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Premature Labour and St Thomas' Hospital

Author: Neil Fearn  Bullet  Dated: 04/04/2013

Around 1 in 12 pregnant women will go into premature labour - that is around 60,000 every year in the UK. If a baby arrives just a few weeks early then the prognosis is generally excellent, but if they arrive a few months or even earlier then the outlook can be very different.

The Preterm Surveillance Clinic at St Thomas' Hospital is a unique and pioneering clinic designed specifically to cater for the needs of pregnant women at risk of premature labour and is run by Professor Andrew Shennan and his team.

The clinic uses new technology to identify pregnant women at risk of going into labour early and if adopted nationally, could prevent nearly 9,000 premature births every year in the UK.

There are 2 main tests that are used by the clinic. The first is to scan the cervix which is something that's been around a while but previously hasn’t been done in women at risk who don't have symptoms, so it's an internal, vaginal scan which measures the length of the cervix. Secondly, a very simple swab is then taken and the results are available in 20 minutes.

Professor Shennan explains that the test measures a glycoprotein called fetal fibronectin, which comes from the baby, so it's made by the baby, it ends up acting like a physiological glue between the membranes and the uterus. The bottom line is if it disrupts, and you may not even feel this, and the cervix shortens, it is found in the vagina when it shouldn't be there, and that correlates very closely with the risk of giving birth. It's probably even more valuable than the scan, for example.

Professor Shennan and his team have also developed a new test which now measures the exact concentration and what they have found through their research is that the higher the level the worse the risk and conversely very low levels, very low risks.

This extra information is used to help manage a high risk pregnancy. The team are looking at hormone treatments like progesterone, putting in stitches (to the cervix). If there is a very high risk they can admit women to hospital, give steroids to prepare the baby's lungs and they now even give other drugs like magnesium sulphate to protect the baby's brains, all in a timely and co-ordinated manner.

However, doctors and midwives would be expected to recognise the signs of premature labour and to act promptly. If there is a delay in diagnosing premature labour then there will be a missed opportunity to prepare a baby for an early arrival. There may be a failure to administration steroid injections which will help mature the lungs, and help reduce the risk of complications.

In these circumstances, a baby may become severely distressed and suffer a lack of oxygen to the brain (hypoxia) resulting in severe disabilities or brain damage. In some tragic cases the injuries suffered by a baby may be fatal.

This article is based on a Radio 4 Programme recently aired: The full interview can be heard:

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