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New unit probes causes of premature births

The first centre in Switzerland devoted to studying the causes of premature birth has opened at Geneva's cantonal hospital.

This content was published on September 15, 2000 - 20:13

Around seven per cent of all babies born in Switzerland are delivered pre-term, that is before the 37th week of pregnancy. This figure is around 10 per cent in Geneva, which has a special premature baby unit.

But these figures are only estimates because many private hospitals are loath to release figures for fear of being accused of carrying out too much unnecessary surgery.

Premature birth is now a major concern for public health services. Because of improvements in medical technology, more pre-term babies are surviving. However, there has been no reduction in the number suffering from long-term problems.

"The earlier a baby is delivered, the greater the danger," says Jean-Claude Schellenberg, head of the hospital's obstetrics department and the man behind the new unit.

"At 25 weeks, the survival rate is around 50 per cent. Of those that survive, handicaps of various kinds are the long-term problem," he told swissinfo. "Of those babies born weighing less than a kilogramme, about 10 per cent will be severely handicapped, while the rest may have less serious problems."

This causes not only suffering to the baby, but also emotional turmoil for the parents, as well as being a financial drain on the health authorities. It costs up to SFr500,000 to care for a very premature baby.

Clearly by reducing the number of premature births, the chances of these childen leading a normal life would be greatly increased. But remarkably little is known about what causes pre-term labour.

"In around 50 per cent of cases, we don't know the cause," Professor Schellenberg says. "It has long been postulated that infections may play a role in around 30 per cent of pre-term labours, but it's not clear if they are a cause of a consequence."

In other cases, the cause is obvious - a multimple birth, an infection or malformed womb.

Despite Switzerland's high level of biomedical research in other fields, until now there has been no department devoted to studying the causes of pre-term labour. This is in stark contrast to countries like the United States and Australia, which have long-standing research programmes.

The Geneva team is concentrating its efforts on studying normal labours that go to term, because even here there is a real lack of knowledge. Pre-term labour is very rare in the animal world and so scientists have not had a comparable model to study.

"We are rather ignorant. We have a lot of data. But there are some key elements that we do not understand," Schellenberg says.

"Once we understand the mechanism of normal labour at term, then we will understand better what causes pre-term labour."

One area that is of interest is the membrane around the foetus which is in contact with the uterus. It is believed this may contain certain proteins that provoke or inhibit labour.

"I'm certain we will be able to reduce the number of pre-term births, maybe by about 50 or 60 per cent," Schellenberg says.

But the obstetrician adds that it is not the aim of the team to reduce the number of premature births to zero: "There are babies who are probably better off being born than remaining in the uterus. There are probably some mechanisms of nature which provoke pre-term birth because the baby is better out than in."

The drugs currently available can delay a labour by only a couple of days. Professor Schellenberg is hopeful that his research will lead to methods of delaying labour by up to three weeks.

"The difference between being born at 25 weeks and 28 weeks is enormous," he says.

by Roy Probert

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