SuPPoRT: finding the best way of preventing preterm birth in women with short cervixes
Professor Andrew Shennan, Professor Rachel Tribe, Dr Natalie Suff, Paul Seed
Start date: 2015
End date: 2022
Why do we need this research?
The cervix is a small canal that connects the vagina to the womb; it plays an important role in stopping a baby from being born too early. During pregnancy, the cervix changes shape as the baby grows. If it gets too short before the baby is due, there is a high risk that the baby will be born prematurely. This can lead to health problems for the baby and is a major cause of death shortly after birth.
If a woman’s cervix is less than 25 mm long when she is under 24 weeks pregnant, it is too short and should be treated. At the moment, there are three treatments that can be used if this happens.
Some women have a small surgical procedure called cervical cerclage. This involves an operation to put a stitch around the cervix to try and help it stay closed, keeping the baby inside the womb. Others are given progesterone, a natural hormone that is usually made in the ovaries during the menstrual cycle. This is given vaginally using a suppository. Finally, some women use a cervical pessary: a silicone device put in by a doctor that sits around the cervix to help it stay closed. Putting a pessary in doesn’t need an operation.
To date, these three ways of stopping premature birth haven’t been compared.
What’s happening in this project?
SuPPoRT is a randomised controlled trial that aims to find out which of these three methods is best at preventing premature birth, or if they are as effective as each other. This study is being carried out in 14 hospitals around the country and includes nearly 400 women who developed a short cervix between 14 and 24 weeks of pregnancy, with the women being randomly allocated to one of the three treatments.
As part of the SuPPoRT trial, samples of vaginal fluid and blood are also being taken before treatment. This will help our researchers to find out more about whether there are any underlying factors that influence how effective the treatments are – this information could be used to personalise treatment in the future.
Recruitment for this study has now completed, and the team are waiting for the remaining women to deliver their babies before they look at the results.
What difference will this project make?
The SuPPoRT trial will provide doctors with more information to help them decide which treatment will most be effective at preventing premature labour in pregnant women with short cervixes, which should give these high-risk women the best chance of having a healthy baby.
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