This issue of O&G Magazine returns to a core topic of O&G management, that of premature birth – why it happens, how we manage it and the complications that can occur. It also touches on fascinating ground-breaking technologies we hope to see in the future that may revolutionise the management of those babies born on the cusp of viability and who face such a precarious course postnatally. We have a touching patient perspective of the daunting and overwhelming journey of being a ‘NICU parent’ from a couple who have brought about so much good from their months sat perched next to a tiny cot. I hope you enjoy the breadth of articles, whatever type of practice you are in, as we aimed to make this issue informative as well as interesting to ensure the messages contained within reach a wide audience.
Premature birth is the biggest issue facing the clinical practice of obstetricians. Prematurity is the leading cause of death and disability in children under five. It is still frighteningly common and the importance of trying to reduce the rate of preterm birth is being recognised by health policy makers with more research and health programs focusing on reducing the rate by identifying and treating preventable causes.
As clinicians, what we also need to recognise is the role we may play in the iatrogenic or non-medically indicated late preterm and early term deliveries. Data continue to emerge about the effect of being born prior to 39 weeks gestation as more studies look at the long-term developmental outcomes of these children. Until recently, long-term outcomes of children born after 36 weeks were thought to be similar to children born close to, or at, their estimated due date. Indeed, when outcome measures focused only on mortality and major markers of morbidity, it did seem that there was little difference. Now, however, there is clear evidence of higher rates of speech delay, attention problems in childhood and poorer primary school performance for children born between 36 and 38 weeks compared with 39 weeks. As someone who has only recently completed my training, I draw the comparison of length of a pregnancy with the six years of FRANZCOG training. By the end of the fifth year of training, most trainees feel ready to finish. Clinically, they are competent and can manage most aspects of the job fairly independently. If they were to head out into the world at this point, the vast majority would perform adequately. A few would hit trouble fairly quickly, like the occasional 37-week infant who ends up intubated in the nursery, but most would fly under the radar and cope. In the long term, however, the loss of 12 months not spent in a training environment means the nuances of the unexpected complication or how to interact with the difficult patient (or colleague) may start to show. It is the finessing of these finer details of being a professional that occur in the last year of training that are similar to the neural connections and pathways being made in utero in those final weeks that can result in a 39-weeker having an improvement in long-term neurodevelopmental outcomes. As clinicians, we must ensure that we give every baby the opportunity to be in the best environment possible when this brain development is occurring, and when there is no medical indication otherwise, this environment should be the uterus.
Finally, I’d like to recognise the previous issue of O&G Magazine, which took LGBTQIA as its theme. The response we had from such a broad range of readers was phenomenal and just a little overwhelming. We have included some of the written responses in this issue, showing just how powerful this publication can be and what an inclusive and progressive College we all belong to.
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