Getting referred to our London clinics
The clinic is held on Wednesdays in the Fetal Medicine Unit, 8th Floor, North Wing, St Thomas' Hospital London.
Women can be referred here by their GP, obstetrician or midwife if they have a higher risk of giving birth too early. This can be for a number of reasons, such as:
- previous birth before 37 weeks
- previous late miscarriage
- the 'waters' (amniotic sac) have broken early in a previous pregnancy
- previous surgery to the cervix after an abnormal smear test
- an unusually shaped womb (uterus)
- you are expecting more than one baby
Usually women are seen two to three times, and then discharged from the clinic around 24 weeks of pregnancy.
There is also a walk-in service available between 2pm and 3pm for women to self refer between their appointments if they have worries or concerns. Please call the Fetal Medicine Unith (020 7188 8003) before attending to make sure the service is running that day.
What will happen at the clinic?
- you will usually speak with a midwife who will ask about your history and discuss your personalised plan of care
- you may be offered a transvaginal ultrasound scan of your cervix, where an ultrasound probe is placed into the vagina. Your bladder should be empty for this scan
- if you are over 18 weeks pregnant, you may also be offered a vaginal swab test (fetal fibronectin) to help predict your risk of an early birth. This is done with a speculum and then a swab (like a cotton bud) is placed in the vagina for a few seconds. Your swab result is usually ready between 10 - 25 minutes
There are some things which make the swab test less reliable. We recommend that you avoid the following for two days before you attend the clinic:
- sexual intercourse
- vaginal douching (this involved flushing the vagina with water for cleaning purposes)
When to seek advice
Sometimes there are signs that you may be going into labour. Often the signs will not lead to preterm labour, but it is important to let your midwife know so you can get advice. These signs may include:
- period-like pains or cramps which come and go
- fluid leaking from the vagina
- bleeding from the vagina
If you think you may be in labour, do not wait for your next appointment - call the Antenatal Day Unit/Hospital Birth Centre immediately on 020 7188 1723 or 020 7188 1722.
While being cared for in the clinic, you may be asked to take part in research that will help us understand the causes and best ways to prevent premature birth. Taking part is voluntary, and will not affect your maternity care. If you would like information on current research projects in the clinic please contact us between 9-5 on 020 7188 3570 or 020 7188 3634.
If you have any questions or concerns about your referral, please contact the Research Midwives on 0207 188 3570 Monday to Friday, 9am to 5pm.
Based at St Thomas’ Hospital, the hypertension in pregnancy (HiP) clinic provides specialist obstetric and midwifery care to pregnant women with high blood pressure (hypertension) and women who are at high risk of having high blood pressure in pregnancy.
You may have been asked to see us because you have:
- an existing medical condition that means you are more likely to get high blood pressure
- high blood pressure diagnosed early in pregnancy
- protein in your urine or other kidney problems in this pregnancy.
At your appointments we will:
- ask you how you are feeling
- check on your baby’s well-being
- measure your blood pressure
- measure the protein in your urine
- take blood tests to check how your kidneys, liver and blood are working.
These tests help us to check that you and your baby are safe. We might recommend you have other tests or treatment.
At the HiP clinic we will get to know your individual needs. If your blood pressure is high, you will usually need to take tablets to treat it. We will work with you to plan your care and any treatment you need to keep you and your baby safe. The leaflets below give more information.
The HiP clinic runs on Wednesday afternoon between 2pm-5pm by appointment only.
Antenatal Clinic, 8th floor, North Wing, St Thomas’ Hospital
Appointment line: 020 7188 8001
The Antenatal Day Unit runs HiP appointment slots on Monday and Thursday mornings.
Antenatal Day Unit, 7th floor, North Wing, St Thomas’ Hospital.
Call 020 7188 1722/1723 and ask for a high blood pressure appointment slot.
Guy’s and St Thomas’ Joint Antenatal Clinic provides education and advice regarding diabetes and pregnancy to women with diabetes in Lambeth. The clinic is run by a multi-disciplinary team which includes specialists in diabetes and obstetrics. The service includes monitoring, medication review, acute risk assessment, and advice on planned delivery and postnatal care.
The service is provided from the Diabetes Unit at St Thomas’ Hospital, Third Floor, Lambeth Wing, and at the Antenatal Clinic, St Thomas’ Hospital, Eighth Floor, North Wing.
Clinics are held weekly on Wednesday afternoons.
Referrals to the service are accepted from primary and secondary healthcare workers and by patient self-referral for Guy’s and St Thomas’ Hospital patients.
Contact the Diabetes Secretary/Administrator on 020 7188 1981 or 020 7188 1993. Fax 020 7188 1991 (St Thomas' Hospital) or 020 7188 1926 (Guy's Hospital).Hide details
Getting referred to our Manchester clinics
Women are managed through the second half of pregnancy by a small team of midwives and doctors who are based in the Clinical Research Area. Women usually have an ultrasound scan of their baby performed at every visit;the frequency of visits is flexible depending upon patient need.The clinic also takes part in research, with patients often being asked to donate their placentas or take part in other studies when they come for their clinic appointments.
