatal practice without doing research," Acosta says. The primary goal of conducting research, Acosta says, is "to improve the standard of care for high-risk patients." The practice treats high-risk patients exclusively. The patients typically are referred to the center by their primary-care physicians because they are carrying multiple fetuses or have other underlying medical issues that put them at high risk. The center delivers babies for about 380 patients a year, and 40 percent of the women seen at the center have preterm births.

Currently, the perinatology center is enrolling patients for a National Institutes of Health study that will help improve diagnosis in first-time pregnant women of a condition that causes preterm labor and will determine whether progesterone treatments would help prevent preterm deliveries in patients who have that condition. The center also is preparing for a study of how much blood is contained in the umbilical cords of preterm babies, and is seeking approval to participate in a drug trial later.

The perinatology research center here is headed by doctor Jorge Tolosa, of Oregon Health and Sciences University, in coordination with Sacred Heart Medical Center & Children's Hospital's Center for Maternal-Fetal Medicine. Portland-based Tolosa spends part of his time working in Spokane at the center. The center here is an ancillary site to OHSU's perinatal research center, which is one of 14 main research sites of the National Institute of Child Health and Human Development (NICHD), a program of the National Institutes of Health.

In becoming a research site of the Oregon Health and Sciences University, Providence Medical Research's perinatology research section has become the only research site in Washington state affiliated with the Eunice Kennedy Shriver National Institute of Child Health and Human Development, a program of the National Institutes of Health.

Acosta says it's exciting to have here a perinatal research center connected to the National Institutes' perinatal research network, as most such facilities are located in the southern or eastern U.S.

Acosta says he hopes that the type of research done here will improve the care of patients who have high-risk pregnancies, or help them avoid becoming high-risk patients.

Cord blood study

The study for which the center currently is enrolling patients is called SCAN, which stands for shortened cervix and nulliparas—the latter term meaning a woman who has never given birth. A shortened cervix is considered a contributing factor in preterm births—delivery before 37 weeks of pregnancy—which can contribute to significant health problems for infants. A normal gestational period is 39 weeks.

Women who already have had other children and who are known to have a shortened cervix frequently are treated with progesterone to reduce the likelihood that they will deliver early, but that treatment hasn't been widely used in women who have never given birth, Acosta says.

The two-pronged study is aimed at improving diagnosis of that condition in first-time pregnant women, and at testing the progesterone treatment used for women who already have delivered other children and are known to have that condition.

The diagnostic piece also will help determine how prevalent shortened cervixes are among pregnant women, Acosta says. A cervix of less than three centimeters is considered shortened, while a normal length would be between four centimeters and five centimeters, Acosta says. A shortened cervix is identified through an ultrasound, and confirmed in a physical exam, he says.

The clinic's three sonographers have received additional training in ultrasound techniques, and their sample ultrasound images have been ranked among the best submitted to NICHD as part of the study site selection process, says Claudia Flores, the nurse coordinator here for the study.

Once patients are enrolled in the study, they will receive weekly injections of 250 milligrams of progesterone suspended in olive oil, or a placebo, between weeks 16 and 36 of their pregnancy.

Acosta says he hopes that about a dozen women will be enrolled in the study here, but many more will be screened at the Center for Maternal-Fetal Medicine. Because the technicians have received additional training and will screen more patients, they expect to improve the screening process and technique at the center. Acosta says the study expects to enroll about 1,000 women nationwide, and that it's been going on in other areas for about two years.


Cord blood study

In conjunction with the University of North Carolina, in Chapel Hill, N.C., the center here also is planning to begin a study in the spring to document the amount of blood in the umbilical cords of preterm babies. It would be a benchmark study.

Flores says the study could lead to additional research later to determine if techniques such as delaying clamping off the cord or "milking" the cord to get as much of the blood into the baby's system could help offset some of the problems such babies frequently experience.

Those problems include low blood sugar, anemia, infections, and intracranial hemorrhaging and sometimes result in the need for blood transfusions, Acosta says. He says it's important to know for future studies how much blood is available because too much additional blood could produce heart failure or a condition in which the infant has too many red blood cells. Preliminary research has shown that complications might be reduced by delaying clamping off the umbilical cord for 30 to 40 seconds after delivery, Acosta says.

The study currently is being set up with private funding by both Providence Medical Research Center and the University of North Carolina, but the researchers will seek grants, Acosta says. At the Spokane site, the researchers anticipate measuring about 30 samples, he says.

Later, the center here also could become involved with an industry-sponsored clinical trial of a medication to halt preterm labor, Acosta says.