Preeclampsia, Premature Birth, and Cord Blood Banking
Preeclampsia is a life-threatening medical condition that complicates about 5% of the pregnancies in the United States. Onset of this disease commonly occurs after 32 weeks gestation but can occur late in the second trimester, and is one of the most common causes of premature birth.
The presentation of this condition varies widely, and can be either mild or severe. The most common symptom is a dangerous rise in blood pressure. Many women will develop sudden swelling in the hands, face, and lower extremities, and unrelenting headaches. Some will develop renal or liver impairment leading to spilling more protein in their urine, a decrease in urine output, elevation of liver enzymes and a decrease in platelets which impair the blood's ability to clot. Rarely, this may lead to a seizure and increase maternal and fetal mortality. This disease may even occur up to 6 weeks after delivery.
What is incredible about preeclampsia is it can occur with only one or two subtle signs or symptoms, and quickly progress without much warning. Sometimes hospitalization is warranted, keeping the patient on bed rest and keeping mom and baby under close surveillance. The only cure for preeclampsia is delivery of the baby, after which preeclampsia most commonly goes away in a few days after the birth.
Physicians have to weigh the severity of the disease, and the risk to the mother by delaying delivery, against the risk to the baby if delivered prematurely. At times we are walking a fine line to get a healthy mom and baby through this disease. Good communication between all healthcare professionals and the patient is crucial in maximizing good outcomes.
One of the discussions that should occur when caring for a mother with any high risk scenario like preeclampsia is making an informed decision about her umbilical cord blood. The more preterm an infant is at the time of delivery, the higher the incidence is of that child being born with Cerebral Palsy (CP). CP is a debilitating neurodevelopmental condition that affects the child and family forever. However, an exciting regenerative medicine trial ongoing at Duke University, lead by Dr. Joanne Kurtzberg, is showing incredible promise. The trial gives children with CP their own umbilical cord blood saved from delivery.
When collecting cord blood from a premature delivery, it is crucial for physicians to maximize the amount of blood collected, since preterm babies especially have smaller volumes of cord blood and hence less stem cells. Unfortunately, these lower numbers make the collection unsuitable for public donation.
To insure the best care for a mother with preeclampsia, we must minimize risk and maximize benefit of both mom and baby, not only in utero, but after delivery as well.