Most pregnant women (over 9 out of 10) spontaneously give birth to their baby after 37 weeks of pregnancy, called ‘term delivery’. Approximately 1 in 10 of women goes into premature labour and give birth to their baby before 37 weeks of pregnancy. 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 Birth Clinic is one of a few UK specialist antenatal services that are designed specifically for the needs of pregnant women at risk of premature labour. The clinic is one of the busiest in the UK. We support women in their pregnancy by close monitoring in the first two-thirds of pregnancy and providing treatment to try to prevent premature labour. Once women reach 28 weeks of pregnancy most can be discharged from the clinic and can be looked after by their midwife, general obstetrician or GP.
We provide multidisciplinary care (professionals from a range of disciplines with different skills) for women who are referred from their midwife, GP and surrounding hospitals. We see women who wish to be seen at UCLH and refer themselves (self-refer). We can also advise women before pregnancy on how to manage a future pregnancy (pre-conception advice).
The service is run by consultant obstetricians and supported by specialist obstetricians and midwives, a midwifery assistant and a research nurse. We also train doctors and student doctors in the clinic.
The Preterm Birth Clinic is for women who have an increased risk of delivering their baby preterm such as:
- Previous spontaneous preterm birth before 34 weeks or late miscarriage.
- Surgery on their cervix (neck of the womb). For example two or more large loop excisions of the transformation zone (LLETZ) (a common treatment for abnormal cervical cells) or one cone biopsy.
- Surgery to their womb. For example resection of a uterine septum or treatment for Ashermann's syndrome.
- Their womb is an unusual shape. For example bicornuate, unicornate, uterus didelphys.
- Their cervix has been found to be shorter that normal by ultrasound.
- They have had a stitch placed in their cervix (cervical cerclage) in a previous pregnancy or in this pregnancy.
- Previous caesarean section at full dilatation.
The service uses new technology to identify pregnant women who are at risk of going into labour prematurely. There are three main tests that are used:
- At your ﬁrst visit we offer pelvic swabs to look for infections such as bacterial vaginosis. These infections are not common, but women who have them have a higher risk of preterm birth, and may benefit from treatment. We also test your urine for infection.
- We measure the length of the cervix (neck of the womb) using a vaginal ultrasound scan. If the length is short we may recommend treatment such as a cervical cerclage (stitch) or vaginal progesterone.
A simple swab taken from the top of the vagina is tested for a protein called fetal fibronectin. The level of fibronectin is used to predict the chance of preterm birth. The result is available within 10 minutes.
In our clinics we are looking for new ways through research to improve the care of pregnant women and their babies by preventing preterm birth. We have helped to develop new methods to predict which women are at risk of preterm birth and we have tested new treatments such as progesterone and different types of cervical stitches (cerclage).
You will be given the choice to participate in research. All our research projects have been formally reviewed by an ethics committee. It is up to you to decide whether or not to take part after listening to the team member who will discuss the study with you and provide an information leaflet. If you decide not to take part in research it will not in any way affect the care you and your family receive.
Professor David offers a range of diagnostic and therapeutic services in the Fetal Medicine Unit (FMU). She specialises in cases where the baby has a structural anomaly, a genetic condition or when the baby’s growth is poor (fetal growth restriction).
She has close links with the talented UCLH neonatal team that are expert in caring for the smallest preterm infants. Professor David set up the Preterm Birth Clinic at UCLH which is now one of the busiest in the UK, providing continuity of care in a nurturing environment. The comprehensive service offers pre-conceptual counselling, a wide range of cerclage and other treatments and predictive tests.
Raf Napolitano was appointed as a Consultant in Obstetrics and Fetal Medicine in 2017. He is the lead clinician for the Ultrasound Screening Unit and one of the developer of the Training Programme in Obstetric Ultrasound and Fetal Medicine. He provides a range of diagnostic and therapeutic services on the Fetal Medicine Unit and the Preterm Birth Clinic along with looking after women in labour.