MATERNAL-FETAL MEDICINE

Reducing Preterm Birth and Stillbirth: Advocacy, Surgery, and a Rainbow Clinic

The Department of Obstetrics and Gynecology leads multi-disciplinary initiatives to improve perinatal health outcomes.

Arnold Advincula, MD, Division Chief of Gynecologic Specialty Surgery, pictured with a robotic surgical system.

nformed by a commitment to improving perinatal health outcomes, the Department of Obstetrics and Gynecology (Ob/Gyn) at Columbia University Irving Medical Center leads various multi-disciplinary initiatives designed to prevent preterm birth and stillbirth.

Across the United States, 1 in every 10 infants is born preterm, or before 37 weeks of pregnancy. Preterm birth is associated with a higher risk of complications, disability, and mortality, and 4.6% of preterm births result in stillbirth. Since 2017, Columbia University’s Center for Preterm Birth Prevention has been providing expert, evidence-based care to patients at risk for preterm birth. At the forefront of innovation in the field, the center is transforming the standard of care for managing cervical insufficiency with the use of the TransAbdominal Cerclage (TAC), a common intervention for preterm birth prevention.

TAC placement is a surgical procedure, conducted before or during pregnancy, where a permanent high stitch is placed around the neck of the cervix at the level of the internal os to help maintain closure and prevent preterm birth. Under the leadership of Arnold Advincula, MD, Chief of the Division of Gynecologic Specialty Surgery, NewYork-Presbyterian Columbia University Irving Medical Center is now one of the few hospitals in the country to offer minimally invasive TAC placement with the use of robotics.

For clinicians, the robotic approach to TAC placement provides high definition, 3-D visualization during surgery and wristed instrumentation, resulting in increased articulation and precision when moving around critical pelvic structures. With fewer complications and quicker recovery times as compared to the traditional open technique, the Department of Ob/Gyn is thrilled to be able to offer patients a minimally invasive option for the TAC.

In continued efforts to offer the highest quality of clinical care, informed by innovative research, the Department of Ob/Gyn recruited Uma Reddy, MD, MPH as Vice Chair of Research in 2022. A renowned researcher, Dr. Reddy is known throughout the field for various ground-breaking studies on stillbirth, preterm birth, and labor management. This year, Dr. Reddy was among a group of 100 individuals elected to the National Academy of Medicine, one of the highest honors in the field of health and medicine.

After the passage of the Maternal and Child Health Stillbirth Prevention Act, Dr. Reddy was invited to the White House to serve as a panelist and share her expertise as a Maternal-Fetal Medicine specialist and researcher with over 20 years of experience in the field. While reflecting on this event, Dr. Reddy shares, “it was such an honor to represent Columbia at the White House and speak about the importance of this law for parents who have suffered the tragedy of stillbirth – and for doing all we can to prevent future devastating stillbirths.”

A diverse group of individuals posing together on the steps of a government building with tall columns. The group includes men and women dressed in professional attire, smiling for the camera.

Uma Reddy, MD, MPH, Vice Chair of Research, at the White House with families, providers, advocates, and leaders in stillbirth prevention

“It was such an honor to represent Columbia at the White House and speak about the importance of this law for parents who have suffered the tragedy of stillbirth.”

– Dr. Uma Reddy, Vice Chair of Research

A family of three poses with a female doctor in a hospital setting. The mother, dressed in a vibrant pink dress, holds a baby wearing a blue polka-dotted outfit, while the father stands to the right in casual attire. The doctor, wearing a white lab coat and green scrubs, smiles warmly beside them. The background features wooden paneling and seating.

Aleha Aziz, MD, Director of the Rainbow Clinic, pictured with the first patient of the clinic and her family.

In 2024, the Department launched a Rainbow Clinic to meet the needs of patients who have experienced perinatal loss. More specifically, the Rainbow Clinic offers care for patients who have experienced the birth of a stillborn child, multiple miscarriages, or a neonatal loss and are planning for another pregnancy, also known as a “rainbow baby”. In collaboration with PUSH for Pregnancy and the Natalie Fund, all Rainbow Clinic healthcare providers and staff received specialized training in supporting families through pregnancy after loss.

At the clinic, patients and providers work together to develop a plan to support conception and positive pregnancy outcomes in an environment specifically designed to prevent future perinatal losses and reduce anxiety. Recently, the Rainbow Clinic supported its first patient through their rainbow pregnancy. With a history of four prior late stillbirths, the patient received interdisciplinary care from Dr. Aleha Aziz, Maternal-Fetal Medicine expert and Director of the Rainbow Clinic, Alexandra Tinfow, Certified Genetic Counselor, and a skilled team of sonographers in the ultrasound unit. After receiving high-quality care, close monitoring, and support, the patient successfully delivered their rainbow baby-and following 3 months in the Neonatal Intensive Care Unit, the family is together at home. The Rainbow Clinic’s specialized maternity services fill a critical unmet healthcare need for families experiencing pregnancy after loss.

The Department of Ob/Gyn is eager to transform the standard of care for preterm birth and stillbirth prevention, supporting improved perinatal health outcomes through a diverse array of patient services and cutting-edge research initiatives.

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