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Premature birth is the leading cause of perinatal morbidity and mortality worldwide. The Perinatology Research Branch has defined preterm labor as a syndrome. One of the causes of this syndrome is an untimely decline in progesterone action, which is clinically manifested by "silent" shortening of the uterine cervix. Indeed, previous work conducted by our Program showed that asymptomatic women who have a cervical length of 15mm or less in the second trimester of pregnancy have a 50% likelihood of delivering an early preterm neonate. Prediction of preterm birth needs to be accompanied by a strategy to reduce the frequency of this complication. Several lines of evidence suggested that the administration of vaginal progesterone in patients with a short cervix may reduce the rate of preterm birth. Our major focus was to conduct a prospective randomized clinical trial at 44 centers worldwide to test this hypothesis. We found a dramatic reduction in the rate of preterm birth, as well as neonatal morbidity. This is an important finding because it has been estimated that the routine implementation of universal screening of all pregnant women in the United States and the administration of progesterone to those with a short cervix can result in a savings of $500 million per year in the United States alone.
Congenital anomalies continue to be a leading cause of perinatal mortality in the United States. The research agenda of the Perinatology Research Branch includes the use of three- and four-dimensional ultrasound (3DUS and 4DUS) and the development of novel approaches and algorithms aimed at facilitating the prenatal diagnosis of congenital defects, in particular, the prenatal identification of congenital heart disease (CHD). CHD is the leading cause of death among fetuses with congenital anomalies. Our Program also explored the development of new 3DUS techniques for volume calculations of fetal organs and fetal weight.