More than one in five women in the UK give birth by caesarean section (c-section) and around half of these happen as an emergency. Recent evidence suggests that c-sections performed late in labour can increase the risk of preterm birth in future pregnancies. Professor Andy Shennan of King’s College London is investigating whether using a different surgical procedure can help prevent preterm birth after a previous emergency c-section. If this treatment is more effective than the current approach, it could lead to happier outcomes for more babies and their families in the future.
This project is jointly funded by Action Medical Research and Borne.
How are children’s lives affected now?
Around one in every 13 babies in the UK will be born premature, before 37 weeks of pregnancy.2-6 Babies who survive preterm birth may experience lifelong problems such as cerebral palsy, blindness, hearing loss and learning difficulties.
“Many preterm births happen when women go into labour too soon, but there is often no obvious reason for why it happens,” says Professor Shennan. “We now know that the risk of preterm birth in future pregnancies is increased following previous c-section performed late in labour. This may be due to damage to the cervix (neck of the womb) that occurs during emergency surgery.”
One treatment available to women at high risk of preterm birth is to have a stitch placed around their cervix, through the vagina, to help prevent early labour. However, initial studies suggest this approach does not work well in women who have had previous emergency c-sections – possibly because the stitch is positioned below the damage to their cervix.
How could this research help?
“We’re aiming to find out whether placing a stitch higher in the cervix through the abdomen, called a transabdominal stitch, is more effective at preventing future preterm birth than a vaginal stitch,” says Professor Shennan.
The researchers will carry out a clinical trial involving 160 women who have a history of emergency c-section, followed by a subsequent late miscarriage or an extremely preterm birth. Participants will receive either a vaginal stitch or transabdominal stitch either before pregnancy or in early pregnancy.
“We will compare how many women in each group enter early preterm labour to find out which approach is the most effective at preventing babies from being born too soon,” says Professor Shennan.
If transabdominal stitch is the most effective treatment, it could become the recommended treatment option for these women in the future.
|Project Leader||Professor Andy Shennan, FRCOG MD|
|Location||Department of Women and Children’s Health, St Thomas’ Hospital, King’s College London|
Dr Lisa Story, BM BCh BA MRCOG PhD
Professor Rachel Tribe, PhD FPhysiol FRSB
Dr Natalie Suff, MBBCh MRCOG PhD
Dr Jenny Carter, RM MSc PhD
|Grant Code (GN number)||GN2967|
- Royal College of Obstetricians and Gynaecologists. Birth after previous caesarean section patient information leaflet: https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/birth-after-previous-caesarean-patient-information-leaflet/ [website accessed 15 May 2023]
- Office for National Statistics, Vital statistics in the UK: births, deaths and marriages - 2020 https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/vitalstatisticspopulationandhealthreferencetables [website accessed 15 May 2023]
- National Institute for Health and Care Excellence - Preterm labour and birth final scope April 2013. http://www.nice.org.uk/guidance/gid-cgwave0660/resources/preterm-labour-and-birth-final-scope2
- Office for National Statistics. Childhood mortality in England and Wales 2021. Table 17. http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/childmortalitystatisticschildhoodinfantandperinatalchildhoodinfantandperinatalmortalityinenglandandwales [website accessed 15 May 2023]
- National Records for Scotland. Section 4: Stillbirths and Infant deaths: https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/general-publications/births-deaths-and-other-vital-events-quarterly-figures/4th-quarter-2022 [website accessed 15 May 2023]
- Northern Ireland Statistics and Research Agency. Registrar General Annual Report 2015 – Stillbirths and Infant Deaths: https://www.nisra.gov.uk/publications/registrar-general-annual-report-2015-tables-and-full-report [website accessed 15 May 2023]