Preventing preterm birth after a previous emergency C-section
Research institutes:
Department of Women and Children’s Health,
St Thomas’ Hospital, King’s College LondonProject dates:
Grant Awarded: 12 Jan 2023
Funding awarded:
Grant Amount (Borne’s share): £123,716
Total Award: £247,432
Women who have had an emergency caesarean section have a higher risk of preterm birth in future pregnancies. Prof Andrew Shennan and his team are determining the best method for inserting a stitch into the cervix to prevent preterm birth. This could lead to a change of treatment for women in this high-risk group, and prevent more babies from being born too soon.
The challenge
In the UK, around 55,000 babies are born prematurely each year, with sadly more than 1,000 dying as a result.
Researchers have found that women who have had an emergency caesarean section (C-section) have a higher risk of miscarriage or preterm birth in future pregnancies. It’s thought that this could be because of damage accidentally caused to the cervix during the surgery, which may weaken the cervix and prevent it from holding the baby for the full pregnancy.
We need to find effective options to prevent preterm birth in this group of women at high risk. This will help reduce the risk of long-term disability or death for their babies.
The project
One treatment option available to women at high risk of preterm birth is to have a stitch placed in the cervix, accessed via the vagina. But this approach may not be effective for women who have had a previous emergency C-section, as the stitch may be too low in the cervix to prevent preterm birth.
An alternative option is to have a stitch placed higher up in the cervix accessed through the abdomen – known as a ‘transabdominal stitch’.
In this project, Prof Andrew Shennan and his team are carrying out a clinical trial to show whether the transabdominal stitch is more effective for this group of women at preventing preterm birth, compared to the vaginal stitch.
The team are recruiting 160 women who have had a late miscarriage or preterm birth following an emergency C-section in a previous pregnancy. They are being split into two groups: one group who are receiving a vaginal stitch (as the standard treatment), and another group who are receiving a transabdominal stitch in early pregnancy or before pregnancy. The women are being followed for the duration of their pregnancy to see which option is most effective at preventing preterm births.
What difference will this project make?
500 women each year in the UK give birth prematurely after having an emergency C-section in a previous pregnancy. This project will determine whether the transabdominal stitch is better than the standard method for these women at preventing preterm birth. If the results show that this is the case, the transabdominal stitch could become the preferred treatment for women in this group in the future, and help make sure fewer babies are born prematurely.
Evidence has demonstrated an association between in-labour caesarean section and recurrent mid-trimester loss and preterm birth. This has proven difficult to treat as transvaginal cerclage appears to be less successful in this group. Transabdominal cerclage may be more effective. Therefore, research is needed to determine which treatment option, transvaginal or transabdominal cerclage, is more effective in this high-risk group of women.
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Updates
June 2024: The team have gained approval from the ethics committee to proceed with the clinical study, known as the ABOVE trial, and the team are starting to recruit women to take part.
This project is jointly funded by Borne and Action Medical Research
