MAVRIC - testing the abdominal stitch

Professor Andrew Shennan, Dr Annette Briley, Mr Paul Seed, Mrs Jenny Carter

Tommy's researchers have found that women receiving the abdominal stitch instead of the traditional vaginal stitch were more likely to have a baby that survived, and less likely to give birth before 32 weeks of pregnancy.

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 Network

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