Jessica Reilly was enjoying a gold star pregnancy. Her routine scans were textbook perfect and her baby’s development was tracking along as expected.
But at just 33 weeks pregnant – almost two months before her due date – the first-time mum realised something was very wrong.
“I was at home alone preparing dinner when my waters broke. I called my mum and she said, yes, you’re in labour. I said, I can’t be. The baby’s room wasn’t even set up yet,” Jessica, 29, says.
She came within minutes of giving birth on the side of the road on the way to the hospital. Less than two hours after her first contraction, her son Connor was born.
“I held him for just two minutes and he was taken from my arms because he wasn’t breathing well. It was so hard. I was in shock. My body was shaking like I’d run a marathon.”
Connor was rushed to the neonatal intensive care unit. It was four days before she would hold him again and more than a month before he could come home.
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In 50 per cent of cases, premature birth is completely unpredictable.
But now, scientists at the University of Melbourne’s Department of Obstetrics and Gynaecology at the Mercy Hospital for Women are close to developing the world’s first simple bedside test to accurately predict early labour.
The affordable, painless and reliable test could be taken at just 24 weeks into the pregnancy, giving doctors a clear indication of risk of pre-term birth within days, or even weeks. The test will most likely take the form of a vaginal swab, administered by a doctor or nurse, and could be taken at multiple points during the pregnancy.
Obstetrician Dr Megan Di Quinzio is leading the project. Her lab houses the world’s largest biobank of cervicovaginal fluid, donated by more than 3500 pregnant women.
By examining patterns in these samples, she has narrowed down to 10 unique chemical combinations – called ‘biomarkers’ – that appear before a woman goes into labour.
“The site where these swabs were taken is very close to where the cervix ripens, matures, remodels and where the membranes thin and rupture before birth, so it’s right at the site of activity. That is where we will find the answer,” Dr Di Quinzio says.
The research team has just begun recruiting 2500 women from the Royal Women’s Hospital in Melbourne to get closer to unlocking the puzzle.
“Our aim is to predict labour within seven to 14 days. Ideally, I would love to see this as a routine test taken during the highest risk stage of pregnancy, between 24 and 28 weeks.”
Dr Di Quinzio hopes the test will be available for women in developing countries.
“In the future this could be a massive opportunity for women all over the world, especially in underdeveloped countries where the incidence of pre-term birth is much higher.”
Dr Di Quinzio and the research team are working with Carmentix, a Singapore-based, venture-backed company.
A worldwide problem
Pre-term birth is the most significant clinical problem in contemporary obstetrics worldwide. Each year, 15 million pre-term births occur worldwide, with 1.1 million infants dying from pre-term birth complications.
Being born too early accounts for 85 per cent of early infant deaths worldwide. Up to one in four pre-term babies suffers chronic lung disease, impaired mental development, cerebral palsy, deafness, or blindness.
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Dr Harry Georgiou, at Mercy Hospital for Women and the Royal Women’s Hospital, is the senior scientist on the project and says pre-term babies are also very expensive to care for.
“Neonatal intensive care units are a huge cost to the community. A baby may cost up to $100,000 before it’s ready to go home,” Dr Georgiou says.
“You can imagine the time involved with nurses looking after the baby, the neonatologist, the total disruption to the family, not to mention how distraught the parents are, for weeks and even months on end.”
Premature birth hard to predict
Despite modern advances in obstetric and neonatal management, the rate of pre-term birth worldwide is actually increasing. Nearly one in 10 births in Australia is premature, rising to 15 per cent in the Indigenous population.
Researchers cannot accurately predict when labour will occur. One in every two cases of pre-term birth will have no warning signs at all.
“There are women who come in contracting early who have been perfectly well throughout their pregnancy. They want to know why has this happened and the truth is often we just don’t know why,” Dr Di Quinzio says. “Pre-term birth doesn’t discriminate. The greatest burden is in the Third World, where access to antenatal care is limited, but it really can happen to anyone.”
Saving lives and reducing emotional impact
A simple and accurate test for women like Ms Reilly would allow doctors to tailor treatments for mother and baby to either delay birth, or strengthen baby’s lungs to give the best chance of survival. However, current tests are not accurate enough.
Dr Georgiou explains: “Three other tests currently exist on the market. The one most commonly used in Australia is a fetal fibronectin test and although it has some uses, it’s not ideal. In about 50 per cent of positive tests the result is actually false.
“This leads to complicated scenarios when, for example, if a woman is living in a rural area and her test is positive, they’ll send her to a hospital in a city centre. If the test was wrong, it’s wasted time and money, as well as putting unnecessary stress on the mother.”
For mums like Jessica Reilly, an early warning would have made a world of difference. She says had she known, she would’ve been able to prepare for the physical and emotional shock.
“Emotionally, I wasn’t ready. It was extremely scary. If I’d known, I could’ve been ready for the birth at the hospital instead of alone at home. They might’ve been able to give steroids to help his lungs or even stopped me from labouring.
“There are so many women like me who give birth early and don’t know why. I hope for my next pregnancy I can get tested. I totally support this research. My hope is it will prevent other women from going through what I did.”
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