The cooperation of 10 Provo women who recently underwent a battery of medical tests may revolutionize the treatment and care of women who develop complications during pregnancy, particularly toxemia.
Under the direction of Dr. Steven L. Clark, the women underwent extensive - and often arduous - testing to help a team of researchers determine what constitutes a normal physiological state during pregnancy.Clark, a perinatologist at Utah Valley Regional Medical Center, led a team of 11 researchers from five U.S. hospitals that analyzed physiological changes in the pregnant women under various conditions.
Clark presented an abstract of the findings of his "healthy mother" study at a meeting of The Society of Perinatal Obstetricians in February in New Orleans and was given the society's annual award for outstanding research. His study was selected from more than 1,000 other studies for the honor.
Because of the nature of the study it is doubtful it could have been performed anywhere else in the country or that it will be repeated, Clark said, and he praised the women who participated in the study.
Clark said researchers from other states were astonished he was able to get volunteers for his study.
"We work with people who believe it's right to sacrifice something of yourself to help others," Clark said. "It is a real tribute to the community, the people and the type of individuals here who are rare these days. That is why I work here."
The 10 study participants were selected from more than 40 volunteers based on a set of criteria requiring the subjects to be 25 years of age, non-smokers, non-drug users, in their first pregnancy, with due dates that fell within a certain time frame, have normal weight gain for their height, a normal blood count and pregnancies progressing normally. Each woman agreed to complete two days of testing, one at approximately 36 weeks of pregnancy, the second three months after the birth.
During each research session, the women had pulmonary artery catheters inserted in their chests and spent a day at UVRMC undergoing tests to measure heart and lung function while in various positions and while exercising on a treadmill and exercise bike. They also were injected with an intravenous solution to allow researchers to measure bodily reactions to sudden fluid infusions, such as occurs when a transfusion is given because of massive hemorrhaging.
Spencer Blake, Provo, whose wife, Michelle, was a study volunteer, said it was an honor to be healthy enough to qualify and be asked to participate in the study, and that Michelle was willing to do what she could to help someone else have a healthy, normal baby.
"Our expectation of the study being helpful has come to pass," Blake said.
The thought of being able to do more for future mothers than just answer questions about what it's like to be pregnant spurred Karen Lanham's interest in participating in the study.
"It wasn't too bad," Lanham said. "It looked different on paper than it actually was. I didn't know I would have to ride the bike with all that stuff on my head." And, as might be expected, Lanham said "it was a lot easier going through the tests after delivery."
Clark underwent the testing procedure himself before beginning the study to understand what the women would have to endure.
Before coming to UVRMC to head its neonatal unit, Clark was the director of obstetrics and gynecology at Los Angeles County Women's Hospital in California.
"I spent many nights (at L.A. County) with dying pregnant women, and nearly every pregnant woman died under my hands while (I was) doing cardiopulmonary resuscitation," Clark said. "I spent many sleepless nights wondering what I could do. We had the drugs; we had the techniques. But we were having to guess what was normal and trying to guess what to do for these people."
Until now doctors have depended on data established for nonpregnant women and for pregnant animals to determine how to treat critically ill pregnant women.
From data analyzed thus far Clark has been able to establish normal comparative values for pregnant women. That information already is being used to adjust treatment for critically ill pregnant women. Also, the study revealed information that will have a dramatic impact on treatment of toxemia, one of the most common complications of pregnancy.
"We had known what the values in toxemics were, but we did not know which were abnormal and which were normal," Clark said. "Some of our treatment for toxemia has been out of line. Some of the values that were thought to be abnormal are normal and vice versa."