Abdominal stitch is more effective than vaginal stitch for recurrent preterm births

A clinical trial has shown that an abdominal stitch can save babies’ lives by reducing preterm birth for high-risk women who have had a previous failed vaginal stitch. The trial was led and co-authored by Professor Andrew Shennan, Clinical Director of Tommy’s Preterm Surveillance Clinic.

A mother holding now born baby

5 November 2019

A newly published study shows that, for a group of high-risk women who have had a previous failed vaginal stitch, an abdominal stitch is proven to be effective in reducing the risk of late miscarriage and preterm birth. Women receiving an abdominal stitch were more likely to have a baby that survives and are less likely to give birth before 32 weeks of pregnancy.

The MAVRIC study was a UK-wide randomised controlled trial that took 10 years to complete, focussing on very high-risk women with recurrent losses and failed treatment. It was designed to see if the abdominal or vaginal stitch was more effective at preventing an early premature birth and improving a baby’s chance of survival.

“We are delighted to show that women who lose multiple babies, even after failed vaginal stitches will usually have successful pregnancies with an abdominal stitch. We have proven this is a life saver in the first randomised trial of the procedure. There are not many treatments in pregnancy that can make that claim. We are so glad to be able to help these women in their desperate situation.”

Professor Andrew Shennan, Clinical Director at Tommy’s Preterm Surveillance Clinic at Guy’s and St Thomas’

Who will this impact?

Women who have had preterm birth in a previous pregnancy, a miscarriage, abdominal surgery, or trauma to the cervix, may be at risk of something called cervical insufficiency, which is widening and shortening of the cervix during pregnancy.

In pregnancy, the cervix helps keep the baby in the womb, as well as protecting the womb – and the baby – from infection. A cervix which shortens and opens early may lead to premature birth or miscarriage. To counteract an opening cervix, ‘stitches’ are often inserted in a process known as a cervical cerclage.

Positioning of vaginal and abdominal cervical stitch

The stitch can be done in two ways: either through the abdomen or the vagina. Mostly the vaginal route is used, as it is less invasive and does not involve surgery. A vaginal stitch also means women may be able to have a vaginal delivery. However, some women still miscarry or have early deliveries even though they have had a vaginal stitch put in. This is called a ‘failed’ vaginal stitch. For this group of women, an abdominal stitch has been proven to be an effective, lifesaving treatment.

An abdominal stitch is placed higher up the cervix and provides a stronger physical barrier to keep a baby inside the uterus and prevent women from going into early labour. Women with a history of a failed vaginal stitch and preterm birth can have an abdominal stitch before they conceive as it does not affect a woman’s ability to become pregnant. If necessary, the stitch can also be done early in pregnancy, before the 14th week.

An abdominal stitch means that women are unable to have a vaginal birth, and will need a c-section, so it is important that the treatment is used in high-risk women who have had a previous failed vaginal stitch.

“Recurrent pregnancy loss devastates people’s lives; the results of this study give hope to many families. This effective treatment now needs to be available across the NHS; saving lives, reducing preterm birth and the lifetime consequences for those affected.”

Jane Brewin, Chief Executive of Tommy’s

Read the published paper, MAVRIC: A Multicentre Randomised Controlled Trial of Transabdominal Versus Transvaginal Cervical Cerclage here 

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