In pregnancy, the cervix helps to keep the baby in the womb, as well as protecting the womb - and the baby - from infection. A weak cervix may lead to premature birth or miscarriage: as pregnancy progresses it gradually opens until there is no longer enough support to keep the baby in the womb. To counteract a weak cervix, ‘stitches’ are often inserted in a process known as a cervical cerclage.
The stitch can be put in in two ways: either through the abdomen or the vagina. Mostly, the vaginal route is used as it is less invasive and there is a lower risk of complications. However, some women still miscarry or have early deliveries even though they have had a stitch put in: only 1 out of 25 vaginal cerclages actually help.
We didn't understand why this method worked for some women and not for others. The MAVRIC study was a randomised trial designed to see if the abdominal or cervical stitch was more effective at stopping premature birth and improving a baby's chances.
The study is now complete. We found that women who had an abdominal stitch were more likely to have a baby that survived, as well as one born after 32 weeks of pregnancy. Only four women would have to receive the treatment to save a life. We suggest that women who have had failed vaginal stitches should be given the abdominal stitch as a more effective method. This should now be offered to all such women, and medical specialists should be trained in how to perform the procedure.
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This study took place in a Tommy's centre and was funded by Tommy's, the Moulton Charitable Foundation, and the National Institute for Health Research's Clinical Research NetworkHide details