• Premature labour
• London research centre
• London centre - pre-eclampsia research
• London centre - developmental programming research

Preterm labour research at the London research centre

Much activity within the unit is concerned with pre-term labour. Why does the womb contract during labour and not before? What triggers this contraction to happen? What can be done to prevent premature delivery? Tommy’s team is conducting research to find out more and to try and answer these important questions. Find out more about premature labour including possible known causes.

Fibronectin testing

Professor Andy Shennan and his team at St Thomas' hospital are developing pilot treatments, analysing blood tests and swabs of women at risk of premature labour in an effort to understand more about what goes wrong. His clinic provides a link between research in the laboratory, and clinical treatments aiming to prevent problems from occurring.  One of Andy's current research projects involves Fetal Fibronectin testing (fFN). fFN testing has been validated within the research setting; it has repeatedly demonstrated its efficacy and reliability in identifying both women at an increased risk of delivering early and those who are not. Importantly, fFN testing optimises the care given to mothers and babies.

Unfortunately, fFN testing is not commonly available in clinical practice partly due to the lack of evidence regarding its cost effectiveness.  In his study, Andy aims to assess the value of fFN testing in terms of cost-savings regarding healthcare resources and subsequently determine whether its implementation as part of routine service provision will ultimately financially benefit health services, whilst simultaneously improving the care delivered to high-risk pregnant women, who are often admitted for long periods of time and subjected to other interventions, some of which may be unnecessary in retrospect

Cytyc, now part of Hologic, produce FullTerm^TM, The Fetal Fibronectin Test that Andy is using in his study, and they are also supporting Tommy's with a £1 donation on every test kit used. ,

For more information please visit http://www.fullterm.net/.

Uterine contraction

Calcium is important in muscle contraction, as when calcium is released or enters into cells it acts as a trigger for muscle contraction.  It is suggested that one possible trigger for contraction of the womb during labour is that calcium enters the muscle cells and that this initiation of contraction of the muscle cells of the womb and triggers labour.  Our research team are investigating the action of calcium channels – pores through which calcium enters the cell and triggers contraction.  If we know more about these pores or channels, then we can look at ways to block them stopping calcium from entering the cells and causing contraction.  In the long-term this could help to prevent spontaneous premature labour.

Cervical stitch (CIRCLE) trial

A cervical stitch (or cerclage) is the name given to a procedure which is a precautionary measure and involves placing a stitch high up in the cervix with the aim of helping to keep the cervix closed.  The stitch is usually removed in the antenatal clinic just before your baby is due, to allow the cervix to open and the baby to be born.  

Current medical practice is for consultant obstetricians to put a stitch in women who are at high risk of experiencing pre-term labour in this pregnancy, regardless of the reasons they have been identified as being at risk.  However, this has never been proven to be successful or to improve the outcome for these women. 

Our research team believe that stitches are likely to be of most benefit to those women at risk for the specific reason that they have an “incompetent cervix”, or cervix which is unable to remain closed throughout an entire pregnancy and will open prematurely when the weight of a baby pushes down on it.  CIRCLE is a clinical trial (12 centres across the UK are currently taking part) aiming to examine whether this hypothesis holds true, and if a cervical stitch is of most benefit in preventing premature birth in women who have a short or shortening cervix, as seen on an ultrasound scan.

Obstetric Cholestasis (OC)

Many babies may be dying at birth or being born prematurely because of a condition called Obstetric Cholestasis (OC), which often goes unrecognised.  This condition of the liver, specific to pregnancy, is characterised by excessive body itching in the last three months of pregnancy (particularly on the palms of the hands and soles of the feet).  It is thought that it may account for as many as 5% ounexplained stillbirths and has to-date been considered to be related to the specific hormones present during pregnancy.  OC is associated with fetal distress, stillbirth and preterm labour.

Results from the London research team represent the largest and most detailed study to-date of bile acids in OC pregnancies.  The project aimed to identify any differences in bile acids early in pregnancy between pregnant who go on to develop OC, those who develop benign itching, and those who have neither.  If there are differences in levels of bile acids then there is the possibility to develop a predictive test to identify women who will go on to develop OC as opposed to benign itching, enabling medical care to be targeted appropriately.

PULSE

Tommy’s London & Manchester research teams are running a clinical trial to investigate the benefits of a new dosing system for oxytocin, a drug commonly given to induce and augment labour.  In natural labour, oxytocin is released in a pulse-like manner, allowing the womb resting time between doses during which vital oxygen passes to the baby.  In induced labour, oxytocin is administered continuously, meaning that the baby might not be getting the oxygen they need.

The research team hypothesise that giving this drug in a pulsed dose (to mimic oxytocin release in natural labour) would be beneficial as continuous oxytocin infusion is associated with significant maternal and fetal morbidity.  If the drug was delivered in the pulsed manner then the total amount of drug required would be reduced and it is thought that some of the negative associations with oxytocin occur because of the high doses currently used.  The research team believe that expectant mums involved will experience less intervention during labour helping to give their baby the best possible chance of life.

[This project is funded GlaxoSmithKline following an application by Tommy’s]