Protocols for the 3 P’s Concept

1. Prediction. This starts with a thorough background history check. If it is found that the patient has a history of preterm births, we will immediately place them into the high-risk category.In addition to this, all pregnant women will undergo screening that includes having the length of their cervix measured using a transvaginal ultrasound scan. If the length of the cervix is less than or equal to 25 millimeters, this is a warning sign that the mother is at risk of a preterm birth. The standard cervix measurement is taken at 16-24 weeks into the pregnancy, but from past experience, we have found that the measurement can actually be taken at 12-13 weeks. The benefit of measuring at 12 weeks is that we can also see if there is sediment (amniotic fluid ‘sludge’) in the uterine cavity, which may indicate a problem. If we perform an ultrasound at 12-13 weeks, we can see any sediment clearly, then immediately administer medication to reduce the inflammation and the risk of a preterm birth. If left untreated, there is the possibility of a preterm birth.We also provide a swab test to monitor for fetal fibronectin. This is a substance that is found between the amniotic sac and the endometrium. The contractions of the uterus cause this substance to be created in the vagina. If it is detected, it indicates that the mother is likely to give birth prematurely.
2. Prevention. Once we come across a patient with any of these risk factors, we will administer natural progesterone medication to prevent uterine contractions. In some cases, the natural progesterone medication does not bring about a positive outcome and the patient may still have a short cervix length. In this case, we will use a cervical pessary or cervical cerclage to increase the strength of the cervix. Nowadays, the ‘cervical pessary’ choice is far more popular as it is more convenient and much cheaper. After the procedure, the patient can go home immediately.
3. Health Promotion This method is used when the first 2 methods have no positive outcome and the patient still feels pain during preterm labor. We will issue medication to stop the uterine contractions and delay labor for at least 48 hours. We will then issue steroids to stimulate the lungs of the infant and prevent brain hemorrhaging. Only then will we allow the infant to be born and enter preterm natal care in the NICU room. Fitted with the latest medical equipment, specially developed for treating newborns requiring intensive care, the NICU room is also staffed by neonatologists whose expertise lies in the care of newborn infants. In addition to all of this, The Preterm Prevention Clinic will also continue to monitor the situation of the prematurely born infant by performing regular checkups and evaluating the growth of the infant.

Genetic Screening/Testing (Precise and Personalized Medicine)

• Check for genetic disease carriers in couples considering having a baby
• Check for genetic causes of infertility
  • Genetic Testing of Infertile Couples
    • Pre-pregnancy genetic screening: with the autosomal recessive and X-linked screening, the at-risk couple detection rate is 3.4%.
    • Pre-implantation diagnosis or PGD (NGS): embryos are screened for recessive genetic conditions before implantation, so that future children are free of genetic problems with an accuracy rate of 95%.
    • Pre-implantation screening or PGS (NGS): screening embryos for chromosomal abnormalities can increase pregnancy rates (from 30% to 55%) and detect the chromosomal abnormalities present in more than 50% of embryos.
    • Embryo selection: using Mitochondrial DNA content as a viability score in embryos can increase the implantation rate from 0% to 59-81%.
    • Endometrium receptivity analysis (238 gene expression): 25% of women were found to have a non-receptive uterine lining at a time it was expected to be receptive, causing a pregnancy rate reduction by half and leading to a 100% chance of miscarriage.
    • Gene testing in infertility (in process): finding the cause of infertility through genetic testing.
  • Immunological infertility issues causing implantation failure and recurrent miscarriage:
    • Autoimmune antibodies: anti-thyroid peroxidase, ANA, anti-mitochondria antibodies (in process)
    • Thrombophilia screening
    • Immune tests:
      1. Natural killer cell assay and immune-phenotype
      2. Th1 (T helper 1) / Th2 (T helper 2) intracellular cytokine ratios (Successful pregnancy rate 39%)
• Check for genetic diseases in the unborn fetus
  • Pre-pregnancy or early pregnancy genetic screening: autosomal recessive and X-linked screening
  • Non-invasive prenatal testing: testing of cell-free fetal DNA in the maternal plasma for Down’s syndrome
  • Prenatal Diagnosis (PND): Chorionic Villus Sampling (CVS), Amniocentesis, Cordocentesis
  • Karyotyping / Chromosomal Microarray Analysis (CMA) / Next Generation Sequencing (NGS)
  • Genetic Diagnosis in Fetus: whole exome sequencing, whole genome sequencing (research)
• Check the immune system of those with infertility and who experience failed embryo transfers and repeated miscarriages

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International Accreditation and award

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About Preterm Birth

Preterm birth is a major concern in Thailand because the rate of preterm births is about 12% of all births. Preterm babies are at increased risk of death, disability or complications. During prenatal care, the cervical length is measured by transvaginal ultrasound between 18-24 weeks of pregnancy. When the cervical length is less than 2.5 cm, women face the probability of preterm delivery.

Preterm birth is a major concern in Thailand because the rate of preterm births is about 12% of all births. Preterm babies are at increased risk of death, disability or complications. During prenatal care, the cervical length is measured by transvaginal ultrasound between 18-24 weeks of pregnancy. When the cervical length is less than 2.5 cm, women face the probability of preterm delivery.

In this video on preventing preterm births, Associate Professor Boonsri Chanrachakul, M.D., Ph.D. and Head Doctor at the Samitivej Preterm Prevention Clinic discusses 5 warning signs of preterm birth. Research at the Samitivej Preterm Prevention Clinic discovered that from 100 pregnancies, 12 developed into preterm births. However, preterm births can be prevented if the warning signs are observed and the risk of preterm birth is detected through preterm screening.

Despite taking great care of her health and having regular ultrasounds during her pregnancy, Opal found out during the fifth month of her pregnancy that she was at risk of a preterm birth. By taking the extreme measure of lying still in bed to keep the babies in the womb for 28 to 29 weeks and increase their chances of survival, Opal finally gave birth to twins after just 29 weeks. Against the odds and with the constant support of Opal’s husband, who is also a doctor, both babies have survived and are growing well. Hear why Opal recommends that every expectant mother should be screened for preterm birth risk factors at centers like the Samitivej Preterm Prevention Clinic.

Due to fertility problems, 35-year-old Rinnada Jindara used the IVF technique to become pregnant. However, during antenatal checkups in the early stages of her pregnancy, she was found to be at high risk of a preterm birth and was referred to Associate Professor Boonsri Chanrachakul, M.D., Ph.D. and Head Doctor at the Samitivej Preterm Prevention Clinic. Far from having a routine pregnancy, Rinnada found herself having to deal with a 5 cm uterine fibroid that grew to 10 cm during the pregnancy, a clog in her uterine artery, a short cervix and gestational diabetes.

Monochorionic-Monoamniotic Twins (MCMA or MoMo Twins)

Most twin pregnancies are considered high-risk and to ensure a safe and healthy delivery, it is important that the pregnancy is closely monitored by expert doctors. Monochorionic- monoamniotic twins is a rare and dangerous pregnancy condition that can lead to the loss of both fetuses. It is essential that couples who want to start a family learn more about this condition beforehand.

• Premature Rupture of Membranes
• Treatment for a high-risk case of monoamniotic-monochorionic pregnancy
• Complications of Multiple Pregnancies Part 1
• Complications of Multiple Pregnancies Part 2
• Top 5 Conditions of Abnormal Pregnancy
• 8 Risks Factors of Placental Abruption
• Monochorionic-Monoamniotic (MCMA) Twins
• Diabetes During Pregnancy
• 3D and 4D Ultrasound for Examining Unborn Babies
• Your pregnancy has been labeled ‘high risk’ – now what?

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