Research to improve prediction, prevention and treatment of preterm labour will save babies' lives.
We are searching for ways of identifying women likely to have preterm babies. We have previously found that fetal fibronectin is a reliable indicator of preterm birth and we have also discovered that lower than expected levels of progesterone in saliva are a predictor of spontaneous preterm labour.
Our research into preterm birth is also focusing on strategies to prevent or delay early labour. We are delighted to report that the MAVRIC trial has now completed. This important trial looked closely at treatments for cervical insufficiency: the abdominal stitch and the vaginal stitch. More than 90% of the high risk women (some of whom have had three or more late miscarriages or extremely preterm babies) who had the abdominal stitch went on to have a healthy full term baby. This result has already begun to influence clinical decision-making.
The Preterm Surveillance Clinic
In addition to the research, Tommy's also runs a clinic in St Thomas' Hospital in London for women who are at high risk of having a premature baby. Women, many of whom who have had several previous premature birth, are cared for and treated in the clinic. The majority of them go on to have a full term pregnancy under our care.
The Preterm Surveillance Clinic has reduced premature birth both locally and regionally by more than 10 percent, against a national and international rise in premature birth, and won an NHS Innovation Challenge Award for reducing premature birth rates.
Recent achievements in premature birth research
We’ve achieved an NHS Innovation Challenge Award for reducing premature birth
Our unique Preterm Surveillance London clinic based at St Thomas’ Hospital and part of the Guy’s and St Thomas’ NHS Foundation Trust has successfully reduced the number of premature births in South East London from 9.2 percent to 7.8 percent.
The clinic is led by Professor Andrew Shennan, who is also Professor of Obstetrics at King’s College London. The clinic focuses on screening for, treating and preventing pre-eclampsia and premature birth. The prize was awarded in the ‘Better Management of Pregnancy’ category and under the challenge of ‘Innovation’ – which rewards innovative healthcare practices and ideas that have demonstrated a positive impact in the local context where they have been implemented, but which have not yet received wider recognition.
We’ve moved a step closer to a predictive test for preterm labour
Tommy’s scientists have shown that a protein called fetal fibronectin enables the membranes around the baby to stick to the walls of the uterus (womb). This protein should only appear at about 22 weeks’ gestation and again at the end of pregnancy; if it appears in between these times, it indicates that early labour is imminent. It is therefore an excellent predictor for preterm birth. Our initial trial was highly encouraging and we have recently confirmed the predictive value of fetal fibronectin using a machine to measure the levels more accurately (the EQUIPP study). If this more accurate test is cost-effective it can be used more widely to identify women at risk for preterm labour. By also identifying women who are not at risk of preterm labour, hospital admissions and unnecessary treatments – and the associated anxiety – will be avoided, and healthcare resources saved.
We’ve identified novel strategies that may promote brain repair in preterm infants
Strategies to prevent preterm labour must be accompanied by strategies to prevent brain injury in the baby in order for the outcome of the infant to be improved. We have established the first model of perinatal brain injury, which accurately reflects the full range of neuropathologies (i.e. different types of damage) seen in premature babies with brain injury. Our recent studies are providing useful insight into ways to prevent or potentially treat brain injury that is associated with preterm birth due to infection.
We’ve developed a simple saliva test for predicting preterm labour
We have filed a patent on a new saliva test for prediction of early preterm labour. If validated in an ongoing study, this simple test could be used to predict which women may go into labour very early, allowing for greater surveillance and early intervention. This may be particularly valuable in identifying women who would benefit from progesterone supplementation.
We’ve shown that omega-3 fatty acids can reduce inflammation in fetal membranes which is associated with preterm labour
The fetal membranes surround the developing baby and produce inflammatory proteins that are crucial for the onset of labour. We’ve shown that omega-3 fatty acids reduce inflammation in fetal membranes. Thus, this may be one way in which fish oil supplements can prolong gestation. We are now extending this work to look at other anti-inflammatory/antimicrobial peptides found in the lower genital tract.
We’ve found a potential treatment to prevent brain injury in premature babies
We have used a mouse model to explore the links between inflammation and preterm birth. We have found that activation of the complement system, which is a key part of the immune system, may be involved in several pregnancy complications, including miscarriage, fetal growth restriction (where the babv doesn’t develop as quickly as expected) and pre-eclampsia. We have recently shown that activation of the complement system has a crucial role in changes in the cervix during preterm labour. This work suggests that inhibitors of complement and drugs called statins might provide a way to prevent preterm labour and, in turn, brain injury which can be associated with early delivery.
We’ve improved our understanding of inflammatory causes of preterm birth
We have investigated whether the spread of infection from the vagina to the uterus (womb) plays a role in preterm labour, and whether two commonly used treatments (progesterone or a cervical stitch) can suppress inflammation and prevent preterm delivery. Our work has provided important information about the causes of preterm birth, and may help us to develop a test to identify women at risk earlier in pregnancy. We will investigate whether this test also helps women in their first pregnancy. This information will help health professionals to decide the most appropriate treatment.
We’ve found a possible way to predict preterm labour early in pregnancy
One potential cause of preterm labour is infection that spreads from the vagina into the uterus (womb); some women are less able to mount an appropriate immune response or to produce natural antimicrobial substances. We have identified a natural antimicrobial peptide called elafin, which may be useful to determine the risk of preterm birth. A patent application has been submitted and commercial partnerships are being explored to develop a bedside test using elafin as an ‘early pregnancy’ biomarker of preterm birth.
We’ve found that therapies which target neutrophils are unlikely to be effective in preventing preterm birth caused by inflammation
In a mouse model of preterm labour, removal of neutrophils (white blood cells that are part of the immune system) from mice late in gestation did not prevent preterm delivery. We concluded from this that neutrophils are not involved in preterm birth, so therapies that target neutrophils are unlikely to be effective in delaying delivery. These results have been published in the high-impact ‘Journal of Immunology’.Hide details
This unique Preterm Surveillance Clinic – funded by Tommy's as part of our research in St Thomas' Hospital, London, has won an NHS Innovation Challenge Prize, for its success in reducing the number of premature births in South East London.
Tommy’s prematurity research centre in London is based at St Thomas’ Hospital. Opened in 1995, it is the first Maternal and Fetal Research Unit in the UK. It houses 87 clinicians, scientists and postgraduate students and last year published 78 scientific papers in peer-reviewed journals.
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