One of the key ways that medical practitioners can reduce the risk of hypoxic-ischemic encephalopathy (HIE) in their patients is by taking all appropriate actions to prevent a baby from being born prematurely. Premature babies are very fragile because they are still in the process of developing – this fragility extends to the baby’s brain as well. Preemies are far more prone to having brain bleeds (intracranial hemorrhages) and other blood-pressure-, nutrition-, and perfusion-related issues that can cause HIE. When a medical practitioner closely monitors a pregnancy and takes action when they suspect that a child will be born early, it can help decrease the risk of HIE. There are several procedures that medical practitioners can do when there are indications that a woman may give birth prematurely, or if she has a history of preterm birth/other risk factors. These preventative measures include the following:
One of the factors that can cause premature birth is cervical insufficiency (sometimes referred to as ‘incompetent cervix’). The cervix is a narrow passage forming the lower end of the uterus. At the beginning of pregnancy, the cervix is long and closed. It remains this way until labor and delivery. In some pregnancies, the cervix begins to soften, shorten, or open up prematurely. This is called cervical insufficiency. This can allow the fetal membranes to go through the opening and break, which can trigger early onset of labor and premature birth or miscarriage. Cerclage is a procedure in which a stitch is placed into the cervix to help keep it long and closed. Later in pregnancy, the stitch is removed so that the baby can be born. To learn more about cerclage and which women may require one, click here.
Progesterone is a naturally occurring hormone produced in the ovaries. Among other roles, progesterone thickens the uterine lining to help avert preterm delivery and protect a growing baby. Women with cervical issues, as well as those who have a prior history of preterm birth or preterm premature rupture of membranes (PPROM) are often given progesterone in order to prevent their babies from being born early. To learn more about the uses for progesterone, click here.
Magnesium sulfate, an organic salt, has many medical applications. One major application is in the treatment of preterm labor. Magnesium sulfate works by slowing or inhibiting contractions in order to delay preterm birth for several days or longer. This delay allows the baby more time to develop and allows medical professionals the time they need to devise the best method of delivery. To learn more about the use of magnesium sulfate, click here.
Closely Monitoring Pregnancies
It is critical that physicians closely monitor their patients for high-risk pregnancy conditions that can lead to preterm birth or HIE. Once a pregnancy has been identified as high risk, doctors must provide more extensive prenatal care and testing. Having more information about the state of the pregnancy can help them determine which measures may be necessary to prevent preterm birth.
Minimizing Harm in Preterm Babies
In some cases, it may be impossible to prevent a preterm birth from occurring. However, there are still treatments that may help to minimize the risk of lasting damage to the baby. Two common options are antenatal steroids (betamethasone) and magnesium sulfate. Antenatal steroids can help the lungs develop faster, which decreases the risk of respiratory distress syndrome. It can also decrease the risk of brain bleeds, white matter damage (periventricular leukomalacia, or PVL), and other complications. Magnesium sulfate can be used to inhibit uterine contractions but is also used to protect the baby’s brain, and reduce the risk of cerebral palsy (CP) and other conditions.
For other strategies for preventing hypoxic-ischemic encephalopathy, please visit our main HIE prevention page.