PROGRAM IN PERINATAL RESEARCH AND OBSTETRICS
The Program in Perinatal Research and Obstetrics (PPRO) conducts clinical and laboratory research in maternal and fetal diseases responsible for excessive infant mortality in the United States. Researchers study the mechanisms of disease responsible for premature labor and delivery, with particular emphasis on the role of subclinical intrauterine infection and inflammation. The prenatal diagnosis of congenital anomalies is also a major area of interest.
The NICHD awarded a contract and a lease to establish a facility and support the operations of the PPRO in Michigan. The facility, housed at Hutzel Women’s Hospital, was delivered to the NICHD in February 2005; work to establish the Program has begun. It has access to a patient population with a high rate of pregnancy complications and brings to bear the academic resources of three major universities: Wayne State University, the University of Michigan, and Michigan State University. The PPRO has developed strong collaborative relationships with these universities, which are all part of the Life Science Corridor established by the state of Michigan to attract and support research and development in the biomedical field. The PPRO has been and will continue focusing on development of the physical plan, organization, and recruitment of support staff.
Premature birth is the leading cause of perinatal mortality and morbidity worldwide. The PPRO has defined preterm labor as a syndrome and determined that at least 25 percent of preterm neonates are born to women with subclinical intrauterine infection. The PPRO has also provided evidence that many premature neonates are critically ill before birth and proposed that, in the context of intrauterine infection, the onset of premature labor has survival value.
The current taxonomy of disease in obstetrics is largely based on the clinical presentation of the mother rather than on the mechanism of disease responsible for the clinical manifestations. The term “preterm labor,” for example, is not informative as to whether the condition is caused by an infection, a vascular insult, uterine overdistension, stress, or some other pathologic process. The same applies to other pregnancy complications such as pre-eclampsia, small for gestational age, and fetal death. The PPRO has proposed that obstetrical disorders responsible for maternal death and perinatal morbidity and mortality are syndromes and hence designated them the Great Obstetrical Syndromes. Key features of the syndromes are (1) multiple etiology; (2) long preclinical stage; (3) frequent fetal involvement; (4) clinical manifestation, which is often adaptive in nature; and (5) predisposition to a particular syndrome influenced by gene-environment interaction.
Congenital anomalies continue to be a leading cause of perinatal mortality in the United States. Advances in imaging techniques have allowed the prenatal detection of many anatomical defects with ultrasound. The PPRO’s goal is to improve the diagnosis and treatment of fetal disease and congenital anomalies by using three- and four-dimensional ultrasound and the development of novel approaches and algorithms aimed at improving the prenatal diagnosis of congenital anomalies, particularly congenital heart disease (CHD). CHD is the leading cause of infant death among newborns with congenital anomalies. The PPRO has also explored the value of combining sonographic and biochemical parameters for the identification of patients at increased risk of developing pre-eclampsia.
