Modern Perinatology: Saving Lives Begins Before Birth
Because some lives are saved before they ever take their first breath
By Dr. Özge Özdemir, Associate Professor specializing in obstetrics, gynecology, and perinatology in Istanbul
One of the most widely discussed concepts in medicine today is longevity; living longer, aging healthier, and preserving health before disease ever develops. But perhaps we should first ask a more fundamental question:
If we cannot ensure that a baby has the healthiest possible start to life, can we truly speak of a long and healthy life?
For this reason, I do not see longevity as a concept that begins later in life.
To me, longevity begins in the womb.
Perinatology is the medical specialty dedicated to the diagnosis, surveillance, and management of high-risk pregnancies. Yet its unique ability to intervene for the lives of both mother and baby before birth also makes it one of the earliest forms of preventive medicine.
As a perinatologist, two clinical conditions have shaped my approach to medicine more than any others.
The first is Cesarean scar pregnancy; a rare form of pregnancy in which the gestational sac implants within the scar of a previous Cesarean section, potentially threatening the lives of both mother and baby if not recognized and managed early.
The second is cervical insufficiency, a condition characterized by painless premature cervical dilation that represents one of the leading causes of second-trimester pregnancy loss and places pregnancies at risk of ending before the fetus reaches the threshold of viability.
At first glance, these two conditions seem entirely different. Yet they share one profound commonality: in both, the challenge is to protect the life of a baby who has not yet entered the world.
Because every decision made in these pregnancies may determine whether that baby will ever take a first breath.
That is why, in modern perinatology, the work of saving lives does not begin in the delivery room; it begins long before birth.
Cesarean Scar Pregnancy: The Story of a Life Begins in the First Weeks of Pregnancy
Over the past decades, the global rise in Cesarean delivery rates has been accompanied by an increasing incidence of Cesarean scar pregnancy and the placenta accreta spectrum disorders that may develop from it.
We now know that a substantial proportion of placenta accreta spectrum disorders originate from pregnancies that implant within a previous Cesarean scar during the earliest weeks of gestation.
Cesarean scar pregnancy can lead to life-threatening complications later in pregnancy, including severe hemorrhage, uterine rupture, and placenta accreta spectrum disorders.
For this reason, maternal safety remains the foremost priority in its management. However, the goal of modern perinatology is no longer limited to protecting the mother’s life. With careful patient selection, experienced multidisciplinary teams, and uterus-preserving surgical approaches, it has become possible in selected cases to safely continue the pregnancy to term, achieve the birth of a healthy baby, and, most importantly, preserve the uterus without the need for hysterectomy. This is why the fight to save a baby’s life often begins in the very first weeks, when a Cesarean scar pregnancy is diagnosed.
Cervical Insufficiency: Sometimes a Cerclage Becomes a Baby’s First Breath
Another area in which perinatology begins saving lives before birth is cervical insufficiency. One of the most effective treatments for this silent condition is cervical cerclage; a procedure in which a suture is placed around the cervix after it has begun to open prematurely, helping to reinforce it and prolong the pregnancy.
Cervical insufficiency is one of the most challenging obstetric conditions because it often progresses without any warning signs, leading to sudden pregnancy loss during the second trimester. Most women experience no pain, no contractions, and no vaginal bleeding. Yet the cervix gradually and silently opens, and a baby who has not yet reached the threshold of viability may be lost. A baby lost before taking a single breath.
When cervical insufficiency is recognized early, cerclage can dramatically change the course of pregnancy in carefully selected patients. Cerclage is far more than a stitch placed in the cervix. It gives a baby the most precious gift of all: time.
Every extra day in the womb is an opportunity for further growth and development. Sometimes it is a few weeks, sometimes a few months. Yet even that additional time can make the difference between a baby taking a first breath and being lost before birth, while also profoundly influencing lifelong health.
That is why, to me, cerclage is much more than a surgical procedure.
It is one of the most meaningful interventions we can offer to protect the life of a baby who has not yet entered the world.
Perinatology: Where Longevity Begins
Today, we speak about artificial intelligence, robotic surgery, digital health, and the concept of longevity. We also discuss intelligent models of maternal care designed to prevent maternal mortality, technologies that save the lives of newborns, and the critical importance of the first 1,000 days of life. Yet all of these advances share the same fundamental goal: to protect health before disease ever develops. If we cannot ensure that a baby enters the world safely, it is difficult to speak of lifelong health. That is why perinatology represents one of the earliest forms of preventive medicine. To me, longevity does not begin at birth; it begins in the womb, with the right diagnosis, the right timing, and the right intervention.
