Predicting problems in labor

How great would it be to be able to tell in advance whether a particular birth would go smoothly or need intervention!

A French team of physicians reported this week at the annual meeting of the Radiological Society of North America that it has developed a new computer model that uses magnetic resonance imaging to predict whether a birth will go smoothly or have problems.Pregnant Graffiti

Olivier Ami MD told a session of the RSNA meeting in Chicago that his team applied the new software, called Predibirth, to 24 MR images of pregnant women, and created a three-dimensional model of the woman's pelvis and the fetus. Using these images, Predibirth calculated the likelihood that the babies could find their way out of their mothers' bodies without assistance.

Of the 24 women studied, 13 delivered normally. Predibirth had predicted normal births for all of these women. Predibirth had tagged three women who opted for elective Cesarean sections as being at risk for dystocia.

Of five women who had emergency C-sections, Predibirth had predicted three might have problems — all three involved instructed labor. However, Predibirth had given thumbs up to two of the mothers, whose problems involved heart arrhythmia.

Predibirth had declared "mildly favorable" three additional moms who wound up resorting to vacuum extraction during birth.

Not perfect, but not bad.

"With this virtual childbirth software, the majority of C-sections could be planned rather than emergency, and difficult instrumental extractions might disappear in the near future," Dr. Ami told his audience in Chicago.

Dr. Ami M.D. is an obstetrician in the radiology department at Antoine Béclère Hospital, Université Paris Sud, France.

Image by Petteri Sulonen

“Carmaggedon” birth story?

My daughter Nora lives in Los Angeles, Cal., so I am aware that Angelenos are so dreading the shutdown of 10 miles of the I-405 expressway there for road work this weekend they have dubbed the event "Carmageddon."

Nora is going to walk or take buses as much as she can this weekend, and being from Chicago, she is comfortable with those activities. But many Angelenos are famously more car-bound than she is.

Carmageddon

Los Angeles commuter traffic

Crosstown airline flights between the suburbs of Long Beach and Burbank are sold out this weekend and the police department is asking celebrities to urge their Twitter followers to avoid the expressway and, indeed, to drive in the city as little as possible.

But Jenny Benjamin, writing in The Stir today, brings up an interesting and, to her and other expectant moms, urgent point: What happens if your baby decides to be born in L.A. this weekend?

Pregnant with twins, less than two weeks shy of her due date, a 30-minute drive away ("without traffic") from the hospital she carefully chose for its neonatal intensive care unit, Benjamin considers the possibility of an early labor and aks, "For the love of all things good and holy, what am I going to do?!?!"

Will her husband wind up delivering the twins (one of whom is in a transverse position) on the side of the road? Should she call an ambulance? "Ambulances aren't hovercrafts -- they're going to get stuck in the same traffic!" Benjamin notes.

Her doctor lives close to the hospital. "Good to know at least one of us will be able to get there," she writes.

"Aargh, it's times like this that I really wish that Segways had caught on!" Benjamin frets.

The best solution, she notes, is not to have the babies this weekend. "I have about as much control over that as I do the traffic," Benjamin writes. "Maybe I should see how much my husband knows about home birthing."

Of birth and renewal: Of spring

It was 41 degrees Fahrenheit when we got up this morning here in Chicago, but this weekend, the Memorial Day weekend, marks the unofficial beginning of summer in the United States.

Officially, it's still spring, though. Here is a poem by e. e. cummings that relates both to the season and to our topic here on Birth Story:

O sweet spontaneous
earth how often have
the
doting

fingers of
prurient philosophers pinched
and
poked

thee
,has the naughty thumb
of science prodded
thy

beauty        how
often have religions taken
thee upon their scraggy knees
squeezing and

buffeting thee that thou mightest conceive
gods
(but
true
to the incomparable
couch of death thy
rhythmic
lover

thou answerest

them only with

spring)

Bank on it

Bernard Fantus, the Hungarian-born physician who was the director of "therapeutics" at Cook County Hospital in Chicago, Ill., established the first "blood bank" in 1937.

Until then, a donor had to be on-site at the time of a blood transfusion.

Bernard Fantus

Bernard Fantus

Dr. Fantus also coined the term "blood bank," in an article in the Journal of the American Medical Association that year that set out the hospital's methodology in clear, understandable terms.

Other institutions swiftly developed their own blood-storage facilities, and helped themselves to Fantus's catchy term as well.

Cook County's blood-storage innovation came at a critical time, just a few years before the start of World War II, when blood donated by people thousands of miles from the battlefronts would make the difference between life and death for a great many injured Allied soldiers.

Alexis Carrel

In 1894, Marie Francois Sadi Carnot, the president of France, was stabbed by a would-be assassin in Lyons. By today's standards, the wound was not severe; however, the knife severed the portal vein in his abdomen. Carnot bled to death because up to that point, no one had figured out how to repair blood vessels.

Alexis Carrel
Alexis Carrel

One man undertook to change that, Alexis Carrel, a student in Lyons who was appalled by Carnot's death, in his hometown, while a number of physicians stood by and watched.

But consider the problem — repairing a tiny, elastic, living tube, part of a network of tubes of different sizes and functions, so that it would retain its ability to channel many gallons of blood every day, birth to death, without a hitch.

The story is that Carrel — Dr. Carrel by 1900 — studied with Marie-Anne Leroudier, one of the most proficient needlewomen in Lyons (her work was exhibited at the Columbian Exposition in Chicago in 1893), learning to make minute, uniform stitches. He developed a triangular system that allowed him to rapidly close up a vein or artery end-to-end without having the stitches adhere to the opposite wall, ushering in the birth of vascular surgery.

Carrel came to the University of Chicago in 1904, where his prodigious 21 months' work as an assistant to G. N. Stewart at the Hull Laboratory laid the groundwork for transplantation surgery. That work was the basis for Carrel's becoming the first scientist working in the United States to win the Nobel Prize for medicine, in 1912. Carrel soon moved on to the Rockefeller Institute for Medical Research in New York.

(Carrel's collaborator at the U. of C., Charles Claude Guthrie, was miffed that he was not included in the Nobel Prize. Guthrie possibly lost points with the Nobel committee for his subsequent experiments in St. Louis with head transplants.)

Carrel was a complicated man, compassion and curiosity mixed up with arrogance and resentment. He was a eugenicist — that is, he subscribed to the false science of "perfecting" the human race by eliminating traits judged to be inferior — and he was also an enthusiastic believer in the miracle cures at the shrine at Lourdes. At the time of his death in 1944, in Paris, he was working on a project for the collaborationist Vichy government.