Murphy's Law governed Kira Marx's first pregnancy.
"Almost everything that could go wrong did," says the Bon Air mother of three. "It was the Job of pregnancies."
She lost two of three triplets in utero, had recurring infections and bleeding, was put on bed rest after contractions at 22 weeks, and finally delivered daughter Aerin 14 weeks early. But the worst part, she says, was the day-to-day stress of not knowing what would happen next.
Three years later, Marx became pregnant again, with twins, after fertility treatments. And even though she knew she was at risk of delivering early (due to her previous preterm delivery), she was able to relax and enjoy the pregnancy.
Thanks to developments in prenatal care, doctors now are able to monitor and reduce the chances of preterm delivery (babies born before 37 weeks' gestation). A new fetal fibronectin test predicts with 99 percent accuracy whether a woman will go into preterm labor, and it can be administered every two weeks to at-risk mothers. The test works by detecting proteins present before the onset of labor. "Think of this as the glue that holds the baby in the womb," says Dr. Victoria Davis of West End Obstetrics and Gynecology. The proteins normally aren't present in the vagina until late in pregnancy, when the glue structure breaks down around 34 to 35 weeks.
For Marx, the test was a godsend. "It helps you know what's coming," she says. "If it's positive, logistically, you could make arrangements. You'd be prepared."
Premature birth is the leading cause of death for newborns in the United States, and premature babies are at risk for a variety of health problems. Nationally, one in eight babies is born preterm, and there is no known cause in almost half the cases. Costs associated with preterm births are estimated at $26 billion annually, according to a report by the National Academy of Sciences' Institute of Medicine.
Dr. Alice J. Hirata, an obstetrician with the Virginia Women's Center at Bon Secours St. Mary's Hospital, describes the fetal fibronectin test as part of a patient's safety net. "We have a loose net for everyone," she says. "For [those] with risk factors, we try to tighten it." Risk factors might include multiple births, prior obstetrical complications or previous cervical procedures.
Positive test results mean doctors can intervene, ordering bed rest, labor-delaying medication or other measures. And families have time to arrange for child care, address work issues and other matters, and prepare emotionally for their newborn to be whisked away to the neonatal ICU.
"The best aspect of this test is that it is easy to use and gives very reliable information," Davis says. "It keeps us from over-treating patients and from being overly cautious."
But, says Dr. Susan Lanni, an associate professor of obstetrics and gynecology at the Virginia Commonwealth University School of Medicine, the test is a double-edged sword. "Sometimes having more knowledge makes it harder to manage my patients," she says. "Even if it's positive, that still only means there's a 40 percent chance they'll deliver early."
The fetal fibronectin test, usually covered by insurance, is one of a handful of recent breakthroughs in obstetrics. Doctors have also discovered that cervical length is a factor in preterm labor — a shorter cervix indicates a good chance of early delivery — and that progesterone injections, known as 17P shots, can help prevent it.
"We're three steps in front of where we used to be," Hirata says.
But, says Davis, "obstetrics is still old-fashioned." The new fetal fibronectin test "is the first major advancement in decades."
Marx has stayed busy since Leni and Camille joined big sister Aerin in January. But she still finds time to volunteer with the March of Dimes and to lobby state legislators to raise awareness of preterm birth issues. Armed with knowledge and the latest medical advances, she hasn't ruled out another baby. "After the twins were born, we were all able to leave the hospital together," says Marx. "That was unbelievable!" ■
