PLACENTIA : Premature Births Delayed by Pump
When Sandra Beigal heard the sound of her newborn daughter crying for the first time, her own tears welled up. The pregnancy had been a difficult one, with her body stubbornly resisting the medication intended to prevent her triplets from arriving prematurely.
“I was so relieved when I heard her, and it was a wonderful surprise because I was expecting three boys,†she said this week while adding the footprints of her daughter and two sons to the family album. “Now they’re three months old, and they’re doing great. I don’t know if it would have happened without the pump.â€
The pump, known formally as a dual-mode microinfusion pump, looks like a beeper with a tube running out of one end. But it is actually the latest high-tech tactic against premature birth, the condition that causes more serious health problems and disabilities for infants than any other.
Similar to a device used for more than a decade by diabetics, the pump has a miniature computer and small syringe that combine to supply periodic, minute amounts of medication to a patient. A tiny needle at the end of the tube is inserted under the skin and covered with a bandage, with the pump worn clipped to a belt.
For expectant mothers who show signs of premature delivery and a high tolerance for terbutaline--the most effective labor-delaying medication--that means a chance to add vital days or even weeks to the length of pregnancy, said Dr. Debbie Sassoon of Kaiser Permanente Medical Center in Anaheim. Sassoon, working with Kaiser’s Orange County Home Health Care Agency in Placentia, is the perinatologist who put Beigal and two other women on the pump after the technology was adopted in February by the agency’s obstetrics division.
“The beauty of the pump is that we can give a very low, constant dosage of terbutaline to a patient who would build up a tolerance to the drug in the larger doses that would be present in, say, an oral application,†said Sassoon, who worked with about 50 pump patients during a fellowship at Cedars Sinai Medical Center. She said the technology has existed about five years.
Beigal, of Newport Beach, was first put on oral terbutaline and bed rest in January, but after less than a month it became apparent that she was building up too much resistance. Doctors repeatedly flushed the accumulated terbutaline from her system (an hours-long, intravenous process Beigal called “very, very unpleasantâ€), but even this was gradually becoming less effective.
In her 29th week of pregnancy, she was told she would probably deliver her triplets at any time, unless a new approach stalled labor. That same week, on Valentine’s Day, Beigal was put on the pump. She did not deliver until March 1.
“Without a doubt, it gave me that 2 1/2 weeks,†she said. “Nothing else was working, nothing was helping. It gave me a chance to have healthy babies. It gave them a chance to live.â€
The triplets--Katherine, Aaron and Ethan--were born eight weeks short of a normal 40-week pregnancy, but Sassoon said the time they gained undoubtedly shortened their stay in the hospital and added to their birth weight.
The two other Kaiser patients put on the pump each gained about eight weeks, said Liz Quint, director of Home Health Care obstetrics.
“It’s not something we slap on every woman, but for the ones that need it, it’s wonderful,†said Quint, whose staff assists women with high-risk pregnancies in their homes. “They’ve been through all the other medications and been in the hospital, and then this comes along and gives them a chance to go home and gives them back a little of their independence. And it works, too.â€
