Currently, the only gauge to help identify mums at risk of giving birth to premature babies is when they have had previous preterm births, said a professor. - ST FILE
SINGAPORE: Her son weighed just 700g when he was born at 24 weeks after she spent the two weeks prior in hospital due to vaginal bleeding and cervix dilation.
So Bee Leng’s son, Ethan Ang, was born in 2017 with multiple disabilities stemming from his extreme prematurity. At seven days old, he underwent his first major surgery when his intestines were operated on.
For the next five years, he underwent four more major operations, which included implanting a cochlear hearing device, laser eye surgery to help with his vision and placing a feeding device through his belly to the stomach.
It is currently a challenge to identify mothers at risk of giving birth to premature babies as the only gauge is when mothers have had previous preterm births, like So, said Professor Teoh Tiong Ghee, director of maternal and child global health and care transformation at KK Women’s and Children’s Hospital (KKH).
To proactively reduce and prevent prematurity, a 10-member team of doctors specialising in newborn care and high-risk pregnancies from KKH and Singapore General Hospital (SGH) will start work on a new Preterm Pregnancy Prevention Programme in October.
The team aims to create a national database of all preterm pregnancies to identify risk factors, and then use this information to develop a screening prediction tool that can accurately assess the risk of preterm pregnancies.
A baby born before 37 full weeks of pregnancy is considered to have been born preterm or prematurely. A preterm baby’s organs may not be fully developed.
A full-term pregnancy typically lasts about 40 weeks, and babies’ birth weights typically range from 2.5kg to 4.5kg.
Globally, 13.4 million babies – 10 per cent of all births – are born prematurely each year and one million die from preterm complications.
Prematurity is the leading cause of death for children under five.
In 2023, 8.2 per cent of births in Singapore were premature, slightly lower than the 8.8 per cent recorded in 2014.
Recalling the dilemma she faced when told she might deliver early and her baby would develop health complications, So, 38, said: “I was given the choice to either terminate the pregnancy or continue with bed rest in the hospital until I gave birth.
“After weighing the pros and cons, and discussing with my husband, we decided to carry on and accept whatever may come in the future.”
When she conceived again in 2023, her doctor told her she was at risk of another premature delivery. She was referred to the Preterm Birth Clinic at KKH’s Stork Centre, where she was closely monitored.
She underwent a procedure to stitch her cervix – the birth canal opening – when she was 12 weeks along, paving the way for the full-term birth of her daughter, Alysha Ang, at 38 weeks.
Called a cervical cerclage, the procedure is done to help the cervix hold a pregnancy in the womb to prevent preterm birth.
Dr Ilka Tan, a senior consultant at KKH’s department of maternal foetal medicine who oversaw Ms So’s care during her second pregnancy, said that infants are able to survive outside the uterus at 24 weeks.
She added that though there are rare cases of infants surviving when born at 22 or 23 weeks, the “outcome is still not very good” for these babies.
Acknowledging that there have been reports from around the world of some babies born around 22 weeks who have survived, she said: “Those are single anecdotal cases, but it’s not the norm.”
If diagnosed through screening and predictive tests early, mothers who are at risk of preterm births can undergo various treatments to help them bring the pregnancy to term, Dr Tan said.
These include taking the hormone progesterone and getting a cervical cerclage.
The Preterm Pregnancy Prevention Programme will use information collated to study common characteristics among women who deliver prematurely. This in turn can be used to develop a prediction tool to identify expectant mothers who are at risk of preterm births early, so that preventive measures can be taken.
“What we’re trying to do is to get all these demographics, and use biomarkers from blood and cervical length measurements, to try to predict each woman’s personalised risk so as to target with specific therapy,” said Prof Teoh.
The programme is funded by a $500,000 grant from Far East Organization.
Besides the child potentially suffering long-term health consequences and an increased risk of disability and developmental delays, the parents and the rest of the family experience long-term stress too, Prof Teoh noted.
“Some have to stop work to look after the kid. So not only does it have a psychological impact on the family, it’s got a big financial impact as well,” he added.
Dr Tan also leads the Preterm Birth Clinic at KKH that provides specialised care for women who may have a higher risk of having premature babies.
The clinic began operations in July 2021 and had 100 patients that year. In 2024, 402 patients were referred to the clinic from January to September.
So said she received personalised care and attention at the Preterm Birth Clinic to help her carry her second child to term.
“I was seen by the same doctor – it wasn’t random. So I felt well-looked after and relieved. I was assured that there was a plan to help me, and that was important.” - The Straits Times/ANN
