Progesterone to prevent miscarriage
Experts at our National Centre for Miscarriage Research have completed a Cochrane review (a high-quality type of study used to inform decisions about healthcare policy and practice), looking at how progesterone can prevent some losses, building on their breakthrough PROMISE and PRISM trials which found we could save 8,450 babies a year using this treatment.
Our team at the University of Birmingham analysed the results of randomised trials with 5,682 women in hospitals across the UK, and their newly published findings confirm that progesterone can reduce miscarriage risk for mothers with early pregnancy bleeding and a history of loss.
Alongside our recent Lancet Series, which recommends lots of changes to the UK’s miscarriage care system such as making progesterone treatment available on the NHS for everyone it could help, we’re urging national decision-makers to update care guidelines in light of this mounting evidence.
Incomplete and missed miscarriage treatment
Last year, the same team published trial findings that a combined drug is more effective in treating miscarriages without symptoms (also known as missed, delayed or silent miscarriage) than current standard medication – and as well as being better for those sadly going through it, last month they proved this treatment is cheaper for the NHS too. Their new paper in the British Journal of Obstetrics and Gynaecology shows the NHS could save £182 each time someone had a medically managed miscarriage if they used mifepristone (a drug used to induce labour) in combination with the misoprostol they use now.
It’s also 1 of 78 studies included in another Cochrane review, this time aiming to find the safest and most effective treatment for incomplete (when a miscarriage begins but not everything comes away from the womb) or missed miscarriages. Our experts looked at data from 17,795 women across 37 countries and concluded that surgical management was the most effective method, followed by medical management.
Combined mifepristone and misoprostol was the most effective medication, and the most effective surgery was suction aspiration after cervical preparation. Expectant management had the most risk of complications, such as needing emergency surgery, which can add to the stress and trauma of the loss. It’s vital for anyone going through miscarriage to understand their treatment options and make their own choice, so by sharing this information we hope that more people will be able to make the right decision for their personal needs in such a difficult time.
Cervical stitch for premature birth
Prematurity experts at our Preterm Birth Surveillance Clinic in London have carried out the biggest ever retrospective study to find out when is the best time for mothers with a cervical stitch (an operation to keep the cervix closed when babies are likely to be born too soon) to have it removed if their waters break early.
A cervical stitch is usually removed at 37 weeks of pregnancy – unless the waters break before then, known as preterm prelabour rupture of membranes (PPROM). PPROM affects 3% of all pregnancies but is far more common for those at risk of premature birth, who often get a stitch to reduce their risk; more than a third of people with a cervical stitch experience PPROM.
PPROM can trigger early labour, but it doesn’t always, so it’s hard for doctors to work out when the stitch needs to be removed. The latest research from the Tommy's team at Kings College London, published in the European Journal of Obstetrics and Gynaecology, found that leaving the stitch in after PPROM helped to keep babies safe inside their mothers for longer and didn’t cause problems once they were born. 43 women from our clinic were involved in the study, so next we need to run bigger and longer-term research projects to see if they still get such good results.
High blood pressure during pregnancy
Our Maternal and Fetal Health Research Centre includes a specialist clinic for people at risk of blood pressure problems in pregnancy, which we call the Manchester Antenatal Vascular Service (MAViS), where scientists have just made a breakthrough that could lead to new treatments for hypertension (chronic high blood pressure) and pre-eclampsia.
Their exciting findings in the Circulation Research journal show that doctors can reduce pregnancy risks for mums with dangerously high blood pressure using metabolites (small molecules naturally created by chemical processes in the body that keep us alive, such as vitamins and amino acids). They discovered that a metabolite called kynurenine can actually change the way pregnant women’s blood vessels behave and help them relax, reducing their blood pressure without affecting how it flows through their placenta, to keep both mother and baby safe.
While initially looking at mothers with hypertension, our scientists realised that kynurenine could also help mothers with pre-eclampsia, which affects 6% of pregnancies and can be life-threatening if not properly treated. It’s the first time we’ve uncovered this, and now our experts will start digging deeper into how kynurenine might be used to prevent such pregnancy complications.