Dr. Dwight J. Rouse, who for more than a decade led the University of Alabama’s Obstetric Complications Clinic and was site director for a major obstetrics national research network, has recently joined Women & Infants Hospital’s department of maternal-fetal medicine.
A specialty within obstetrics, maternal-fetal focuses on the diagnosis, treatment and ongoing care of expectant mothers with such health problems as diabetes and high blood pressure, and on preventing health problems in their unborn babies.
Described by Dr. Joanna Cain, chief of obstetrics and gynecology at Women & Infants, as “one of the nation’s brightest minds” in his field, Rouse has focused on “evidence-based” obstetric medicine, particularly the management of labor and delivery.
Rouse spoke about his work and about advances in his field.
PBN: What drew you to Women & Infants?
ROUSE: Several things. It’s a great women’s hospital, but what I’ve spent a lot of my recent academic life has been the National Institute of Child Health and Development’s Maternal-Fetal Medicine Units Network, which is a 14-center NIH-funded clinical trials network. The centers change on five-year cycles, and in Alabama, we had been a participating center for three cycles, and I was the principal investigator.
It so happened that my wife was interested in coming to Providence, and the division director job for maternal-fetal medicine at Women & Infants opened up at the same time that the possibility of becoming principal investigator for the Brown site opened up. … So a constellation of factors lined up that made it attractive for us to move here.
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PBN: One major project of yours involved the use of magnesium sulfate during pregnancy to prevent cerebral palsy in premature babies. Tell us more about that.
ROUSE: Maybe 10 to 15 years ago, it was observed in a retrospective study that babies born very pre-term who’d been exposed to magnesium sulfate were much less likely to have cerebral palsy, a condition that results in the impairment of movement and motor control. … So we and two other major trials did prospective randomized trials … and it turns out that indeed, if you give magnesium sulfate to a mother who’s going to deliver prior to 32 weeks, it cuts the risk of cerebral palsy by 40 to 50 percent. [That’s substantial, because] in our study, 7 percent of the babies in the placebo group had some form of cerebral palsy, and in about 3 percent it was moderate or severe, meaning by the age of 2, they couldn’t walk or needed assistance.
PBN: How does joining Women & Infants change your role in the NICHD network?
ROUSE: I had to learn a new system. There’s a lot of getting to know people, getting to know the local research team, getting to know the obstetricians, but the protocols are ongoing, and they typically take anywhere from two to seven years to complete. So all the trials were familiar to me, and the mechanism in the network was familiar to me. We have quarterly meetings at the NIH … meetings of 50 to 75 people, to talk about the protocols that we’re doing, what people are proposing, what’s going on with our publications.
PBN: Are there specific research areas you plan to focus on?
ROUSE: The things that cause the most morbidity and mortality in developed countries are preeclampsia and prematurity, so a lot of the focus of the network has been on prematurity prevention or at least improving the outcomes for babies born preterm. …
[With the magnesium sulfate study], now we’re doing mostly secondary analyses of the trial. The five trials that have been done have been aggregated in a meta-analysis to pool the results – someone in Australia is doing that. No one else is doing additional trials because they’re so expensive and time-consuming; it took us 10 years and 20 centers to do our trial, and I think it cost $25 million. I don’t see anyone replicating that.
It’s my sense that the utilization of magnesium sulfate for this purpose is diffusing into the obstetric community. Most of the centers that participated in the trial are using it, and other academic centers and other community hospitals are starting to use it as well.
PBN: What other projects are you taking on?
ROUSE: We’re about to embark on a trial with 11,000 patients to see whether additional technology can help us reduce the rate of birth asphyxia in labor, so half the women will have traditional monitoring and half will have this monitor that measures the status of the baby’s EKG. That will be a big trial.
We are also about to start another trial where giving the mother steroids before preterm birth is standard prior to 34 weeks because it improves the baby’s status after birth, but there is still a fair amount of respiratory [problems] in babies born at 34 to 36 weeks. In this country, steroids haven’t been studied in that group, and we’re about to study it. That has the potential to improve the outcomes for these so-called “near-term” babies.
Another trial that we are doing is we are measuring the length of the cervix of first-time mothers, with ultrasound, and if it’s short, randomize them to a progesterone compound that has been shown in some women to reduce the rate of prematurity.
What trials we’ll do after that sort of depends on the priorities of the network, the time and the availability of funds.
