PROMPT – evaluating tests to help give the right treatment to delay labour
Research institutes:
Department of Metabolism,
Digestion and Reproduction,
Imperial College LondonProject dates:
Grant Awarded: 3 Nov 2022
Funding awarded:
Grant Amount: £135,631
Infections are a common cause of preterm labour, and giving the right antibiotics quickly might delay birth. Dr Nishel Shah and his team are investigating new techniques which could identify the correct antibiotic much quicker than standard tests. This project could one day help mothers get early treatment to stop their baby from being born too soon.
The challenge
15 million babies worldwide are born prematurely. Sadly, preterm birth is the leading cause of disability and death in children under five years old.
Half of pregnant mothers who go into labour prematurely do so without any warning, or any previous indication they could have been at risk. In this situation, finding out the cause of their preterm labour could provide an opportunity to give the right treatment to delay labour. But current methods are too slow, or not accurate enough, to give doctors the answers they need quickly.
We need to find ways to quickly identify what is causing a pregnant mother to go into premature labour. This would help doctors deliver treatments that could prevent their baby from being born too soon.
The project
One of the leading causes of preterm labour is a bacterial infection within the amniotic fluid. Dr Nishel Shah believes that treating these infections as soon as possible with the right antibiotic might delay preterm labour. The first task is to determine which bacteria is causing the infection, as different bacteria may need different antibiotics.
The standard test to identify which bacteria is causing an infection can take a long time (two days or more). But Dr Shah thinks a newer lab technique, which identifies the bacteria by reading its DNA code, could give an answer much quicker – in about two hours. This could mean that mothers in preterm labour get the correct antibiotics sooner, providing a better chance of delaying birth.
The bacteria DNA test needs a sample of the amniotic fluid, taken by a needle into the belly in a procedure called amniocentesis. Though it is a common and safe procedure, we don’t know whether pregnant mothers whose waters have broken early would be willing to undergo amniocentesis to test for infections.
Dr Nishel Shah and his team aim to find this out in this study, called PROMPT. They also want to find out whether it is feasible to get the DNA test results in a timescale that would enable doctors to give the correct antibiotics to delay birth.
As well as the bacteria DNA test, the team are also evaluating other rapid ‘bedside’ tests to spot infections, to see if they give similar results to existing tests.
What difference will this project make?
Dr Nishel Shah aims to find quick and accurate tests to determine what is causing a woman to go into preterm labour. In this initial phase of the PROMPT study, Dr Shah and his team are finding out whether women whose waters have broken early would be willing to have amniocentesis to identify any bacteria present, and receive antibiotics to treat the infection. This project is laying the foundations for a large clinical trial in the future, which would test whether this approach is effective at delaying birth.
If successful, Dr Shah’s research could make sure that women going into preterm labour get treatment as soon as possible, and help improve their baby’s chances of a safe birth and healthy life.
Project details
Project Leader
Dr Nishel Shah
Location
Department of Metabolism, Digestion and Reproduction, Imperial College London
Project Team
Dr Luke Moore, Prof Anna David, Dr Angela Yulia, Prof Rachel Tribe
Updates
September 2025 – In a review of previous clinical studies, Dr Nishel Shah and his team have confirmed that amniocentesis (taking a sample of the amniotic fluid with a needle) is safe for women whose waters have broken early, or who are going into preterm labour.
Dr Shah and his team have been recruiting participants to the PROMPT study since April 2024 at Chelsea & Westminster Hospital in London. In that time, they have recruited 11 participants, while 18 people they approached have declined to take part. To achieve their target of recruiting 100 mothers in the study, the team are planning to open recruitment to two additional sites: University College Hospital in London, and a hospital in Oxford.
As well as amniotic fluid, the women in the study have donated a range of samples which have been stored for future research aimed at determining the causes of preterm labour.