This clinic is held in the Clinical Research Suite, 5th Floor, Saint Mary's Hospital on Wednesday mornings.
Patients receive combined midwifery and consultant obstetric care and ultrasound scans at each visit. Risk assessment and delivery planning based on this also take place.
Patients are referred by their midwife or consultant direct to Dr Ed Johnstone.
The Rainbow Clinic is a specialist service for women and their families in a subsequent pregnancy following a stillbirth or perinatal death. We care for families from the time of the postnatal appointment to discuss investigations onwards and into a subsequent pregnancy.
The clinic provides additional scans to identify placental dysfunction and detect complications early in a subsequent pregnancy. We make use of the scanning methods pioneered in Manchester Placental Clinic to look at the placenta in more detail. In addition we provide continuity of care and additional psychological support.
Women are offered:
- An ultrasound scan at 23 weeks and then at intervals throughout pregnancy
- Consultant led care with midwifery support
- Discussion regarding timing/mode of delivery
Women are referred through their midwife or consultant.
The clinic is located at:
5th Floor Tommy's Research Clinics
Saint Mary's Hospital
The clinic is held every Thursday
The secretary can be contacted on (0161) 701 0866, Monday - Friday, 8.30 am - 4.30 pm.
Rainbow Clinic Midwife (0161) 701 6965
At Saint Mary's Hospital, we help run a specialist antenatal clinic for pregnant women with Lupus Spectrum disorders including Systemic Lupus Erythematous (SLE), incomplete Lupus Syndrome and the Anti-phospholipid syndrome (APS) as well as other connective tissue disorders. These disorders are associated with serious problems during pregnancy such as pregnancy loss, pre-eclampsia, premature birth and failure of the baby to grow.
The specialist team within the clinic provides pre-conception advice, routine antenatal care such as blood pressure and urine checks, routine antenatal advice, detailed ultrasound observations of the baby and placenta, monitoring of medication, monitoring of blood tests, monitoring and management of symptoms related to the specific disorder such as 'flare ups'. Surveillance of maternal and fetal health is tailored to individual requirements and a care plan is made for the antenatal period in addition to delivery.
All women attending the LIPs clinic are invited to take part in ongoing research on lupus in pregnancy and will be sent information with the appointment letter. Women should be reassured that their decision to help or not with the research project does not influence their clinical care.
Clinics are held on the 5th Floor, Maternal and Fetal Health Research Centre, Saint Mary's Hospital, every Tuesday afternoon.
The clinic offers
- Pre-conception consultation
- Antenatal care
- Management of Lupus in pregnancy including additional pregnancy scans
- Opportunity to be involved in research
Patients can be referred to the service via:
- Their GP
- Community midwife
- Reproductive Health Service
The clinic is designed to provide additional monitoring, ultrasound scans and support for women with a history of high blood pressure and those at high risk of developing high blood pressure complications during pregnancy. Additional blood pressure measurements (including 24 hour ambulatory blood pressure monitoring) are offered to women attending the clinic to ensure that blood pressure medication is optimised. Surveillance of maternal and fetal health is tailored to individual requirements, for the majority of women appointments are offered 2-4 weekly.
Dr Myers, who runs the clinic, runs an active research programme within the Maternal & Fetal Health Research Centre and women attending the MAViS clinic are invited to take part in the research studies.
Patients can be referred from antenatal services and the renal hypertension antenatal clinic.
Clinics are held in the Clinical Reseach Sutie, 5th Floor, Saint Mary's Hospital every Friday morning.
The clinic helps women with:
- Previous early onset pre-eclampsia
- Chronic hypertension
- Renal hypertension
- Pre-gestational diabetes with evidence of vascular complications (retinopathy, nephropathy)
Women attending the clinic are offered:
- Antenatal care
- Additional ultrasound scans,12-14, 16-18, 22-24, 26-28 weeks
- Shared care with Renal Hypertension Antenatal Clinic team
Getting referred to our Edinburgh clinic
Women who are severely obese (have a BMI of over 40) can be referred to the metabolic clinic by their GP, midwife or obstetrician.
The metabolic antenatal clinic is home to specialists in pregnancy care and diabetes, as well as midwives and a specialist dietician. Care offered to women includes frequent check-ups of mothers and babies, as well as personalised advice about health eating. The clinic uses specialist equipment such as Tanita scales, that allow clinicians to measure women's weight and body composition at each visit. We also use 'thigh' cuffs to accurately measure blood pressure, and have access to extra-large support stockings for thromboprophylaxis.
We have developed a special care pathway for helping obese women to have healthy pregnancies:
At the first clinic visit all women are reviewed by the dietician and given personalised healthy eating dietary advice and advice to maintain their weight during pregnancy. We explain to women that they have a high risk pregnancy and reassure them that they will be monitored closely during their pregnancy. We recommend that women attending have early screening for gestational diabetes following the Scottish Intercollegiate Guidelines Network (SIGN) guidelines with a fasting glucose test at less than 20 weeks' gestation, and a 75g oral glucose tolerance test at 28 weeks' gestation.
