Date: 19 December 2019
Researchers in south London have found that an abdominal cerclage, or stitch, is proven to save babies’ lives and reduce the risk of preterm birth.
The MAVRIC study, led and co-authored by NIHR CRN South London Co-Clinical Director Professor Andrew Shennan at Tommy’s Preterm Surveillance Clinic at St Thomas’ Hospital, has found that women receiving the abdominal stitch, with prior failed cerclage, rather than the traditional vaginal stich were more likely to have a baby that survived and are less likely to give birth before 32 weeks.
The results from the study were recently published in The American Journal of Obstetrics and Gynecology. Professor Shennan, who is Clinical Director of Tommy’s Preterm Surveillance Clinic at St Thomas’ Hospital and Professor of Obstetrics at King’s College London, said:
“Some women will have multiple pregnancy losses in-spite of best management. We are delighted to show that women who lose multiple babies, even after failed stitches will usually have successful pregnancies with an abdominal stitch.
“We have proven this is a life saver in the first randomised trial of the procedure. There are not many treatments in pregnancy that can make that claim. We are so glad to be able to help these women in their desperate situation.”
Susan Harper-Clarke (pictured top right), 41, has a weak cervix and suffered two late miscarriages in 2010 and 2011.
Early into her third pregnancy she enrolled onto the MAVRIC trial at St Thomas’ Hospital and was allocated to undergo having the abdominal stitch.
Together with her husband, Graeme, they now have two healthy boys – Tom born in July 2012, and Will born in April 2015, who recently started school. Susan, a physiotherapist, said:
“It was heart-breaking to lose Emilia at 19 weeks and then Grace at 21 weeks, knowing that a little more time could have made all the difference and they could have been saved.
“I had a failed vaginal stitch when I was pregnant with Grace, so I was relieved when I was told that I’d be having the abdominal stitch as part of the trial.
“Although it was a major operation, I knew that I was in safe hands and that it was likely to be the only way I was going to have a healthy baby.”
Women who have had premature labour in a previous pregnancy, a miscarriage, surgery, or trauma to the cervix, may be at risk of something called cervical insufficiency, which is widening and shortening of the cervix during pregnancy. In pregnancy, the cervix helps keep the baby in the womb, as well as protecting the womb – and the baby – from infection. An opening cervix may lead to premature birth or miscarriage. To counteract an opening cervix, ‘stitches’ are often inserted in a process known as a cervical cerclage.
The stitch can be done in two ways: either through the abdomen or the vagina. Mostly the vaginal route is used as it is less invasive and requires no major operations. However, some women still miscarry or have early deliveries even though they have had a vaginal stitch put in. For this group of women, an abdominal stitch has been proved to be an effective, lifesaving treatment.
An abdominal stitch means that women are unable to have a vaginal birth, and will need a cesarean section, so it is important that the treatment is used in high-risk women who have had a previous failed vaginal stitch.
Jane Brewin Chief Executive of Tommy’s said: “Recurrent pregnancy loss devastates people’s lives; the results of this study give hope to many families.”