The Tommy's Preterm Surveillance Clinic has been running at St Thomas’ Hospital for over ten years. The clinic was set up with Tommy’s funding as a focus for research into clinical trials relating to preterm birth. Owing to overwhelming demand and clear clinical value, it is now also supported by the hospital trust.
The clinic runs all day every Wednesday and accepts national referrals. Approximately 50 women are seen each week. Any woman with a risk factor for preterm birth can be referred by any healthcare professional.
Experts state that national roll-out of this clinic’s model could prevent almost 9,000 premature births - 15% of all premature births - in the UK.
The clinic is run by Professor Andrew Shennan (a consultant obstetrician), with the help of a senior registrar and a specialist midwife sonographer. The research is conducted by this team, who are also supported by research staff.
The clinic also provides valuable training for clinicians and students, and has contributed to the work of several higher degrees awarded to clinical academics. Other consultants frequently visit to learn about the clinic’s practices.
Most of the women that Professor Shennan sees each week have had multiple pregnancy losses, often late in pregnancy. However, using the latest research and care an incredible 90% of these high risk women go on to have a healthy baby.
"The emotional trauma my husband Graeme and I experienced when we lost our two baby girls, Emilia and Grace, was indescribable. When pregnant the third time, the fantastic support and care we had from Professor Shennan and his team at the Preterm Clinic was second to none."
Each woman has an extensive risk assessment and an individualised management plan for her pregnancy. Other units such as those at University College Hospital, Warwick and Manchester have now adopted the protocols used and developed in this clinic.
The Preterm Surveillance Clinic has demonstrated a more than 10 percent reduction in premature birth both locally and regionally over ten years, and this has been achieved against a national and international rise in premature birth.
As well as providing care for high-risk women, the clinic serves to recruit pregnant women to clinical trials, including several large national studies, and has played a part in the publication of many internationally recognised studies.
The Clinic has won an NHS Innovation Challenge Prize, for its success in reducing the number of premature births in South East London.
The impact of the clinic
- Despite nationwide increases in preterm birth, the care provided by the clinic means that rates have reduced by 15% in the high-risk local area from 9.2% to 7.8% (same as the UK average of 7.8%).
- Over 90% of high-risk women seen at the clinic have had a healthy baby at full-term, compared to a national average of 50-70% of women.
- Now the largest preterm clinic in the world, it has influenced development of similar specialist clinics in the UK (London, Birmingham, Liverpool, Manchester and Belfast) and abroad (USA, China and India).
- The clinic has pioneered a test that more accurately predicts preterm birth in women at risk. The test, developed by Hologic, measures the exact level of a protein known as fetal fibronectin (fFN) that reliably indicates whether a woman will give birth prematurely, and as such has led to significant cost-savings: for each patient admitted from the pre-term clinic, the test saved an average of £1,800 per patient because many women didn’t receive unnecessary treatment and could be discharged home. Given the expense of the 60,000 premature births per year in the UK, the national uptake of this new test could lead to national NHS savings of over £100 million a year.
"We are very proud that our clinic is bucking the trend, by offering a unique package of care for high-risk women, based on best research and clinical evidence.”
Professor Andrew Shennan
Giving hope to women who had suffered previous losses
Susan Harper-Clarke had two late miscarriages before she was put under the care of the Preterm Surveillance Clinic at St Thomas’. A week later she had an appointment, and was then under the care of the clinic during her next pregnancy. Under the team’s care (her treatment included an abdominal stitch, regular fetal fibronectin testing and cervical length tests) she gave birth to her son, Thomas Harper, at 38 weeks.
Susan says: "The emotional trauma my husband Graeme and I experienced when we lost our 2 baby girls, Emilia and Grace, was indescribable. When pregnant the third time with Thomas, the fantastic support and care we had from Professor Shennan and his team at the Preterm Surveillance Clinic was second to none. The relief at being surrounded by such a professional and caring team throughout the entire pregnancy meant our stress levels were kept to a minimum. Thomas arrived safe and sound all thanks to them."
Louisa Caroline-Hines, 46 previously had three premature babies - two whom didn’t survive. In her fourth pregnancy Louisa was treated by Professor Shennan at St Thomas’ Preterm Surveillance Clinic and gave birth to daughter Cicely at full term.
“Our lives were falling apart, but Professor Shennan gave us the conviction that we could have a normal pregnancy, and I gave birth at full-term under his guidance. I am so indebted to the team at the Preterm Surveillance Clinic, and Tommy’s, for the care we received.”
The NHS and economic resources required to meet the burden of preterm birth are huge and long-lasting, and so even a small reduction in preterm birth can make a significant impact: 90% of NHS costs are focused around neonatal care, and total costs to the NHS is £2.9billion a year: comparable to those of smoking, alcohol and obesity. This makes preterm birth a major public health issue that has not, to date, received major investment for prevention.
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.
Around 60,000 babies are born prematurely each year in the UK and many suffer lifelong consequences as a result. Preterm birth is the leading cause of neonatal death in the UK.
A preterm birth, one that happens before 37 completed weeks of pregnancy, is the number one cause of newborn deaths and the second leading cause of deaths in children under five.
Individual premature birth research projects