For uncomplicated pregnancies, women are usually reviewed at the clinic 4 times. At these visits, women will have fetal growth scans and meet with the interdisciplinary team. Women with extra risk factors such as gestational diabetes are seen as often as every one to two weeks.
Women attending the clinic will continue to see their community midwife to provide continuity of care during and after pregnancy.
|Weeks into pregnancy||Care|
|12-16||Initial visit, personalised pregnancy plan, dietetic review, screen for diabetes|
|28||Glucose tolerance test, growth scan, review risk|
|32||Growth scan, anaesthetic review, delivery plan, review risk|
Review delivery plan if indicated
Post-dates plan if required
Discuss postnatal weight management/contraception
Getting referred to our National Centre for Miscarriage Research
Tommy’s National Centre for Miscarriage Research has recurrent miscarriage clinics in three different sites in the UK:
- Birmingham Women's Hospital
- University Hospital Coventry
- Queen Charlotte's & Chelsea Hospital and St Mary's Hospital, London
All of the clinics will accept patients who have had 3 miscarriages and an appropriate General Practitioner (GP) referral from anywhere within the UK (there is more specific information on criteria for each clinic below). This will provide you (and your partner) with the opportunity to be part of research towards finding the cause of repeated miscarriages.
Tommy’s strong view is that all women should get referral after 2 miscarriages and our clinicians and centre directors are working towards this goal. However, until it is made normal NHS funded practice, we are unable to offer it as standard across the clinics. Most doctors realise that this can cause considerable distress to women and many hospitals will investigate after two miscarriages. Currently only the clinic in Coventry has an arrangement that allows women with 2 miscarriages to be referred and then only from the local area (see more below).
Talk to your GP, explain how you are feeling and ask to be referred as soon as possible.
The clinics work hand in hand with the research centres by offering women the opportunity to have new tests and take part in new trials.
If you have had 3 miscarriages and wish to be referred to a Tommy’s clinic, you do not have to live within the area of any of the clinics; a GP referral can be made to whichever centre is convenient to you.
Your referral can be made on the basis that the Tommy’s centre offers tests and treatments not offered by your local hospital. This can be the reason for your request for out-of-area referral.
Choice is enshrined in the NHS charter.
There is not a specific referral form that needs to be used; your GP can use their own.
Our Birmingham clinic
- 3 or more early miscarriages
- GP registered in England, Scotland or Northern Ireland
Contact details for referrals
The Tommy’s Miscarriage Clinic @ Birminghamc/o Mrs Wendy Gibson, Medical Secretaries
Birmingham Women's NHS Foundation Trust
Our London clinic
- 3 or more early miscarriages
- one or more late miscarriage(s)
- women referred should be <42 years old
- women do not need to be from the local area
Contact details for referrals
Professor Lesley Regan
Department of Obstetrics & Gynaecology
St Mary's Hospital
Recurrent Miscarriage Office
Ground Floor, Mint Wing
South Wharf Road
Our Coventry clinic
- 2 or more miscarriages if local to Coventry
- 3 or more early miscarriages if from outside this area
- one or more late miscarriage(s)
Contact details for referrals
Department of Obstetrics and Gynaecology
University Hospitals Coventry and Warwickshire NHS Trust
Clifford Bridge Road
Fax: 02476967584Hide details
Tests available at our National Centre for Miscarriage Research clinics
|lupus anticoagulant test||to test for anti-phospholipid antibodies (sticky blood conditions)||Y||Y||Y|
|anti-cardiolipin antibody test||to test for anti-phospholipid antibodies (sticky blood conditions)||Y||Y||Y|
|thrombophilia screen||to test for congenital sticky blood conditions||Y|
|thromboelastogram analysis||to test for global bleeding tendencies||Y|
|detailed pelvic ultrasound scanning||to look for abnormalities in the womb or ovaries||Y|
|rubella test||to ensure immunity to German measles or rubella||Y|
|TSH, T3 and T4 tests||to identify any problems with the thyroid gland||Y*|
|vitamin D test||to identify vitamin D deficiency||Y*|
|coeliac disease screen - TTG antibody test||to investigate autoimmune serology, whereby healthy cells inside the body may be attacked by abnormal cells||Y||Y|
|HbA1C test||to investigate for diabetes||Y*||Y|
|fetal karyotyping||to identify any structural or genetic problems of the foetus||Y*||Y*||Y*|
|parental karyotyping||performed if the above test reveals any genetic issues, to identify any genetic abnormalities in either partner||Y*||Y*||Y*|
*if indicatedHide details
Tommy’s exists to save babies’ lives. That’s why we give over £1.5 million every year to our four research centres to carry out vital work on preventing pregnancy loss.