A safe nonsurgical treatment for miscarriage. About one out of every seven pregnant women will need medical help this year because her pregnancy failed in its early stages. [i]   Previously, doctors relied on dilatation and curettage (D&C) to prevent complications and clear the uterus following miscarriage. In seeking a less invasive treatment, some doctors began using misoprostol, a drug originally approved to reduce the risk of stomach ulcers in people who take aspirin or similar drugs, but that also can cause uterine contractions. No large-scale trials, however, had evaluated the safety and effectiveness of misoprostol as a follow-up to miscarriage until NICHD researchers collaborated in a study with four U.S. university hospitals. The study demonstrated that misoprostol was nearly as effective as D&C and was well accepted by the women who used it. Misoprostol is appropriate for use on an outpatient basis as an effective, safe, acceptable, and economical alternative to surgery after a miscarriage. Misoprostol also offers hope for improving the health of women in developing countries where financial resources and access to medical facilities are limited, making medical treatment after a miscarriage difficult to obtain.

First steps in better predicting preeclampsia. Preeclampsia causes 15 percent of premature births in developed countries and kills 50,000 women worldwide each year. [ii]   Preeclampsia, which strikes pregnant women without warning, is identified by a rise in blood pressure and protein in the urine. It can progress quickly to life-threatening seizures and kidney failure in the mother and premature birth of her baby. Compared to whites, black women are 2.4 times more likely to develop preeclampsia and twice as likely to die from its complications. [iii] [iv]   NICHD researchers, collaborating with extramural colleagues, discovered a more specific method to identify women at risk. Noting that a urinary protein called placental growth factor (PlGF) normally increases during the first two trimesters of pregnancy, the researchers found that, in some women, PlGF levels become abnormally low and that preeclampsia develops in these women about five weeks later. The researchers hope to translate these findings into a simple urine test to identify earlier and more accurately women at risk of developing preeclampsia. This would allow high-risk women to receive specialty care as early as possible, further reducing maternal and neonatal complications and deaths.

Risk with vaginal delivery after a Cesarean birth is low. In 2002, one of every four American infants was delivered by Cesarean section, a marked difference from 1970, when only one of every 20 infants was a Cesarean birth. [v]   This increase in Cesarean deliveries, however, highlights an important medical question faced by millions of women each year: Once a woman has delivered by Cesarean, what procedure is best for her for future births? Anecdotal accounts of uterine rupture and other problems frightened expectant mothers away from attempting vaginal births for subsequent pregnancies, but were they making the best decision? To answer this question, NICHD scientists studied the records of more than 30,000 women and found that the risks from a vaginal delivery after a prior Cesarean delivery are low. This large-scale study provides important information for women and their physicians when deciding whether to have a vaginal or repeat Cesarean delivery. The U.S. Public Health Service (PHS), in its Healthy People 2010 report, proposed a target rate of increasing vaginal births after Cesarean delivery by 12.5 percent. This study may help the nation meet this important public health goal.