New research paves way for predicting future preterm birth, helping healthcare professionals support those at risk

A new ultrasound scanning technique can be used to predict future risk of premature birth in women and birthing people who’ve had a late c-section, and help doctors treat them.

Most premature births are unexpected, so new ways to predict and prevent them are crucial to stop babies being born too early. That's why we're excited to share research that shows hundreds of premature births could be prevented thanks to a new test developed at our National Centre for Preterm Birth Research

Previous research has shown a link between women and birthing people who have a caesarean section (c-section) late in labour and future premature births. As late c-sections are sometimes needed in an emergency to make sure baby arrives safe and well, we’ve been looking at how to support women and birthing people in future pregnancies. 

What the study found

If women and birthing people have a c-section late in labour, their cervix is nearly fully dilated when their doctor makes their c-section incision. If the cervix is fully dilated, these c-section scars can weaken the cervix, causing it to soften, shorten and open too early in a future pregnancy.

Between 2,000 and 5,000 women and birthing people become pregnant each year in the UK after a late-stage c-section in a previous pregnancy. However, not everyone will go on to have a premature birth. This can make it hard to work out which women are at risk and would benefit from treatment, like a cervical stitch (cerclage), to help them carry their baby to term.

Our previous research found when the scar is lower down - within or close to the top of the cervix - the cervix is more likely to shorten too early in a next pregnancy. This means there is a higher risk of premature birth. However, there hasn’t been an easy way to pinpoint a c-section scar’s internal position and work out who would benefit from a cervical or transabdominal stitch (TAC). 

This breaking research, led by Tommy's Professor Anna David at UCL, has shown that a new ultrasound scanning technique can be used to work out the location of a previous c-section scar.

Identifying those who will benefit from a cervical stitch

Thanks to these findings, women and birthing people found to have a lower scar can confidently be offered a stitch (cerclage) placed around the neck of the womb to prevent it opening.

Previous research by Professor Andy Shennan, Tommy's Chair of Maternal and Fetal Medicine, looked at how and where to place these stiches to give women and birthing people the best chance of delivering their baby after 32 weeks. 

As well as helping doctors place the stitch in the right place for some women, the scanning technique will also prevent unnecessary procedures for people not at risk. 

Together, these findings into the prediction and prevention of premature birth could save thousands of babies every year. 

The Tommy’s team plan to rollout training for this ultrasound technique on a wider scale across our Preterm Birth Research Centre locations.

Kate Davies, Tommy’s Research, Policy and Information Director says: 

Unplanned c-sections can be very stressful, especially when they’re done in an emergency to make sure baby arrives safely. Women may already be feeling anxious going into their next pregnancy, and then devastated to be told they’re at increased risk of giving birth early.

This new ultrasound technique developed by Tommy’s researchers will make sure we can identify the women and birthing people at highest risk, giving the right treatment to the right women, and helping to reduce worry for many others.

Find out more about Tommy’s National Centre for Preterm Birth Research.